November 14th is World Diabetes Day and this year the theme for activities is “Diabetes care for everyone”. World Diabetes Day is a time to bring greater awareness to Diabetes mellitus, a condition that affects more than 200 million people worldwide and appears to be significantly increasing in Anguilla every year.

What is diabetes mellitus?
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia (high blood sugar levels) resulting from defects in insulin secretion, insulin action or both. Type 2 diabetes, formerly known as non-insulin-dependent diabetes, is the most common type of diabetes seen in Anguilla and is due to insulin resistance with an insulin secretory defect. The pancreas continues to make insulin, but the insulin is not used well by other body tissues.

Complications of diabetes
Many diabetic patients who have good glycemic control have significantly decreased their risks of complications from diabetes. Diabetes control can be improved by adopting a healthy lifestyle, including a normal weight, doing regular physical activity and following instructions from their health care providers. Diabetics, especially those with poor blood glucose control, are at risk for many medical complications such as blindness, kidney disease and failure, amputations, nervous system disease and cardiovascular disease such as strokes and heart attacks. Individuals with diabetes should maintain a normal blood pressure, normal cholesterol and low-density lipoprotein (LDL) levels and maintain a haemoglobin A1c less than 7%. If these can be achieved on a consistent basis for a number of years, then complications from diabetes can be drastically reduced and even eliminated.

Screening for diabetes
Many people in Anguilla do not know that they have diabetes, while many individuals do not have symptoms suggestive of diabetes.Those with symptoms often refuse to seek medical care. A simple blood test can confirm whether you are a diabetic or not. Once a diagnosis is made then a specific management plan can be developed so that the individual can live successfully with diabetes. It is important for individuals to have regular medical check-ups.

Diabetes care for everyone
The theme for this year’s World Diabetes Day is “Diabetes care for everyone”. It is recognized that in many countries, including Anguilla, many individuals who have diabetes do not receive optimal care. Some individuals are unable to have regular blood investigations due to financial constraints. Others cannot afford to buy the strips for glucose metres, while others cannot access health care for a number of reasons.
Diabetes is a chronic lifelong disease and in many countries the cost of diabetes medications, and investigations, are markedly subsidized by government so that all individuals can have good care for their diabetes. Health planners and others involved in the care of individuals with diabetes must look at ways to ensure that all individuals with diabetes obtain optimal care which, among other things, will serve to reduce the economic cost of managing complications from diabetes. Many amputations can be prevented if there is good care of individuals with diabetes. The economic and other costs associated with amputations for the individuals and the country as a whole are enormous. The other complications of diabetes such as kidney failure, leading to dialysis or kidney transplants, can also cause severe financial strain on the individual and community as well.

Prevention
Although many individuals already have diabetes, much more can be done here in Anguilla to prevent or delay the onset of diabetes. The high number of children with obesity is a cause for concern. Many health professions in Anguilla are seeing teenagers with obesity who are pre-diabetic or diabetics. We must adopt new strategies to deal with the epidemic of obesity in children. If we do not the incidence of diabetes would be much more in the next few years. Dealing with obesity in adults would also help to decrease the incidence of diabetes.
The promotion of healthy lifestyles is crucial in the prevention of diabetes. Attention to nutrition is important.Individuals who adopt a low-fat, low-calorie diet and engage in regular physical activity like brisk walking or swimming can reduce their risk of developing diabetes tremendously.

What are the risk factors for developing type 2 diabetes?
Many individuals have a genetic predisposition for developing diabetes.Even these individuals can decrease their risk significantly. Other risk factors for developing diabetes include the following:
• 45 years and older
• Overweigh or obese
• A family history of diabetes
• Had gestational diabetes during a pregnancy
• Inactive lifestyle
Due to the high incidence of diabetes in Anguilla, all individuals over the age of 40 years are encouraged to have a blood test for diabetes and those who are overweight or obese should also be tested as well, even if they are children.

Conclusion
Diabetes mellitus is a disease that affects a significant number of people in Anguilla and all indicators point to even greater numbers in the next few years. All of us must ensure that all individuals with diabetes achieve the best quality care so that many of the complications associated with poor care can be prevented. It is important that we identify groups that are disadvantaged or vulnerable in terms of their access to appropriate diabetes education, prevention and care and then put measures in place so that all residents of Anguilla receive optimal care for their diabetes.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.

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