THE latest study on patient self-management of diabetes in Trinidad and Tobago is out and the results are dismal.
The research was based in South Trinidad, where data from more than 500 patients between the ages of 25 and 87 was collected and studied.
Patients of the Penal Health Centre were asked to complete a Patient Self-Care Risk Assessment which focused on social and behavioural history, general health and disease-specific regimen behaviour. The results revealed serious shortcomings in patient self-management of diabetes.
The research found that nearly all the patients lacked an understanding of how to manage their diabetes and how the disease affects the body.
One in three diabetes patients at the Penal Health Centre fail to take their medications prescribed by their physicians for high blood sugar, blood pressure and nearly all the patients fail to engage in physical exercise. Symptoms of high and low blood sugar and targets for blood pressure, blood sugar and cholesterol control were also not understood by most patients who reported they either forgot to take their medications or stopped taking them whenever they felt better.
Patients with diabetes self-monitored their blood sugar only 35 per cent of the time and paid attention to foot care and diet only half the time.
Fewer than five per cent of the patients had heard of a test called HbA1c as a measure of long term blood sugar control.
Nearly all of the patients engaged in harmful dietary habits, including the regular consumption of fast food and heavily sweetened beverages. More than half of those surveyed reported that they had never tried to increase their physical activity, 85 per cent reported "sitting" as their primary leisure activity.
Some reported financial problems as a barrier to following a good diabetes control regimen. One in five patients was clinically diagnosed with depressive disorder. Almost 49 per cent said they experienced occasional symptoms of depression.
One in five patients identified family-related problems and care-giver roles as barriers to managing their own care. And one in four diabetes patients reported heavy alcohol use.
The study was conducted by a team of experts from the Trinidad and Tobago Health Sciences Initiative's Diabetes Outreach Programme—a collaborative programme between Johns Hopkins Medicine, the University of Trinidad and Tobago, the University of the West Indies, the Ministry of Health and the Ministry of Tertiary Education and Skills Training and several other local organisations.
The researchers were led by associate professor at the Johns Hopkins University School of Medicine and director of diabetes research for the TTHSI, Dr Felicia Hill Briggs and acting chief medical officer, Dr Akenath Misir.
Their were a few positives arising from the study, those surveyed reported prior success with modifying behaviours, including smoking and alcohol consumption and reported interest in fully understanding the behavioural aspects of managing their conditions.
Over the past 25 years, the incidence of diabetes has increased worldwide. Today, T&T is ranking among the countries with the highest prevalence and the fastest-growing number of cases therefore a patient's daily management of the disease is critical, said Hill-Briggs.
"The World Health Organisation (WHO) estimates that the prevalence of diabetes in Trinidad and Tobago is 12 per cent to 13 per cent, almost twice the global average. This means that improving diabetes care and its outcomes requires intervention at multiple levels including the health care system and providers and the community. However, day-to-day management of diabetes depends largely on the patient, who must change his or her behaviours and strictly adhere to a complex self-care regimen,"said Hill-Briggs.