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Deadly Diabetes

Jan 27, 2012 Editorial

 

Four years ago the Ministry of Health embarked on a programme to deal with the diabetes epidemic in Guyana. And there can be no other word than ‘epidemic’ for what is going on.
Overall, diabetes has become one of the world’s main disablers and killers. Apart from the obvious connection with renal failure and kidney diseases,  worldwide and in Guyana, it is the leading cause of blindness and a major factor in the development of cardiovascular and heart diseases, as well as of  neuropathy (nerve diseases). However all these pathologies arise out of  largely silent though deadly processes working through from within the body.
Foot ulcers, on the other hand arise from outside of the feet and are thus visible in their early stages. Foot disorders such as ulceration, infection, and gangrene are the leading causes of hospitalization in patients with diabetes mellitus or Type 2 diabetes, which affects adults. Yet for all of this, too often the ulcers are allowed to develop beyond control and result in either foot amputations or even death. Diabetes is the leading cause of foot amputations in the world and also in Guyana.
In 2008, Dr. Ramsammy, claimed that thirty-thousand people suffer from the disease in Guyana. By 2011 the figures were revised upwards to “40,000 living with it and perhaps 20,000 not aware of their condition”. It was always conceded that diabetic foot disease is recognized as the major cause for hospital admission in the diabetic population.  At the G.P.H.C, this problem is the single most common reason for admission to the surgical ward estimated at 30 percent of all admissions of them with 60 percent spending more than one week in the hospital.
Back in September 2007, the Minister announced the opening of the Diabetes Foot Centre (DFC) at the Georgetown Hospital for the prevention, diagnosis and treatment of diabetic foot disease and promised that in three years time every hospital in the country will also have a DFC facility. Established the following year through partnership with the Canadian International Development Agency (CIDA) and the Canada Caribbean Fund (CCF), the two phased Diabetic Foot Care Project was supposed to have been extended to six other administrative regions of Guyana, which constitutes Phase II of the Programme.   Phase I spanned July 2008 to May, 2010, and Phase II – 2010 – 2013. Where does the expansion stand now?
In recent years the Ministry has claimed that “there has been a reduction in the number of amputations in Guyana”. We have some doubts about this claim. More rigorous reporting of the facts is necessary because we do accept the dangers of untreated diabetic-related foot ulcers and it is important to learn whether our interventions are having positive impacts.
Three years ago, the Minister expatiated on the “fancy equipment” utilised by the DFC at Georgetown Hospital for screening and diagnosis. But we asked then “what about the treatment aspects? Removable cast walkers, or specialised non-pressure shoes is the mainstay of initial treatment but we have been informed that these are not utilised at the DFC. Pressure relief using total contact casts (TTC’s) is considered the optimal method of management for neuropathic ulcers. Are they utilised at DFC? We understand that the traditional bandages, which demand just as high a skill level from the nurses that apply and remove them to avoid iatrogenic lesions have remained the mainstay. Do we have, and are we maintaining the requisite skill level at the DFC? The genetically engineered platelet-derived growth factor becaplermin (Regranex gel) is approved for use on neuropathic diabetic foot ulcers and can expedite healing. Is this available in Guyana?
We are a poor and developing country and we understand that we face funding constraints on many of the innovations that can improve our living conditions. However, we must set standards for our performance in line with those in comparable environments. In the drive to deal with the devastating scourge of  foot amputations arising from diabetic ulcers, we cannot afford compromises. Or false promises.

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