More Guyanese making positive lifestyle choices

Oct 30, 2011 News

…as National Diabetes Programme intensifies

Guyana like the rest of the world is facing a growing diabetes epidemic, and the Ministry

More persons are accessing the early screening available

of Health has been intensifying its approach to tackle and conquer the incidence of diabetes in Guyana. Although still an uphill task, there is evidence to suggest that significant inroads are being made.
Diabetes is a chronic endocrine condition that affects the body’s ability to process sugar. There are two main types of diabetes, type I and type II, although the defining characteristic of both types is the dangerous buildup of sugar in the bloodstream. Type I diabetes is an autoimmune disorder that is present at birth and manifests itself within the first 10 years of a child’s life. Type II diabetes is a developed condition that, while it often involves a genetic predisposition, is triggered by hormonal events or lifestyle habits. Diabetes affects many aspects of the body; however, these affected elements can be successfully managed with treatment.
Deeply concerned about the physical, economic and social burdens caused by the increasing prevalence of diabetes and other chronic Non-Communicable Diseases (NCDs ) such as hypertension, stroke, heart disease, obesity and cancer – the Ministry designed and has been involved in a comprehensive and aggressive plan of action focused on effective prevention and treatment programmes aimed at stemming the epidemic .
This includes a wide ranging multi sectoral response, diverse mass media campaigns, numerous outreach activities, ongoing training of staffers, and aggressive management of diabetes as well as surveillance of the disease.
The substantiation of this success is the fact that more people are accessing the early screening available, making more health conscious choices and generally making the lifestyle changes needed to prevent the disease.
This is critical since while there are un-modifiable risk factors that can contribute to a person becoming diabetic, like all of the other chronic diseases, lifestyle plays a major role.
In the last few years, the pervasiveness of diabetes climbed to disquieting and alarming proportions. Between 30.000- 40,000 Guyanese are living with either type one or two of the disease. This is in part due to better diagnostic capacity and wider access to health care services.
It is anticipated that some 50,000 Guyanese would be diagnosed with diabetes over time based on the numbers being recorded, and women are likely to be the majority of patients. Statistics in the health sector show that women account for 60 per cent of the patients at present.
Every year 5,000 new cases of mainly Type 2 diabetes emerge. The numbers are worrying because the likelihood of developing Type 2 diabetes can be assessed years before the onset of the disease by measuring blood glucose levels.
What is even worse is that the NCDs work in concert so that diabetic patients are usually also affected with hypertension and/or some other chronic disease. Approximately half of the adults living with diabetes in Guyana are also hypertensive.
With the early detection of both diseases, the national medication bill has increased over the years, with medication for diabetes and hypertension costing $400M. Previously, this amount was around $75M. Health Minister Dr Leslie Ramsammy asserted that by 2015 the amount being spent on chronic diseases would reach its $1B mark.
While diabetes can take a long time to develop in an individual, it brings with it debilitating complications such as kidney problems, nerve problems in the legs, issues relating to blockages in the blood vessels, vision problems and coronary heart disease.
Identifying diabetes as one of the ‘biggest health problems in the country”, Minister Ramsammy has been indefatigable in his pleadings to the local populace over the years to be cognizant of the four main behavioural risk factors for diabetes; tobacco use, harmful use of alcohol, unhealthy diet and physical inactivity and the fact that Guyanese are heeding the call is a “ huge step forward and shows that Guyanese are finally translating all the knowledge they have been receiving into action.”
However while the future looks optimistic, the fight is still a long way from being won, Minister Ramsammy cautioned, since too many new cases still emerge annually and many diabetics are not complying with treatment.
FOOT CARE PROGRAMME
Effective management of diabetes is a key strategy of the National Diabetes Programme which also includes initiating appropriate treatment early, diabetic foot care and regular follow-ups.
One of the most revolutionary and impacting initiatives in this area is the Diabetic foot care programme,
This comprehensive initiative has resulted in a reduction of amputation rate by 46 %
It also represents a great collaboration among the Ministry of Health, the Georgetown Public Hospital Corporation (GPHC), the Canadian International Development Agency (CIDA) and the Caribbean Association of General Surgeons, aimed at addressing foot care in Guyana with a goal to decrease the number of amputations and complications related to foot care, primarily for those living with Diabetes Mellitus through three phases and in several ways.
This project aims to help what already existed in Guyana for foot care through the Chronic Disease Unit to reach new heights. It is part of a primary health care response in dealing with chronic diseases like Diabetes and Hypertension.
In 2009 it was augmented by the PAHO/WHO collaborative care project on Diabetes Mellitus which comprises health care workers across several regions coming together to make plans to work even better together in addressing the burden of diabetes in their regions.
