Addressing Trinidad and Tobago's diabetes landscape

Bavina Sookdeo

As the world grapples with the escalating prevalence of diabetes, it becomes imperative not only to understand the profound impact of the disease on individuals but also to explore avenues for effective management, reduce economic burdens, and implement supportive policies.

In an interview, Dr Melinda Nancoo, a specialist physician in internal medicine, endocrinology, and diabetes, shares her expertise and sheds light on the challenges and opportunities in diabetes care.

Trinidad and Tobago faces a significant diabetes burden, with alarming statistics painting a stark picture of the disease’s prevalence and impact. Nancoo said, "In 2021, the International Diabetes Federation estimated that 12.7 per cent of the population of TT (148, 900 people) were living with Type 2 diabetes and that 2,365 deaths that year were attributable to diabetes.

"By 2045, this is expected to increase, with approximately 15.4 per cent of the population (177,600 people) living with Type 2 diabetes in TT. In 2019, among the countries in the Americas with the highest age-standardised mortality (excluding chronic kidney disease) due to diabetes, TT ranked third, with 69.6 deaths per 100,000 persons."

This emphasises the urgent need for proactive measures and targeted interventions.

She underlined the empowering potential for individuals who take control of their diabetes. Through proper management, patients can lead healthy, active lives, breaking free from the shackles of uncontrolled diabetes.

Beyond the individual level, Nancoo delves into the economic implications of diabetes.

"According to the International Diabetes Federation, TT spent US$180.1 million in total diabetes-related health expenditure in 2021. This is projected to increase to US$188.4 million in 2030.

"It is estimated that each year, TT spends US$85 million, or 0.4 per cent of our GDP, solely to treat patients hospitalised for diabetic foot infections."

On an individual basis, diabetes-related health expenditure per person was US$1,209.7 in 2021 and is projected to be US$1,265.5 by 2030.

Diascan (blood sugar testing) strips are costly. Newer, highly effective medication for the treatment of diabetes also presents a significant economic burden to the individual.

"Where the sole breadwinner of a family suffers from a diabetes-related health complication such as a heart attack, disabling stroke, blindness or kidney failure that renders them unable to work, the impact on their entire household and dependants is a significant social and economic concern,” she said.

Nancoo emphasises that early detection, aggressive risk-factor modification and timely treatment of complications can significantly reduce healthcare costs over an individual’s lifespan.

However, the rising trend of diabetes diagnosis at a younger age poses new challenges, potentially increasing healthcare costs over a more extended period.

The backbone of managing Type 2 diabetes lies in maintaining a healthy diet, an active lifestyle, and weight management.

Addressing co-existing conditions like hypertension and high cholesterol is crucial. Nancoo advocates for increased nutrition literacy, encouraging patients to seek guidance from registered dietitians and nutritionists. She also recommends frequent home testing of blood sugar readings, allowing individuals to identify and manage blood-sugar spikes effectively.

Continuous glucose monitors (CGMs) have emerged as a game-changer in diabetes management.

Nancoo highlights their potential to improve outcomes by providing accurate real-time information, reducing the need for painful finger sticks, and empowering patients to self-manage their diabetes.

However, the challenge lies in the limited availability and high cost of these technologies in TT.

The wider availability of CGMs and the use of mobile apps for blood sugar monitoring and trend analysis can significantly contribute to improved diabetes management.

"CGM’s and education of patients and health care providers about their effective utilisation can contribute to better diabetes management," she said. "On a simpler note, the use of mobile apps that log fingerstick blood sugar readings and reveal trends to the patient and their health care providers is also useful. Frequently, patients check their blood-sugar readings at suboptimal times, or do not keep a record of it. Apps that provide reminders and allow charting of readings can help overcome this."

Nancoo proposes various ways businesses can collaborate with healthcare providers to support employees with diabetes.

Workshops, medical assessments, collaboration with dietitians, and access to mental health care providers are essential components of creating a supportive environment.

Businesses catering to diabetics

Unicakery

Unicakery is one business that stands out not just for its delicious creations but for its commitment to inclusivity, especially for individuals managing diabetes.

When it comes to crafting desserts for individuals managing diabetes, Unicakery follows a meticulous process.

Founder Naomi Anderson elaborates, "The process involves first becoming educated on the impact different ingredients can have on diabetics’ diet. We then research and develop recipes that include substitutes, aligning with diabetes-friendly principles."

The focus is on selecting sugar substitutes, whole grains, and nutrient-rich components to create desserts suitable for those with diabetes.

Unicakery places priority on ingredients such as almond flour over regular wheat flour and starches to minimise the impact on blood-sugar levels.

Anderson notes, “We also use natural sweeteners and incorporate fruits and berries for colour, flavour and decoration.”

Anderson has observed a rising demand for special-occasion cakes among those managing diabetes.

Acknowledging concerns about cost, Anderson says, “Some ingredients that are diabetic-friendly are definitely on the costlier side. However, we still strive to make diabetic-friendly options affordable.”

Through consultations with clients, Unicakery collaborates to validate recipes, ensuring they align with specific dietary needs while managing diabetes. This collaborative approach helps create customised solutions for a diverse range of customers.

Fresh Press Factory

The Fresh Press Factory focuses on health and wellness, especially for individuals managing diabetes.

Kinesha Sylvester, the owner, underscores the deliberate choice of the term “fresh” in the brand’s name, signifying a dedication to using the highest quality ingredients.

The goal is clear – to serve meals, beverages, and desserts that are not only delicious but also free from preservatives and unnecessary sweeteners.

Crucially, the Fresh Press Factory recognises the significant prevalence of diabetes.

Sylvester explains how she accommodates diabetic individuals by offering flourless options, a departure from the misconception that such choices are unrelated to diabetes. Natural ingredients are a staple, appreciated by customers who prioritise health.

Recognising the need for additional support, the Fresh Press Factory recommends dieticians to customers seeking personalised guidance.