Diabetes: confronting the invisible disease
I attended the 76th Scientific Sessions of the American Diabetes Association, of which I am a member, in June in New Orleans. November has been designated Diabetes Awareness Month, a month that in days gone by was solely devoted to this disease. However, November is now also devoted to Movember, a worthy cause highlighting men's health issues, especially prostate cancer.
One of the lessons that I took from that conference was how all over the world diabetes continues to face an uphill task at being recognised as a serious disease worthy of being given the attention it so rightfully deserves.
This article, which is being published on consecutive days, has been timed to appear at the end of Diabetes Awareness Month, as it wraps up and the disease is again “forgotten” for another year.
In his presidential address at the conference mentioned above, Desmond Schatz, the Professor and Associate Chairman of Paediatrics, Medical Director of the University of Florida Diabetes Institute and the Director of Clinical Research at the University of Florida titled his talk; “Diabetes at 212° — Confronting the Invisible Disease”.
The temperature 212F, or 100C for those who are metric-minded, is not just a number, as he said; it is the boiling point of water, where water is no longer still, but erupts with urgency. He went on to say that this is the point of transformation where matter dramatically changes form as the boiling water turns to steam. Steam, as he continues, can power a generator and create energy, and energy powers movement.
In Bermuda as well as the rest of the world, diabetes has become an epidemic that is becoming too difficult to control. In Bermuda as with the rest of the world, this disease has also become invisible.
Unfortunately, so many people still underestimate how serious and deadly diabetes really is. It is an invisible epidemic that threatens our health and the health of our families, our communities and our nations.
One does not have to look far for proof: diabetes is the leading cause of blindness, chronic kidney disease and lower-limb amputation among adults. It doubles the risk of heart disease and stroke.
This month of November, which is drawing to a close, has been Diabetes Awareness Month, but the fanfare in Bermuda has been muted. Speaking on the initiatives included in the 2016 Throne Speech, the Minister of Health and Seniors mentioned that through the work of the ministry with the Bermuda Diabetes Association, there are programmes to ensure that things are done differently.
What are these programmes and what are the different things that are being done? What are the results of this collaboration with this association? We have seen very little movement. We need to consider how everyone can help to create a “boiling” sense of urgency in tackling this disease. Diabetes should be as hot a topic as any other high-profile disease, such as the recently worrisome Zika virus explosion.
Physicians and scientists working on diabetes think that they know a lot about this disease, but there is a great deal more that they do not know. They know very little about how this disease affects the patients suffering from it.
There is a video at professional.diabetes.org/NoMoreHiding, which I implore any reader of this article to watch. This video illustrates one young patient's perspective and daily burden of managing this disease. This is a situation that is not experienced even by those closest to this patient.
This invisibility of diabetes even extends to doctor-patient interaction. A recent study showed what little time a person with diabetes spends in a year with a medical professional.
The time is less than 150 minutes out of a possible 525,600 minutes in a year; a figure of less than 0.03 per cent. We, the healthcare providers, are virtually invisible as the patient battles alone with and manages this very complex disease.
A recent report in the November 8 edition of the Journal of America Board of Family Medicine cited the result of a study by the University of Florida researchers.
In a study involving 1,200 family practitioners, only 50 per cent of those interviewed follow the board's guidelines on screening patients for prediabetes; the result is probably similar, if not worse, in Bermuda where a “Guideline for Diabetes in Bermuda” developed locally in 2009 has remained virtually ignored.
More than one third of adult Americans have prediabetes and most do not know about it; the figure, I am sure, is higher in Bermuda. The sad reality of this study is that only those doctors with a positive attitude towards prediabetes as a clinical condition are more likely to follow these guidelines and to offer treatment to their patients.
How often do we hear our friends and family members say, “My doctor says that I have a touch of sugar”? Persons with prediabetes have a high risk of developing full-blown diabetes. However, many doctors still believe unfortunately that the prediabetes diagnosis somewhat “overmedicalises” patients.
What is prediabetes? These are some points that you and your doctor should consider with regards to this condition:
• Fasting blood sugar between 100 and 125 — the normal range is 70 to 99. A figure above 126 indicates the presence of diabetes
• An overweight or obese person
• Family history of diabetes
• Diabetes during pregnancy (gestational diabetes)
• Certain ethnic groups: Africans, including those in the Diaspora, Hispanics, Indians, both Asiatic and Native American
• Blood pressure over 140/90
• HDL, good cholesterol, less than 40 in the male and less than 50 in the female — normal range is 40 to 60
• Triglycerides, fatty acid, over 250 — normal range is under 150
• Females with a condition called polycystic ovarian syndrome or PCOS
The present guidelines from the American Diabetes Association recommend active screening of adults who are overweight or obese after the age of 45.
The US Preventive Service Task Force recommends screening of the same group from the age of 40 to 70. The treatment of prediabetes include medications, exercise and weight-loss programmes.
These are simple enough screening and treatment options that will help to address the epidemic of this invisible disease. Is there such urgency in Bermuda in helping to stave off this epidemic?
Having had a diagnosis of Type 2 diabetes, or T2DM, how many patients choose to become invisible because of their sense of failure?
They are frustrated time and time again when on doctor's visit they are told that their blood glucose remains poorly controlled, that their weight has not changed, and that they have made little or no effort to diet or exercise.
Some patients — and from my observations, more males than females — go into denial. They stop medication after a few months, thus losing most of the clinical benefits. They feel ashamed of the stigma and blame that are directed at them, leading to a sense of worry and fear; fear especially in many patients who have seen relatives suffer appalling consequences of advanced diabetes, including premature death.
I feel ashamed to say that we, the healthcare professionals, find it easy to criticise and to cajole our patients with the hope of improving their clinical status. However, often what we do is fail to provide time to hear or to learn about our patients' burden and the real reasons why they cannot seem to control their diabetes.
As we are gatekeepers, we need to have a sense of urgency to resolve their burdens and questions rather than doling out the same pieces of advice with the same expectations, which we know will achieve the same lacklustre results.
Enough of bashing my colleagues. What about you, the public? Diabetes is like a wild fire ranging through Bermuda as well as other countries in world. Who pays attention? Who cares if every year we hear the same similar statistics? Who cares about how the disease and its skyrocketing healthcare costs seem invisible to those in power?
• Fémi Badà, MD is an age management medicine specialist and the former chairman of the Bermuda Diabetes Association