Diabetes does not affect the patient alone, but the family and community at large. This is why when the world observed World Diabetes Day last week, focus was put on the role family has to play in the prevention and management of the disease. The day is celebrated on November 14, and this year’s theme is ‘Family and Diabetes.’ At the national level, events were held in Kiramuruzi, Gatsibo District, and as part of the countrywide programme that started on November 11, at least 800 people were screened for diabetes and blood pressure. In line with the theme, focus has been put on raising awareness regarding the impact that diabetes has on families, and consequently seeking out its role in the prevention and management of the illness. 2017 International Diabetes Federation (IDF) report showed that over 425 million people are currently living with diabetes. Most of these cases are type 2 diabetes, which is largely preventable through regular physical activity, a healthy and balanced diet, and the promotion of healthy environments. THE ROLE OF FAMILY According to officials, diabetes can be expensive for an individual and the family. In many countries, the cost of insulin injections and daily monitoring alone can consume half of a family’s average disposable income, and regular and affordable access to essential diabetes medicines are out of reach for many. Edison Rwagasore, Senior Officer — Diabetes, Chronic Diseases and Other Metabolic Diseases at Rwanda Biomedical Centre (RBC), says diabetes is a concern for every family. This, he says, ranges from parents of children with diabetes to the relatives caring for an adult family member living with diabetes. All families are potentially affected by diabetes and so awareness of the signs, symptoms and risk factors for all types of diabetes are vital in helping detect it early, he says. Rwagasore highlights that families have a key role to play in addressing the modifiable risk factors for type 2 diabetes and must be provided with the education, resources, and environments to live a healthy lifestyle. According to IDF, one in two people currently living with diabetes are undiagnosed. Most of these cases are type 2 diabetes. “Early diagnosis and treatment is key in preventing the complications of diabetes and achieving healthy outcomes,” Rwagasore says. Less than one in four family members have access to diabetes education programmes. Family support in diabetes care has been shown to have a substantial effect on improving health outcomes for people with diabetes, according to IDF’s report. Simon-Pierre Niyonsenga, the director of diabetes at Rwanda Biomedical Centre, says improving access to affordable diabetes medication and care is urgent to avoid increased costs for the individual and family, for this has an impact on health outcomes. Rwagasore, therefore, says it is important that ongoing diabetes self-management education and support be accessible to all people with diabetes and their families, to reduce the emotional impact of the disease that can also result in a negative quality of life. EFFORTS FROM THE MINISTRY Rwanda has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, its achievements will strongly rely on an innovative approach to improve awareness among the general population on preventive measures, early detection, and uptake of medical services. Because of this, Ministry of Health through Rwanda Biomedical Centre in partnership with other stakeholders, has organised World Diabetes Week (WDD) that will run from 14 to 20 November 2019, with the theme ‘Uruhare rw’Umuryango, mu kwirinda indwara ya Diyabete’ ( the role of family in the prevention of diabetes). The WDD campaign is predicted to raise awareness of the impact that diabetes has on the family, and support network of those affected. Also, it aims at promoting the role of the family in the management, care, prevention, and education of diabetes. Meanwhile, a survey conducted by World Health Organisation in 2013 revealed that obesity was the leading risk factor more predominantly in urban regions, probably due to sedentary lifestyles. This urges the need to establish intervention among people at higher risk. In consideration of this, Rwanda Ministry of Health is planning to initiate self-testing model for non-communicable diseases at the workplace. This is aimed at improving the uptake of regular screening for hypertension and obesity among the staff of public and private institutions, officials say. ABOUT DIABETES Dr Anju Goel, MD, Medical Consultant at Life for a Child/Rwanda Diabetes Association says the two main types of diabetes are type 1 and type 2. Type 1, she says, is an autoimmune disorder that results in an inability of the body (specifically, the pancreas) to make insulin, adding that it often presents itself in childhood (and, therefore, was previously referred to as ‘juvenile diabetes’), but can present in adulthood as well. Approximately five per cent of people with diabetes have this type of diabetes. It is related to genetics as well as to an environmental trigger that as of yet has not been identified, Goel says. She notes that people with type 1 diabetes need to take insulin via injection several times a day, or via an insulin pump that delivers insulin continuously. She also says type 2 can happen due to resistance to insulin. About 90 to 95 per cent of people with diabetes have this type. It is related to lifestyle factors such as obesity, inactivity, unhealthy diet as well as genetics, she says. “People with type 2 generally start treatment with lifestyle modifications including diet and exercise changes, oral medications, and eventually need insulin injections,” Goel says. The medic goes on to mention that some women develop gestational diabetes while pregnant. This, she says, is also a resistance to insulin and resolves after delivery of the child, though women who have it remain at higher risk to develop type 2 diabetes later in their lives. CHALLENGES AND WAY FORWARD Jean-Claude Habineza, a medical doctor at Rwanda Diabetes Association, says diabetes imposes a heavy economic burden on individuals and their families, not forgetting productive time lost during acute illness and going for treatment. However, he notes that people should understand that having the condition is not a death sentence. “People with diabetes can still live a healthy, happy and productive life. To do so, they need to adhere to their caregivers’ advice. Eat a healthy and balanced diet, exercise regularly, and take their medications as prescribed,” he advises. For prevention measures, Dr Habineza says, people should first change their perception on being healthy. He mentions that being overweight or obese is not a sign of good health or wealth. Instead, one should strive to eat a diet rich in fibre. He also says people should as well exercise regularly, consume alcohol in moderation, quit smoking, and go for medical check-ups regularly. Dr Goel says for people with diabetes, it’s important to check blood glucose several times a day and adjust their lifestyle; exercise regularly, eat a healthy whole grain plant-based diet with fruits and vegetables and minimum sugar and processed foods. Because there is no cure for diabetes, she notes that patients have to do these things every day for the rest of their lives, which can be very exhausting. She points out that family and friends can help by encouraging their person to take good care of themselves. Friends/family can also modify their diet and exercise regularly. This, Dr Goel says, will help to support the person with diabetes and also help them stay healthy. In addition, she says some people with diabetes may feel depressed and alone. “Friends and family can help by communicating that they still love and accept the person and don’t think any less of them because they have diabetes,” she says. editor@newtimesrwanda.com
