Association takes diabetes to heart

THE correlation between cardiovascular disease (CVD) and diabetes has been well studied and documented, but not publicised effectively enough, which is why the Diabetes Association of TT’s (DATT) named his year’s theme Taking Diabetes to Heart.

Between 13-15 per cent of TT citizens have been diagnosed with diabetes, according to the International Diabetes Federation, while 15-20 per cent live with diabetes without a diagnosis. Such startling figures are even more worrying given that nine out of every ten people living with diabetes also have at least one risk factor for heart disease. About three-quarters of people living with diabetes do not understand they have an increased risk of a suffering a heart attack or stroke, or developing CVD with the condition. CVD is a group of disorders of the heart and blood vessels and includes coronary heart disease (narrowing of coronary arteries), cerebrovascular disease (affecting blood flow to the brain) and peripheral arterial disease (affecting blood flow to the limbs). There are several factors attributed to the growing rates of people living with diabetes, who are two to three times as likely to develop CVD than those without diabetes. Both diabetes and CVD are global epidemics, leading mortality figures around the globe, particularly in developing countries.

DATT president Andrew Dhanoo, speaking with Newsday about TT’s worrying diabetes statistics and the correlation between diabetes and CDV, said educating the public about the disease and its associated risk factors is key to lowering the soaring figures.

“(The theme) for World Diabetes Month was spurred on as the Ministry of Health launched the Hearts Initiative recently, in collaboration with the Pan American Health Organisation.

“Our aim is to make our population aware of the link between diabetes and cardiovascular disease. Although CVD events account for most of the deaths in TT, almost all of these patients would have been living with diabetes and this would have been a significant contributor to their condition and their ultimate fate,” he said, adding that education about the subjects is available but perhaps unrelatable to the public.

“While information about diabetes prevention and management (and its risk factors) is ubiquitous at health institutions, the reason why it has not been effective may be that the message is not tailored for the target audience.

“Many of the pamphlets and materials available are adapted from foreign literature which may not be relatable to our local population. A patient who is told to change their diet is less likely to start eating broccoli as described in much of the literature available since it most often is a foreign food item for them, particularly the elderly.”

He said both the Ministry of Health and the DATT are making strides towards producing material that can be understood more easily by the public.

“We also need to consider the medium for delivery. Because so much of our younger population is now susceptible, posters and pamphlets may now be a dated means of communication,” Dhanoo said, adding, “Social media and mobile messages may be a more effective means of sensitisation which we need to invest into now.”

There are three types of diabetes: type one, type two and gestational diabetes. Around 90 per cent of cases are of type two, which is more common in adults.

A person with type two diabetes does not make proper use of the hormone insulin that the body produces. Type one is can develop at any age but occurs more frequently in children. A person with type one diabetes produces little or no insulin, and requires daily insulin injections to maintain sufficient blood glucose levels.

A person with gestational diabetes has high blood glucose during pregnancy. It can result in complications to both mother and child.

Dhanoo said much attention needs to be given to dealing with type two diabetes.

“We are seeing increased rates of both type one diabetes and type two diabetes. However, since we don’t have a definite cause for the rarer of the two (type one), our focus should be on type two diabetes as this is preventable and controllable in most instances.

“Population-wide interventions which involve nutritional education, availability and access to healthy foods, activity sensitisation and screening are needed to reduce the rapidly increasing rates of new incidences of the disease. There has been a marked increase in rates of new diabetes diagnoses over the past several years.

“I think (the rising rates of diabetes and obesity) are alarming.

“However,” he continued, “it is expected, as we are seeing ever increasing rates of obesity, dyslipidemia (an abnormal amount of lipids, for example triglycerides, cholesterol and/or fat phospholipids in the blood) and elevated blood pressures in more and more of our population who present much younger than we typically expect.”

The overweight and obese population among TT’s adolescents has grown considerably, with the World Health Organisation estimating a surge from 33 per cent in 2011 to 53 per cent in 2017.

The increase, Dhanoo said, is coupled with noticeable shifts in the health status of our population “towards unhealthy ranges.”

Asked his view on the effectiveness of a ban on sugary drinks in public schools, Dhanoo said he does not consider it to be a major deterrent.

“I don’t think that this may have a significant effect on obesity in these children, simply because the reduction of access at schools does not equate to the all round access and neither does it mean that the children will seek out these sugar sweetened beverages any less.

“To really see a shift here, we must intervene in the marketing outside of schools and incorporate a significant education campaign about (these beverages) in schools.”

Dhanoo said government can nevertheless play its role to curb the surge.

“Major interventions through legislation for the marketing of foods which are unhealthy, especially to children, and package labelling regulation and enforcement are means through which our government can intervene.

“We need to limit how food is marketed to our population, sentimentalisation of unhealthy foods has become the norm and studies have shown that there are population-wide shifts in health when this is limited. Front of package labelling which indicate when foods are high in sugar, fat and salt is necessary for our population to become more conscious of the foods they buy and consume.”

He advised that parents test their children for diabetes, although a blood test might not be necessary.

“Unless the child shows signs of diabetes or is overweight, then blood tests may not be necessary. However, if there is any history of diabetes in the family, if the child is overweight, has Acanthosis Nigricans (darkening of the neck and skin folds), is suddenly very thirsty, wets the bed or is usually too tired to do usual activities, then parents should seek our medical counselling. We do advise that everyone over the age of 30 have annual physicals which include diabetes screening.” The DATT, he said, is stretching its resources to educate the public about the disease as effectively as possible.

In July, Dhanoo announced a programme initiated by the association to educate teachers about diabetes, in order to help them deal with children with the disease.

“We have been developing the curriculum for teachers to educate them about the effects of diabetes on children living with type one diabetes and how they can encourage children to reduce their risk of developing type two diabetes.”

The programme is set to be launched during the 2020 Easter vacation and teachers from around the country will be invited.

“As a prelude, however, in September the association wrote all school principals who have enrolled children with diabetes, to explain the precautions and special treatments which are needed to properly involve these children living with diabetes in school activities.”