THE RECENT REPORT titled “Health of the Nation” [HotN], by our Ministry of Health and the Chronic Disease Research Centre [CDRC], published in January 2015, gave a prevalence of diabetes in Barbados at 18.7% in adults 25 years and over, one of the highest in Latin America and the Caribbean.
The HotN report also suggested that a majority (62%) of patients known to have diabetes had poor blood sugar control, and 40% of them had poor blood pressure control.
The Barbados Drug Service (BDS), from July 1, 2015, suddenly “announced” a reduction in the number of strips being made available to patients for the personal monitoring of their blood sugars, a process called self-monitoring of blood glucose (SMBG or SBGM). This “announcement” was made to the pharmacists, with many patients and physicians finding out after the change.
Flashback: As recently as 2011, changes by the BDS were accompanied by a major public relations campaign, with the BDS organising town hall meetings for the general public and for physicians, and even included a television campaign. At that time, there was a reduction in the availability of some types of blood pressure lowering medications; some critics suggested that blood pressure control, already sub-optimal in large numbers of patients here, would deteriorate further. Since then there has been a steady stream of patients with complications of hypertension like heart attacks and strokes, flocking to our hospital, significantly increasing the hospital burden.
Now, just four years later, without fanfare, the BDS suddenly reduced the allocation of blood glucose testing strips. This is also likely to have a negative impact on the management of diabetic patients. There is no doubt that SMBG is an important part of diabetic patients “taking responsibility for their diabetes” by monitoring their blood sugars. Non-availability of testing strips is likely to add to the 62% of known diabetic patients who have poor blood sugar control. Poor blood sugar control increases the chances of any complication of diabetes including blindness, amputation, heart attack, stroke or chronic kidney disease, all being very difficult and costly to treat.
While the medications made available by the BDS are but one aspect of the management of the chronic non-communicable diseases, the battle becomes more difficult to fight, and the battleground shifts to the hospital, if the patients not given the appropriate tools to help themselves. Available evidence does not suggest that a policy that attempts to save a few cents in medical supplies, and hopes that our main hospital takes up the slack, is saving dollars or lives.
– DR. COLIN V. ALERT, MB BS, DM.