Malta should work on locating those 12,000 people estimated to be undiagnosed diabetics in order to treat them and thereby slash the risks of further complications, according to the president of the International Diabetes Federation.
Sir Michael Hirst explained that the “missing 12,000” can be located through public awareness programmes and family doctors, who are key players in preventing and diagnosing diabetes before it causes serious damage to the eyes, heart, teeth, feet and kidneys.
“It’s much cheaper for a country to identify the undiagnosed and treat them than it is to deal with the costly complications which can develop otherwise.”
Malta has the second highest percentage of diabetics in the Mediterranean, surpassed only by Cyprus, with more than 30,000 adults known to be diabetic.
“By and large, members of the public have greater interaction with the family doctor than they do with any specialist in the hospital. The family doctor would know if a patient has a history of Type 2 diabetes.
“You wouldn’t have undiagnosed Type 1 diabetes because, with Type 1, people become very sick, very quickly,” Sir Michael said.
Family doctors would recognise overweight people as, very often, such people would go on to develop insulin resistance, which is the precursor to diabetes.
They would also recognise patients with high blood pressure and high cholesterol levels, which is the cocktail of conditions that lead to diabetes.
Sir Michael is currently in Malta to meet the Parliamentary Working Group on Diabetes, which has supported the steering group responsible for drafting the consultation diabetes strategy for the years 2015-2020.
I watched her go through amputation, blindness and being nursed in a home until she died
Describing the consultation document as “exceedingly welcome”, Sir Michael said it was the first and essential step in identifying the scale of the problem and seeking ways to address it.
“The fact that many governments have got there first is a fact of life – I’m not here to condemn, I’m here to praise. It would have been great had it happened sooner but at least it’s happening now.”
He urged for greater vigilance, sustained public awareness programmes and educating children. The authorities should ensure that the schools’ curricula provided for physical exercise and included advice about sensible eating. Children could be an important influence on their parents – they have been proven to be quite effective in persuading their parents to give up smoking, Sir Michael pointed out.
One of the imaginative ways in which awareness has been raised in Britain is through free screening organised by a chain of pharmacies. Through blood tests, people with impaired glucose tolerance were identified and directed to their family doctor for more tests.
Sir Michael also stressed the importance of providing psycho-social support for people at risk to encourage them to make the necessary behaviour and lifestyle changes.
Such support was also needed for people who had been diagnosed because it was easy for them to slip into denial.
He said he experienced this with his daughter, now 34, who was diagnosed with Type 1 diabetes at the age of four.
“She’s a very intelligent child who thought she was able to manipulate everybody. Yet she found behaviour change very difficult.
“It can be very painful to talk about it but my daughter has had complications and looking back, if she had had more psycho-social support in her teenage years, certain things might have been prevented or delayed.”
Parents, no matter how much they loved their child, were not the right people to offer psycho-social support given by professionals, he said.
“This is important for children in their teenage years because that’s when they go off the rails. But it’s also important for people in the early stages of diabetes because there are some people who are fatalistic about it.”
In the village where he lived, Sir Michael knew a woman who was diagnosed with diabetes but was unable to make the necessary behaviour changes.
“I watched her go through amputation, blindness and being nursed in a home until she died. Some people can become fatalistic and think: ‘Does it really matter?’
“If you’re elderly and you don’t have any dependants, you may be able to make that choice. But if you’re younger and if you do have dependants, that should never be a choice. Such people should be helped and supported to stay healthy as long as possible so that they can, in turn, support their family and support society.”