New and comprehensive study of diabetes care in Trinidad and Tobago released
The most current and comprehensive study in almost a decade of people with diabetes and the health care services they receive in Trinidad and Tobago has been completed by a team of experts from the Trinidad and Tobago Health Sciences Initiative’s (TTHSI) Diabetes Outreach Program. The survey focused on the South-West region.
The survey reveals that only 1 percent of patients self-monitor their glucose levels and only one-third can recall having a hemoglobin A1C test, an important step in achieving long-term glucose control and in minimizing the risk of serious complications.
TTHSI is a collaborative effort between the University of Trinidad and Tobago, Johns Hopkins Medicine of Baltimore, Md., USA, the Ministry of Health, the Ministry of Science, Technology and Tertiary Education, the University of the West Indies, and several other government departments and local organizations.
“Comprehensive and up-to-date survey data helps to identify potential gaps in care, where resources should be allocated, and how to provide treatment to patients in the most efficient manner,” says Rita Kalyani, M.D., M.H.S., an assistant professor of medicine in Johns Hopkins Medicine’s Division of Endocrinology and Metabolism. “The innovative TTHSI Diabetes Outreach Program used diabetes mobile units that traveled on a rotating basis to health clinics throughout the region to work with local providers to collect information on the current status of patients with diabetes and their health care as a basis for further management. This program is a successful model of collaboration between Johns Hopkins and local health care providers for diabetes care initiatives and can be used in many other regions around the world.”
The incidence of diabetes has increased worldwide over the past 25 years, with Trinidad and Tobago ranking among the countries with the most prevalent and fastest-growing number of cases of this chronic and potentially life-threatening disease. According to the Diabetes Association of Trinidad and Tobago (DATT), it is the nation’s second leading cause of death. Every year, 1,000 adults in the island nation are diagnosed with diabetes, adding to a population of more than 150,000 patients nationwide, a rate of diabetes prevalence (12 to 13 percent) that is almost twice the global average.
A team of experts analyzed data collected over a 10-month period from more than 2,000 patients in 31 of the 33 health centers and clinics affiliated with the South-West Regional Health Authority (SWRHA). The experts assessed the health status of individuals with diabetes and the quality of care provided to them using a questionnaire, focused examinations, and point-of-care tests that provided immediate results for glucose, hemoglobin A1C, cholesterol, and urine protein levels.
The survey indicates that two-thirds of diabetes patients saw a doctor or a nurse regularly for diabetes care and had received at least some education about their condition. However, only 28 percent of the patients had seen an eye specialist and only 9 percent had received a foot exam within the previous year. Other significant findings of this survey show that some of the most commonly self-reported complications of diabetes included heart disease (24 percent), stroke (7 percent), neuropathy (41 percent), foot ulcer or amputation (13 percent), retinopathy or damage of the retina (13 percent), nephropathy or damage of the kidneys (5 percent), hypertension (67 percent) and high cholesterol (51 percent). Two-thirds of the survey participants were overweight or obese, with metabolic control measurably worse in children and women.
The report reveals that the individual and societal burden of diabetes and its complications — including heart disease, stroke, blindness, amputations and end-stage renal disease — will continue to grow in Trinidad and Tobago unless appropriate and effective interventions are implemented. The expert team recommends measures to improve diabetes care in the near term, including the expansion of a national diabetes performance surveillance program aimed at monitoring progress and improving performance of local health care clinics; expanding the medical education of health care providers who are treating diabetes patients; training local providers on the use of point-of-care testing in local health centers; and the implementation of new programs to address the need for better screening of diabetic complications, such as retinopathy, heart disease and foot ulcers.
The long-term goal of the Diabetes Outreach Program is to improve longitudinal care for the estimated 150,000 people living with diabetes in Trinidad and Tobago through implementation of sustainable programs. The program is currently being expanded to other regions of the country.
