There are approximately 180,000 people living with diabetes in T&T. With 1.3 million people living in this country, this represents 14 per cent of the population.
However, President of the Diabetes Association of T&T (DATT), Andrew S Dhanoo, is concerned that a further 180,000 people are walking around undiagnosed with this lifestyle disease—and these people who are pre-diabetic or diabetic represent another 14 per cent of the population.
“Our major concern is the number of persons in T&T who are undiagnosed.” In fact, Dhanoo said, almost every single household in T&T is affected by diabetes. Dhanoo admitted that with these figures, T&T can be considered a "sick nation."
Dhanoo pointed to statistics coming out of the International Diabetes Federation (IDF) which also claimed that similar statistics could be found worldwide.
Meanwhile, people living with diabetes in T&T have been putting a strain on the healthcare services, with Government being forced to fork out billions of dollars annually to treat this lifestyle disease.
According to Wikipedia, lifestyle diseases are defined as diseases linked with the way people live their life. This is commonly caused by alcohol, drugs and smoking abuse as well as lack of physical activity and unhealthy eating. Diseases that mostly have an effect on our lifestyle are heart disease, stroke, obesity and type II diabetes.
A study titled Rapid Assessment of the Economic Dimensions of Non-communicable Diseases in T&T conducted by RTI International for the Inter-American Development Bank (IADB)—and published in 2017—estimated that the economic burden from diabetes, hypertension, and cancer to T&T is more than $8.5 billion (TT) annually.
This represents a cost of approximately five per cent of the current GDP.
Diabetes had the highest total cost of about $3.5 billion (TT), followed by hypertension at $3.3 billion (TT). The total cost of cancer was $2 billion (TT).
In November 2018, Ministry of Health officials estimated that Government spent around $10,000 per person per month for dialysis, one of the consequences of renal failure brought on by diabetes.
In addition, a cocktail of medication including insulin can cost as much as $2,000 per month and does not include doctor's visits, tests at labs, and hospitalisation if necessary.
Dhanoo said while an exact figure still cannot be determined, the Pan American Health Organisation (PAHO), working with information supplied by the ministry, estimated that it was around US $350 per person per year.
Asked about the disparity in the estimated costs, Dhanoo said medications are provided under the Chronic Disease Assistance Programme (CDAP) and that a patient would only be required to undertake personal costs whenever they were not available. He did, however, concede that it was difficult to determine the exact figure. "We just don't have that figure," he added.
Burden on the State, households, employers
Speaking days ahead of World Diabetes Day which will be celebrated on November 14, Dhanoo said apart from placing a burden on the State, direct and indirect costs also affected entire households and by extension, employers.
“When a person is diagnosed with diabetes in a household, he or she may not be able to work if they develop some sort of complication which means everyone else may have to invest more or do with less in order to ensure the person affected has what they need.
“The indirect cost of having to make sure these persons went to their appointments, took their medication on time, and adhere to a diet means a loss of man-hours and loss of productivity.”
Dhanoo said when someone living with diabetes experiences an episode of low/high blood sugar spikes, he/she would be unable to perform as required at work.
And when there is a significant portion of the workforce living with diabetes, Dhanoo said this would also amount to significant drawbacks for an employer when it is lumped together.
Dhanoo said it was not sustainable for the State either. “This simply means there are more sick people so if it is is the trend continues in this way, the health budget has to increase significantly because we will need to buy more medications to treat more people, amputate more limbs, and give people more dialysis.
“This would not be sustainable as you are going to have more sick people to deal with, than you have healthy people who are paying for that.”
Dhanoo called for significant investments to be made in education to teach children about healthy food options and the importance of exercise.
Get tested, get treated
Dhanoo, who is gravely concerned about people who are walking around undiagnosed, said, “There are lots of people who may be having the symptoms and are just taking it for granted and, of course, in T&T, we don’t take things seriously until it gets too bad or it gets to the point where you can’t do anything about it.”
Admitting it was challenging to make people understand exactly how important it is to get tested, he said the DATT was issuing a challenge for people to come into their office at 10-12 Success Street in Chaguanas and complete a Risk Assessment Score by inputting information relating to their weight, height and genetic background from which a preliminary determination could be made.
Dhanoo explained, “Those are at high risk for diabetes, we want those people to come in to us and get their HbA1c or blood glucose testing done.”
The results, he said, would assist in directing these people for further medical treatment.
He said, “In T&T, people don’t present at the health centres until it is time to get their feet cut off or it is time for them to be told that nothing can be done about their vision loss…or they end up in a position where they need a $50,000 surgery or lose their eyesight.
“That is the case for a lot of people in T&T simply because they are afraid to go to the health centres or go to the clinic doctors.”
