Alverston Bailey | Being educated critical to diabetes prevention

As we observe World Diabetes Day on November 14, we continue to expand the focus on access to diabetes care. Over half a billion people are living with diabetes globally, and it is for this very reason we must unite in action and call on our policymakers to increase access to diabetes education to help improve the lives of persons living with diabetes.

Diabetes mellitus or “sugar”, as Jamaicans call it, is a condition that causes high levels of glucose (sugar) in the blood and occurs when there is a problem with the hormone insulin. Insulin is produced by the pancreas and moves glucose from the bloodstream into the body’s cells, where it is used for energy. In type one diabetes, which is more common in children, the pancreas fails to produce insulin. In type two diabetes, the more common form of diabetes, the pancreas produces insulin, but the body is resistant to its effect.

ALL FACTS, NO SUGAR-COATING

A local study done in 2013 by Professor Rainford Wilks and his team highlighted that the overall prevalence of diabetes in Jamaicans was 7.9 per cent, with rates significantly higher in women than men and increases with age. Seventy-six per cent of persons with diabetes mellitus were aware of their status; urban women and rural men were less likely to be aware.

Persons without health insurance were less likely to control their diabetes and the prevalence of diabetes risk factors was higher in women than men. Not to mention, the treatment of diabetes puts an added burden on our already strained healthcare systems.

The latest figures from the Ministry of Health and Wellness (MOHW) show that one in eight adult Jamaicans is living with diabetes while one in four Jamaicans is unaware that they even have the condition. Similar to Professor Wilks’ study, the data and messages from our local health officials consistently show that an increased waist circumference, overweight/obesity and physical inactivity are some of the many attributable factors.

With these facts and figures striving in our midst, it is imperative that healthcare professionals know how to detect and diagnose diabetes early and make the most of the limited time they have to provide the best possible advice and care for people living with diabetes.

TOMORROW’S PREVENTION, TODAY

From Professor Wilks’ study, only 43 per cent of patients receiving therapy for diabetes had reached their target goal. One of the primary factors for this failure to achieve goals is inadequate patient health literacy about diabetes. Therefore, we need to significantly improve diabetes education in Jamaica.

The aim of diabetes education is to enable persons with diabetes to improve their knowledge, skills and confidence, thus enabling them to take control of their own condition and incorporate effective self-management in their daily routine. High-quality structured education can have a significant effect on health outcomes and improve the quality of life of persons afflicted with type two diabetes in numerous ways such as:

• Improved knowledge, health beliefs and lifestyle changes.

• Improved patient outcomes – e.g., weight, haemoglobin A1c (HbA1c), lipid levels, smoking and psychosocial changes, such as quality of life and levels of depression.

• Improved levels of physical activity.

• Reduction in the need for – and potentially better targeting of – medication and other items such as blood-testing strips.

It is also important that diabetes education programmes be flexible to suit the needs of the individual. To meet this dire need, the following criteria should be taken into consideration in the development of an effective diabetes education programme:

• Be evidence-based and suit the needs of the person.

• Have specific aims and learning objectives, and supports the person and their family members and carers in developing attitudes, beliefs, knowledge and skills to self-manage diabetes.

• Have a structured curriculum that is theory-driven, evidence-based and resource-effective.

• Have supporting materials and be written down.

• Be delivered by trained educators who have an understanding of educational theory appropriate to the age and needs of the person, and who are trained and competent to deliver the principles and content of the programme.

• Be quality assured and is reviewed by trained, competent, independent assessors who measure it against criteria that ensure consistency.

• Ensure that the outcomes are audited regularly.

COLLABORATIVE APPROACH

Policymakers have a critical role to play in shaping the health and future of Jamaica. It is recommended that the MOHW in collaboration with the National Health Fund consider establishing a national diabetes education programme for every person and/or their carer at and around the time of diagnosis of diabetes.

Compelling evidence from other countries shows that the patient-centred, group-based self-management programme (X-PERT) and the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) are two such programmes that have been shown to be very effective programmes which can be emulated in Jamaica. The X-PERT programme, developed by UK dietitian Dr Trudi Deakin, aims to increase knowledge, skills and confidence leading to informed decisions regarding diabetes self-management.

Participation in the X-PERT programme by adults with type two diabetes has been shown at 14 months to have led to improved glycaemic control, reduced total cholesterol level, improved body mass index and waist circumference, reduced requirement for diabetes medication, increased consumption of fruit and vegetables, increased enjoyment of food, and improved knowledge of diabetes, self-empowerment, self-management skills and treatment satisfaction.

DESMOND is a structured education programme designed by a number of organisations under the National Health Services UK for patients with type two diabetes, and is the first one to meet the criteria set down by the National Institute for Health & Clinical Excellence for suitable education programmes. Results from a UK study that compared patients who underwent the DESMOND programme with patients who did not, showed there were greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness.

The above programmes cited, provide compelling evidence that diabetes education is indeed an effective tool to help patients to combat this scourge and is strongly recommended in an effort to combat this disease.

IN A SPOONFUL...

As Jamaica continues to grapple with the onset of novel contagions and the rapidly increasing rates of chronic non-communicable diseases, it is important to note that people living with diabetes need to understand their condition, how to manage it, and keep their knowledge updated.

Presently, type one diabetes cannot be prevented. While a number of factors influence the development of type two diabetes, the most influential are lifestyle behaviours commonly associated with urbanisation. These include the consumption of unhealthy foods and inactive lifestyles with sedentary behaviour. Diabetes risk is also affected by socio-economic status – groups with less income tend to have more diabetes.

Prioritising diabetes education will ultimately pay off. It must also be recognised that policy initiatives such as regulations on food labelling go hand-in-hand with diabetes education. While we urge Jamaicans to practise reading the nutrition facts panel on food products as part of education, the introduction of food policies such as front-of-package warning labels have the power to enable persons living with diabetes to make healthier food choices, and further reduce and prevent the onset of a number of other non-communicable diseases. With substantial and quality information, Jamaicans will be empowered to use primary care and preventive services, take medications as prescribed, control their blood glucose, blood pressure and cholesterol levels and inevitably, experience lower health costs.

Let’s all play our part to make a diabetes-free Jamaica not just a dream, but our pledge. Remember, there’s nothing sweeter than a healthy lifestyle!

- Dr Alverston Bailey is an occupational and family physician and co-chair of the University Diabetes Outreach Programme, Jamaica. Send feedback to ghapjm@gmail.com