In Guyana, diabetes represents a serious public health problem as nearly 40,000 persons are living with it and there are perhaps another 20,000 that have not been diagnosed, the Ministry of Health said in a release Friday.
Diabetes continues to increase as a global pandemic and every country is reporting an increase in the impact of diabetes on people’s lives, the release also noted.
“In spite of our continuing efforts to make people aware of the dangers, people continue also to ignore the warnings from the Ministry of Health and from health care providers. This is of major concern to the Ministry of Health and the Minister of Health recently talked about this in a meeting with people from various communities,” the release stated.
Minister of Health Dr. Leslie Ramsammy and the staff of the Chronic Diseases Department have been meeting and discussing the problem of diabetes with community groups around the country.
The minister himself has led teams to Regions 4, 5, 6 and 8 recently and will lead a team to have a discussion with a group of senior police officers in Georgetown next Friday. During these engagements, he highlighted his ministry’s expansion of the fight against diabetes.
Improved services
HbA1c testing has been introduced for all diabetics in the public sector and there are plans for easier access to this test which has become an important part of a quality clinical management programme for diabetes. The introduction of HBA1c testing is a part of an expanded programme to add new services to improve the clinical management of diabetes around the country.
HbA1c is a test that looks at glucose (sugar) control over a period of time and is a better indicator of diabetes control than the everyday testing for blood glucose (sugar) level. Indeed, HbA1c levels in the blood are good indicators for persons who are likely to develop complications.
Research has demonstrated that persons with HbA1c levels of greater than 7% are likely to develop major complications and suffer from adverse outcomes, such as foot amputations, eye diseases, kidney diseases and heart diseases.
Even at this early stage, the results from HbA1c testing in Guyana are showing why the decision by the Ministry of Health to introduce this test throughout the public health sector is critical.
In the first analysis of results so far, the Georgetown Public Hospital has shown that people with overt foot problem have HbA1c levels much higher than diabetic persons that have not yet develop foot problems.
Patients in the Diabetic Foot Clinic (DFC) at the GPHC had an average HbA1c level of 9.11% compared to patients in the regular Diabetic Clinic (without foot problem at this time) who had an average HbA1c level of 7.77%.
Clearly, the availability of HbA1c results can be used by health care providers to evaluate patients better and to project which of the patients are progressing towards complications, resulting in adverse events and even premature death.
The Ministry of Health is promoting HbA1c testing for all diabetics at least twice per year.
The HbA1c testing is one of the interventions being added to the package of services for diabetics in the public sector health clinics.
HbA1c is not a new test, but it was not widely available in Guyana. It was only available in the private sector and is relatively costly.
However, the Ministry of Health is now making it possible for persons being treated in the public sector to have full access to HbA1c testing. While the test is available at GPHC, the ministry has established a referral service whereby all Regional Hospi-tals and District Hospitals would send specimens for testing at the National Public Health Referral Laboratory and the results would be sent back within one week.
As the programme expands, the Regional Hospital Laboratories would be developed with capacity for HbA1c testing.
The community face-to-face meetings are a part of the campaign to make people more aware, knowledgeable and motivated to take action to prevent diabetes or if they are living with diabetes to avoid major complications of diabetes.
The campaign being carried out by the ministry seeks to ensure people become aware of how serious the problem is. Besides the large number of persons living with diabetes, the Ministry of Health is endeavouring to make people become aware of how deadly and dangerous diabetes is.
Meanwhile, diabetes, which is either number 3 or number 4 cause of death in Guyana (it changes place with cancer from year to year), accounts for an average of about 425 deaths each year, or about 6 deaths for every 10,000 persons in Guyana.
About 8.5% of all deaths in Guyana are because of diabetes.
In 2008, diabetes ranked as the most important cause of death in Region 9, number 2 in Region 5, number 3 in Regions 3 and 6, number 4 in Regions 4 and 7, number 5 in Regions 2 and 10 and number 7 in Region 1.
While diabetes affects people of all ages, it is also a disease that becomes more prevalent with the aging process, the release noted. In the age group 15 to 44 years, diabetes ranks at number 9 as the most important cause of illness. But in the age group above 45 years old, diabetes ranks at number 2 as the most important cause of illness today in Guyana.
The truth is that a recent study has shown that persons living with diabetes have a greater than 80% chance of dying prematurely. The Ministry of Health also wants people to know that diabetes is also a contributing factor in other illnesses such as heart diseases, hypertension, stroke, eye diseases, kidney diseases, erectile dysfunction etc.
One of the most important causes of heart diseases is diabetes and this message is being carried to the people by the Ministry of health over the next three months and beyond.
In the meantime, every patient is to receive a DVD seeking to make them expert patients. In addition to the face-to-face campaign to make people more knowledgeable, the Ministry of Health is ensuring that every patient being treated in the clinics would be provided with the DVD. This DVD is a 42-minute documentary that provides a comprehensive education and awareness package for patients and their families. It presents information through an animated model and tells the story of diabetes in a very simple way.
The MOH is also working with the team of health care providers who have been trained in preventing and managing foot problems in diabetics to train health care providers around the country in an effort to provide better care of foot complications in diabetics.
Depression
The ministry will begin to pilot a new clinical intervention in Region 6 in June and this programme recognizes that depression is a major complication among persons with diabetes.
Data from the TB clinic shows that a higher percentage of TB patients are also diabetics than in the general population and this is consistent with findings in other countries. Health workers are therefore being urged to be vigilant and to consider TB in the clinical management of diabetics, the release concluded.
