‘Diabetes is not a death sentence’
Type 2 diabetes is a challenge, not a death sentence, according to Annabel Fountain.
But Dr Fountain stressed that patients needed the right tools to succeed and education is key.
The island’s only endocrinologist spoke with The Royal Gazette to shed light on the disease that is threatening to cripple the island’s healthcare system.
“If we look at it from a public health perspective, we have to focus on type 2 because that’s the area we can prevent and the population is so large, of people with type 2 diabetes, and the outcomes are so poor that if we don’t actually focus on that group and help them to live more healthily, we’re not going to be able to afford our healthcare system.
Unlike type 1 diabetes — an autoimmune disease caused by the pancreas producing insufficient insulin, a hormone necessary for the body to turn blood sugar into energy — type 2 diabetes is associated with lifestyle and diet, and can be prevented or reversed.
“Type 2 is insulin resistance, so your pancreas can actually make more, three, four times more than what somebody normal can make, yet it’s not working and it can be for all sorts of reasons,” Dr Fountain explained.
“It can be because you’re obese and it’s just not enough or it can be that the signalling isn’t working.”
She added: “We used to think that type 2 diabetes was for older people. But we have sick, working-age people in the hospital with type 2 diabetes.
“If we don’t start targeting that group and in fact the group below that — the 20 to 45 years old — if we don’t start helping them to be healthier, we’re in this downward spiral.”
But Dr Fountain added: “Not only is it that we have a high incidence, we also have really bad outcomes and that could be for many reasons but part of it is low health expectations.”
According to Dr Fountain, Bermuda’s dialysis and blindness rate is ten times that of the United States and Europe, while the amputation rates is the highest in the world.
“Ten years ago we had about 60 people on dialysis and now we have 170,” she said.
However, controlling diabetes can cut the chance of developing diabetic eye disease by 76 per cent, kidney disease by 50 per cent, and neuropathy — numbness in the feet — by 60 per cent.
Dr Fountain works with a multidisciplinary team at the Diabetes Respiratory Endocrine and Metabolism (Dream) Centre, based at the Mid-Atlantic Wellness Institute.
“The goal is to help people to live healthily with diabetes, whether its type 1 or type 2, and help them realise that the complications of diabetes don’t have to happen to them.
She added: “My role is to really try to help people accept that this isn’t a death sentence.
“But it is a challenge and if you don’t have the right tools, it’s very difficult to be successful.
“It’s like studying for an exam.
“If you don’t have good teachers and the right materials, you’re not going to get the best grades.”
Education is critical and new patients, whether they already have diabetes or pre-diabetes, are first referred for education and encouraged to take a 12-hour diabetes self-management course.
“Very frequently, people who come and do that course require less medications than they needed before,” Dr Fountain said.
“They can reverse their diabetes just by understanding what their disease is and what their role is in managing it.”
But she also stressed that more specialist services are needed to support people living with diabetes, although not every one needs specialist care.
“If you invest more in diabetes services and people have better education, we can make a really big impact on whether they have complications.”