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In light of the fact that the health sector’s efforts to combat diabetes has realised notable successes, including a 50 per cent reduction in amputations, diligent moves are being made to expand related services.At least this is according to the Health Ministry’s Coordinator of Chronic Diseases, Dr Karen Gordon-Boyle.However, facilitating the expansion plans will not only require funding, but careful planning. As such, a meeting held at Project Dawn, Liliendaal, Greater Georgetown, yesterday saw the gathering of stakeholders to help plot the way forward.Among the stakeholders in attendance were officials from the Georgetown Public Hospital Corporation, persons trained specially in Diabetic Management, Community-based individuals, doctors, nurses, statisticians, surveillance officers, planners and economists.It is expected that funding will be garnered through the World Diabetes Foundation. Moreover, the preparation of a proposal is currently in the making, according to Dr Gordon-Boyle.The diabetes stakeholders meeting in session yesterday.Already a draft report has been crafted and was the subject of discussion yesterday.“Today (yesterday) is a review of the draft proposal document that deals with the various components,” said the Chronic Diseases Coordinator, who disclosed that the local Health Sector is working in collaboration with two Canadian-based entities – the Banting and Best Diabetes Centre at the University of Toronto and Orbis International.“We are reviewing, critiquing and editing the draft…We are asking questions and making sure that everybody is on board; that they agree with it, so that we can finalise it and submit it,” Dr Gordon-Boyle said of the draft proposal. She disclosed too that the final document will be ably crafted by a Pan American Health Organisation-sponsored Consultant.The proposed expansion of the diabetes-combating programme will represent a third phase of local efforts undertaken in collaboration with the Canadian entities. Phases one and two, through which sterling advances were made in the fight against diabetes, had in fact attracted an award from the Journal of Wound Care earlier this year, according to Dr Gordon-Boyle.Moreover, the draft for the proposed expansion will entail efforts to further address diabetic conditions that affect the eyes and pregnancy, and there will be moves to facilitate public health expansion of the diabetic foot projects possibly into Regions Seven, Eight, Nine and One. Although there are currently seven diabetic foot centres catering to the population, most of the cases are seen at the GPHC.In addition, in the quest to expand the diabetic programme, Dr Gordon-Boyle said that moves will also be made to train ophthalmologists to treat diabetic retinopathy and optometrists to diagnose such cases so that more persons will be able to have their eyes checked.Currently there are three or four trained ophthalmologists in the public health sector and there will be moves to train nurses, medexes and other health officials to manage diabetes, even as efforts are made to integrate it with the management of hypertension and high lipids.Added to training of needful medical experts, the Chronic Diseases Coordinator said that “we would like to look at diabetes in pregnancy and being able to diagnose it early and manage them.”According to Dr Gordon-Boyle, one of the big challenges that has been realised is that 50 per cent of people who have diabetes are “totally clueless. They don’t know that they have it and by the time they do go to the hospital it is usually when they have some kind of complication and by then they have had it for years.”But the key to preventing amputations and other complications, such as those with the eyes, is early detection and managing, Dr Gordon-Boyle asserted. And the primary means to detect the condition early is to ensure that screening and testing is done in a timely manner.“The screening has been happening quite a bit already, but we have been doing screening of the general population…Anybody who comes just does a screening, but we now want to try doing screening using a risk assessment; so we are going to be screening persons who are at high risk versus just anybody,” said Dr Gordon-Boyle.Added to this, she said that moves are being made by the Health Ministry to introduce a new tool called the ‘Indian Diabetic Risk Score’ and doctors will be specially trained to utilise this so that more individuals can be targeted for training.“Screening the persons that need to be screened is what we have to do, because we have limited resources…You have to be wise where you allocate and use them,” Dr Gordon-Boyle stated. She explained, too, that another main area to be addressed is that of governance, whereby there is a strong system to support the expansion.As such, she noted that efforts will be made to target particularly high-risk patients using the four parameters of age, weight, physical activities, and a history of family diabetes. The total score that any one patient can have is 100, but those with scores of over 60 will be considered high-risk and in need of testing.The diabetes expansion proposal in its completed form is expected to be submitted by January to the World Diabetes Foundation, and it is the expectation of the Chronic Diseases Coordinator that funding will be made available soon after.