Dhanoo said once detected early, people can live a normal and healthy life.
Significant increase in overweight and obese adolescent population
A 2017 World Health Organisation report titled Global School Health Survey T&T claimed the overweight and obese adolescent population in T&T increased from 33 per cent in 2011, to an alarming 53 per cent in 2017.
Dhanoo revealed an epidemiological surgery first done in 1968 showed a prevalence rate of two per cent, while another in 1996 found this had increased to 11 per cent. A 2011 STEP survey found this figure had moved to between 12 and 13 per cent. New estimates, he said, have placed the prevalence rate at 15 per cent.
“There is an increase that we can see based on those estimations,” Dhanoo said.
He said this was further evidenced by the increased enrolment at health centres during the past few years and also the high numbers of people living with complications relating to diabetes.
Dismissing preconceived notions that diabetes only affected a certain segment of the population, Dhanoo said, “Being a person of colour automatically puts you at higher risk for diabetes and this simply means, somebody who is not Caucasian. This describes 99 per cent of the population in T&T.”
Labelling Type 2 diabetes as the more prevalent form of diabetes, Dhanoo said, “This type was traditionally called adult-onset diabetes but we are now seeing this appearing more and more in children.”
He said this included pre-teens, teenagers, and young adults—many under the age of 30 who are now developing symptoms and/or being diagnosed.
He said this was an indicator of how dire the situation is. “As this hasn’t happened in the last ten to 15 years, and it is only now that we are actually seeing it. All of these persons are now presenting with diabetes so we know that it is no longer an old person’s disease.
“Everyone is at risk and everyone can be affected because almost every single household is affected by diabetes in T&T.”
Facts About Diabetes
What is diabetes?
It is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood.
What is the main cause of diabetes?
Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood. Insulin produced by the pancreas lowers blood glucose. Absence or insufficient production of insulin, or an inability of the body to properly use insulin causes diabetes.
What are the early signs of diabetes?
Common warnings include increased thirst; increased hunger (especially after eating); dry mouth; frequent urination or urine infections; unexplained weight loss (even though you are eating and feel hungry); fatigue (weak, tired feeling); blurred vision; headaches; slow healing wounds; tingling in hands and feet; and skin problems.
Diabetes leads to:
Diabetes can be effectively managed when caught early.
However, when left untreated, it can lead to potential complications that include heart disease, stroke, kidney damage, and nerve damage.
How To Avoid Contracting Diabetes
1. Cut sugar and refined carbs from your diet.
2. Work out regularly.
3. Drink water as your primary beverage.
4. Lose weight if you’re overweight or obese.
5. Quit smoking.
6. Follow a very low-carb diet.
7. Regulate portion sizes.
8. Regulate alcohol consumption.
The ministry's strategic plan
The ministry's National Strategic Plan for the Prevention and Control of Non Communicable Diseases (NCDs): Trinidad and Tobago 2017 - 2021
Declaring that T&T had experienced an epidemiological transition over the last 40 years, with NCDs now being named as the major health problems replacing the communicable diseases of the 1960s.
A report prepared by the Ministry of Health stated that today, the onset of NCDs is being observed more frequently in the under 45 years age group.
Under the heading of Childhood Obesity, officials wrote, “Over the past two decades, T&T has seen the emergence of NCDs such as Type 2 diabetes among its youth. The results of the survey of BMIs conducted by the Caribbean Food and Nutrition Institute (CFNI) for the MOH in 2010, revealed that overweight and obesity in schoolchildren aged five-18 years, increased from 11 per cent in 1999, to 23 per cent in 2009 representing an increase of 109 per cent.
“Over the same ten-year period, obesity in children increased some 400 per cent from 2.4 per cent to 12.5 per cent. This five-fold increase in obesity in children over a ten-year period means that T&T has a significant childhood obesity problem that must be arrested immediately, given that it can contribute to higher levels of adolescent and adult obesity. Research has shown that 24 per cent of school-aged children (five-18 years) are overweight or obese and as high as 35 per cent in St George East.”
They added, “Ultimately, this high level of overweight and obesity, beginning from childhood and continuing in adulthood, further contributes to the overall increased risk of NCDs in the population. This leads to increased limb amputations, heart attacks, kidney disease, and blindness, which are increasing health care costs, while at the same time reducing the productive capacity of those affected.”
Officials stated their goal by 2025 was to reduce the burden of preventable mortality (before the age of 70) due to heart diseases, diabetes, cancer, and stroke by 25 per cent.
Starting on Monday, look out for special features during the CNC3 7 pm newscast where we shine a spotlight on people living with diabetes.