Yvonne Ba­boolal

There is an ex­plo­sion of di­a­betes in Trinidad and To­ba­go and the Caribbean and it is now the sec­ond lead­ing cause of death in T&T. Di­a­betes, which is now be­ing de­scribed as an epi­dem­ic in the med­ical world, is al­so the lead­ing cause of adult blind­ness in T&T. The alarm­ing news was dis­closed at a news con­fer­ence at the Hy­att Re­gency Trinidad yes­ter­day to launch a White Pa­per ti­tled "The State of In­di­vid­u­als with Di­a­betes and their Health­care in the South-West Re­gion of Trinidad and To­ba­go". The study found that there are short­falls in the pub­lic health care sys­tem in the treat­ment of peo­ple with di­a­betes. Fur­ther, peo­ple with di­a­betes them­selves have not been ad­e­quate­ly re­spond­ing to the sys­tem, it was re­vealed. Ac­cord­ing to the White Pa­per, di­a­betes af­fects an es­ti­mat­ed 150,000 peo­ple in T&T and the num­bers are grow­ing, with 1,000 new cas­es every year. "T&T has been se­vere­ly af­fect­ed by the epi­dem­ic of di­a­betes. It is, ar­guably, among the coun­tries with the great­est bur­den of this dis­ease," the White Pa­per stat­ed.

It dis­closed that the num­bers af­fect­ed with the dis­ease in T&T rep­re­sent an adult di­a­betes preva­lence of around 12-13 per cent. Ac­cord­ing to Dr Claude Khan, pres­i­dent of the Acad­e­my of Di­a­betes Clin­i­cians of T&T, who spoke at the con­fer­ence yes­ter­day, this coun­try's fig­ures triple those in the Unit­ed King­dom and al­most dou­ble those in the Unit­ed States. He said the adult di­a­betes preva­lence in the UK is be­tween three and four per cent and be­tween sev­en and eight per cent in the Unit­ed States. The White Pa­per was pre­pared and launched by the Di­a­betes Out­reach Pro­gramme of the T&T Health Sci­ences Ini­tia­tive (TTH­SI). TTH­SI is an um­brel­la pro­gramme rep­re­sent­ing a col­lab­o­ra­tion among the Min­istry of Sci­ence, Tech­nol­o­gy & Ter­tiary Ed­u­ca­tion, the Uni­ver­si­ty of T&T (UTT), the Min­istry of Health and Johns Hop­kins Med­i­cine In­ter­na­tion­al (JHI). In fact, di­a­betes has seen such ac­cel­er­at­ed growth world­wide, es­pe­cial­ly among de­vel­op­ing coun­tries, that it is termed a pan­dem­ic. In T&T the dis­ease now cross­es eth­nic lines with Afro and In­do-Trinida­di­ans, T&T's two largest eth­nic groups be­ing equal­ly af­fect­ed. Dr Paul Lade­s­on of JHI, said the ge­net­ic pre­dis­po­si­tions of Afro and In­do-Trinida­di­ans make them more vul­ner­a­ble to di­a­betes.

The White Pa­per said, "Rea­sons for the high preva­lence of di­a­betes in T&T in­clude the ge­net­ic pre­dis­po­si­tions of its pre­dom­i­nant eth­nic groups, as in­di­vid­u­als of both East In­di­an and African de­scent are known to have high rates of di­a­betes." Oth­er im­por­tant fac­tors con­tribut­ing to the high preva­lence of the dis­ease in T&T are in­creased calo­rie in­take and more seden­tary be­hav­iour which comes with in­creas­ing af­flu­ence, the study stat­ed. The sec­ondary com­pli­ca­tions of di­a­betes in­clude heart dis­ease, stroke, blind­ness, am­pu­ta­tions and end-stage re­nal fail­ure. "For heart dis­ease, a lead­ing cause of mor­tal­i­ty in the coun­try, ap­prox­i­mate­ly 65 per cent is at­trib­ut­able to pre-ex­ist­ing di­a­betes," the White Pa­per said. In Ju­ly 2008, the UTT con­tract­ed with JHI to de­vel­op the out­reach pro­gramme de­signed to col­lect de­tailed da­ta on di­a­betes that would as­sist re­gion­al health au­thor­i­ties in al­lo­cat­ing re­sources.

Dr Lade­s­on said it would have been dif­fi­cult to con­duct the pro­gramme through­out the coun­try and the SWRHA was an en­thu­si­as­tic and ef­fec­tive part­ner. He said there are plans to take the pro­gramme to the rest of T&T. In the SWRHA, the pro­gramme de­liv­ered a ro­tat­ing ser­vice mod­el of care to 31 of the au­thor­i­ty's health cen­tres. The out­reach team eval­u­at­ed 2,124 pa­tients and as­sessed each one's lev­el of di­a­betes care. Some of the re­sults were that the ma­jor­i­ty of pa­tients were fe­male East In­di­an and cur­rent smok­ers. Half of the pa­tients rat­ed their health as fair or poor and on­ly 28 per cent had seen an eye spe­cial­ist and a mere nine per cent had re­ceived a foot ex­am­i­na­tion. Fur­ther, on­ly one per cent mon­i­tored their blood/urine glu­cose. The White Pa­per said the out­reach team pro­pos­es to con­duct sev­er­al in­ter­ven­tions, in­clud­ing con­tin­u­ing med­ical ed­u­ca­tion of doc­tors and nurs­es ex­pan­sion of a na­tion­al di­a­betes pro­gramme to im­prove health clin­ics.