Towards a more holistic approach to managing the lives of diabetics

Nov 15, 2024 Letters

Dear Editor

World Diabetes Day 2024 calls for “Breaking Barriers, Bridging Gaps”. There are still many barriers to overcome, much gaps to bridge for people and families living with diabetes.

Millions of people with diabetes face daily challenges managing their condition at home, work, and school. The need for resilience, for meticulous organization of their daily lives, and the financial stress they face have onerous impacts on their physical and mental well-being. Diabetes care in our health institutions, further reinforced by the National Guidelines, places almost its whole emphasis on managing blood sugar levels. While this is important and an imperative, it is not a successful strategy and leaves too many people living with diabetes overwhelmed.

Three out of 4 people living with diabetes have experienced anxiety, depression or another mental health condition because of their diabetes. Four in 5 people living with diabetes experienced diabetes burnout. Seventy- five % of people living with diabetes would like to receive more support for their emotional and mental well-being from their healthcare provider. These statistics from the global research conducted through the International Diabetes Foundation (IDF) represent an urgent call for action to address the mental health status of people living with diabetes.

Impacting mental health is the fear of developing life-threatening diabetes-related complications, a fear reported by 83% of persons. Among other fears are the daily management (76%), stigma and discrimination (58%) and fear of needles (55%).

On World Diabetes Day 2024, the Presidential Commission on the Prevention and Control of the NCDs urge a more holistic approach to managing the lives of diabetics. While we must aggressively intensify our prevention efforts, ensuring fewer persons develop diabetes, we must acknowledge that far too many people for years to come do live with diabetes. The health sector must up its game when it comes to Mental Health for Diabetics. Guyana’s NCD Commission

wants to ensure that all persons living with diabetes must have access to social workers, counselors, psychologist and other mental health providers. The MOH must articulate within the Diabetes Care Guidelines a Mental Health Care and Treatment component.

The Commission is of the view that the mental health component of the National Guideline is woefully weak. We urge the Minister to personally ensure that this weakness in the national program is remedied without delay. Our call for more comprehensive approach to deal with the mental health crisis among diabetics in no way diminishes the other serious life-threatening diabetes-related complications such as kidney and renal failure, retinopathy, atherosclerotic cardiovascular disease (ASCVD), strokes and other microvascular complications.

The Commission acknowledges investments and improvements in national efforts to deal with nutrition support for people living with diabetes, with the efforts to ensure people have full access to blood sugar and HBA1c testing, consistent and reliable access to medicines, including insulin, programs to reduce complications, such as diabetes food care access across the country and access to routine testing to pick up early renal complications.

However, we would be dishonest if we do not express concerns with obvious weaknesses in these efforts. Many health centers still do not have reliable capacity for blood-sugar and HBAIc testing. No hospital – Levels 3, 4 or 5- should ever not be able to test for blood sugar and HBA1c every single time for every single person. We are disappointed that primary care is still not making routine the availability of albumin, creatinine and bun testing. We question why every hospital does not have a foot-care program in place. We urge also that more efforts be put in place to ensure regular oral and dental health care are available for diabetics. WE also urge that a special program to diagnose COPD and other respiratory problems be put in place for diabetics.

In this regard, we commend the Ministry’s Oral and Dental Health Department for beginning to roll out special programs for diabetics. WE also commend the TB Program for including in their 2025 budget a new kind of portable x-ray system that could be taken into remote areas to screen people for respiratory deficiencies. We acknowledge the continued efforts to ensure that children with Type 1 diabetes have all the diagnostic and medicine needs, including pen insulin administration systems. Still the supply chain sometimes experience shortages. This must end once and for all. We also continue to be dismayed that the children and parent annual diabetes camps have not yet been resuscitated. In addition, we need to resuscitate the expert patient program both with children and adults.

In 2023, the Commission urged the public health sector to consider introduction of new medicines that have become routing in developed countries and that have made a major difference in diabetes management, including in the management of diabetes complications. Glucagon-like peptide-1 receptor agonists, or GLP-1s, are a type of medicine for people with diabetes. They lower blood sugar levels, can help with weight loss, and protect the heart and kidneys. Sodium-glucose cotransporter-2 inhibitors, or SGLT-2s are a type of medicine for people with diabetes. Similar to GLP-1s, they lower blood sugar levels, can help with weight loss, and protect the heart and kidneys. Because GLP- 1s and SGLT-2s work in different ways, they can be taken together.

These are expensive medicines, and Guyana might not be in a position to provide every diabetic patient with these kinds of medicines. But a strategy must begin now for the introduction for some patients. The Ministry of Health and the Government are making a valiant effort to combat the scourge of diabetes in our country. The Commission continue to push for further improvements to ensure that the global trend of increasing morbidity and mortality associated with diabetes is not Guyana’s reality.

Dr. Leslie Ramsammy

Chairperson

Presidential NCD Commission

(Towards a more holistic approach to managing the lives of diabetics)