The Diabetic Foot Clinic- the center of excellence- located at the GPHC became operational in 2008 with the primary objectives of preventing ulcers and the reduction of the number of amputations. Since then, thousands of Guyanese have been helped in a number of ways including through screening, education in diet, exercise, healthy living, and foot care as well as foot wear.
Guyana has been innovative in implementing the ‘60-second screening tool’, which identifies the patient with a high risk for foot disease and then engages in education. Patients are taught about dressings, how to clean the foot, medications to use and are even provided with footwear to offload pressure on certain parts of the foot
Over two thousand (2000) persons with diabetes have been screened
The clinic has also recorded remarkable success in the prevention and treatment of ulcers, which are common in diabetic patients, as well as the consistent reduction of patients HBA1c and blood pressure levels which are crucial to them enjoying an improved quality of life even though diabetic .
But one of the most remarkable accomplishments of the clinic has been the herculean task of reducing the number of amputations.
Three years ago, amputations of limbs in Guyana as a result of diabetes occurred in about 500 persons annually. In the past year, that number has reduced significantly and about 60 amputations of limbs were executed.
The expansion of this service nationally has been part of the programme objective and as such, regional diabetic foot centres are now existent in Regions 2,3,4,5,6 and 10 where diabetes is more prevalent.
To facilitate this massive scope of expansion, in excess of 66 health care professionals, inclusive of: doctors, nurses, physiotherapists, medexes have been trained.
THE DIABETES REGISTER
The Diabetes Register is part the Ministry of Health’s Non-Communicable Diseases Surveillance System. It was designed and developed by the Ministry of Health to enable efficient management and monitoring of diabetic patients.
The register serves as a tool to document all the diabetics, as well as monitors the patient’s progression with the disease for life. It is designed to record vital information about the patient’s demographics; this includes name, date of birth, address, race and sex.
Information about the patient’s diabetic history is then entered. This includes date of diagnosis, type of diabetes, and the type of Treatment – name of drug (s)
At the patient’s next visit and subsequent visits, if there are any changes in the patient’s condition, such as they are now hypertensive or have developed a complication, their name is found and this condition is recorded, thereby updating the patient’s record and monitoring their progression with the disease.
This system improves the management and care of chronic disease patients as it allows for documentation, registry, monitoring and follow-ups on the individual patient, as well as generates relevant timely reports which provide the required information and evidence needed for effective planning and utilisation of resources.
SPONSOR A CHILD
Approximately 54 children are on the local diabetes register, a significantly low prevalence when compared with other countries, but the ministry assures that a lot of effort is being made to ensure that these children enjoy the best possible quality of life
A major contributor to the attainment of this task is the ‘Sponsor a child’ programme
This initiative began as part of the Ministry’s activities for World Diabetes Day 2007, and is a partnership between the Ministry of Health and the Private Sector, which aims at providing assistance to children living with diabetes in the form of supplies for the management of Type 1 Diabetes Mellitus. These supplies are usually in the form of glucometers, glucose test strips, lancets, alcohol prep pads and even insulin.
The International Diabetes Federation also supports the programme and to date has donated 18,000 vials of insulin and over US$10,000 for testing supplies for the children living with Type 1 Diabetes.
Head of the Health Ministry’s Adolescent Health Unit, Dr Marcia Paltoo, noted that the Novo pens received are greatly assisting the children in making the process of self testing each day less traumatic since they are less “scary than regular needles”
Once a year, a Diabetes Camp is held with the children to provide them with an opportunity to learn self-confidence, independence from parents or caregivers, interact with other diabetic children, share experiences and generally enjoy themselves. In addition, it is an excellent opportunity for parents to take a break from the regimented lifestyle associated with diabetes, according to Dr Paltoo.
The objectives of the camp are to inform children about diabetes, and to help them find inner strength each day to do what it takes to live a healthy lifestyle and to live with a chronic disease at such a tender age.
The programme of activities that are planned for the camp covers areas in nutrition, focusing on healthy eating, reading food labels, use of the glucometre and testing supplies, education session on foot care; refresher session on Type 1 Diabetes; and physical activity.
Diabetes interrupts children’s lives since they need to monitor on a regular basis their blood glucose levels, take medication and balance the effect of food and activity. It can also interfere with the normal developmental tasks of childhood and adolescence, which include succeeding in school and transition to adulthood. In young children, frequent episodes of very low blood sugar may result in brain abnormalities and impaired cognitive functions.