By Dr. CHRISTOPHER J. MORGAN
Everyone reading this article knows someone with diabetes.
Diabetes has reached epidemic proportions around the world and here in Canada. Today, more than nine million Canadians live with diabetes or pre-diabetes and according to Health Canada, the number of people with diabetes is increasing by seven per cent, or more than two million each year. Globally, every 10 seconds two people develop diabetes, resulting in more than 285 million people being affected. Based on current trends, it is expected that 380 million will be affected by 2025.
The human cost of diabetes is devastating. According to the World Health Organization (WHO), more than 80 per cent of diabetes deaths occur in low and middle income countries. Over time, diabetes can damage the heart, blood vessels, eyes, kidneys and nerves. It significantly increases your risk of cardiovascular disease. In fact, 50 per cent of people with diabetes will die of heart disease or stroke. Due to damage to the nerves and small blood vessels, diabetes is the leading cause of blindness for people over 20 and the number one cause of non-traumatic limb amputation. It is also among the leading causes of kidney failure, accounting for 10 to 20 per cent of diabetes deaths. Here is another alarming fact – the overall risk of dying among people with diabetes is at least double the risk of their peers without the disease. Diabetes is a chronic disease without a cure.
The financial burden of diabetes is also devastating. The Canadian Diabetes Association estimates that diabetes accounts for $9 billion in direct and indirect health care spending. For example, it costs approximately $50,000 a year per patient on kidney dialysis. The WHO estimates that in the period 2006-2015, China will lose $558 billion in foregone national income due to heart disease, stroke and diabetes alone.
Mark your calendar: on Saturday, April 27, the Fourth Annual Black Diabetes Expo will be held, presented by the Canadian Diabetes Association (CDA) and its Caribbean Chapter. The free, full-day (9 a.m. to 4 p.m.) event will take place at the Jamaican Canadian Association, located at 995 Arrow Road in North York. A free shuttle bus from TAIBU Community Health Centre in Malvern will help ensure no one has to stay home and miss out. Event partners include CHRY 105.5 FM, G98.7 FM, Jamaican Canadian Association, Janssen Inc., TAIBU Community Health Centre and Viv’s Catering.
Guests of the Expo will be able to have their blood pressure checked and determine their personal level of risk of developing diabetes by completing the CDA CanRisk Questionnaire. A CanRisk score of six or less indicates your likelihood of developing diabetes within the next 10 years is one in 100, whereas a score of 20 or greater the risk is one in two or 50 per cent. What’s your score?
The keynote speaker will be Dr. Jacqueline James, Vice President, Education, Mount Sinai Hospital. There will be an expert panel which includes Dr. Jay Carey, an optometrist who will discuss eye disorders related to diabetes; Andrew Springer, an chiropodist who will provide advice on foot care; Ann Petgrave, clinical pharmacist, will answer questions on diabetes medications and interactions; Vida Stevens, nutritionist, will offer counsel on dietary modifications and Kathy Nelson, RN and Certified Diabetes Educator, will provide advice on what you need to know to live well with diabetes.
The Black Diabetes Expo will also include a physical activity demonstration by Dr. Michael Sarin of Toronto Rehab, a Caribbean dance fit demonstration by SuzyMari Health & Fitness Studio and a nutrition presentation by Inge Wettach-Hager of Black Creek Community Health Centre. In addition, the Expo will feature a trade show with a variety of diabetes and health related organizations and companies promoting their products and services.
This year’s Expo has a complimentary goal of expanding the reach of the Caribbean Chapter of the Canadian Diabetes Association. The Caribbean Chapter provides on-going, year-round education and support for people at risk of developing or living with diabetes. The vision is to form a Caribbean Chapter – West Division likely to be based in Brampton or Mississauga and a Caribbean Chapter – East Division in Ajax or Pickering. Ann Petgrave, pharmacist, Certified Diabetes Educator and current Vice-President of the Caribbean Chapter, will lead the West division. Anyone interested in being a part of this group or the East division will have an opportunity to connect with Ann and Kathy at the Expo.
Leading up to this year’s Expo, I had a chance to talk with Kathy Nelson, President and Founder of the Caribbean Chapter of the Canadian Diabetes Association. She spoke to me about the recently released CDA 2013 Clinical Practice Guidelines (CPG) for the Prevention and Management of Diabetes in Canada. According to the guidelines, the diagnostic criteria for Type 2 Diabetes is made based on one of the following test results:
• Fasting (no caloric intake for at least eight hours), plasma glucose (i.e. blood sugar) reading which is 7.0 mmol/L or greater.
• Random (any time of day regardless of the time of the last meal) plasma glucose (blood sugar) reading which is 11.1 mmol/L or greater.
• A two-hour plasma glucose in a 75 gram oral glucose tolerance test which yields a test result of 11.1 mmol/L or greater.
• A haemoglobin A1C greater than 6.5 per cent in adults.
The A1C test is becoming a popular diagnostic tool in part because you do not have to fast, it can be done at any time without any special preparation. However, the CPG advises that A1C results can only be considered validated in the absence of factors that may affect the accuracy of the test, such as chronic anaemia, iron deficiency, a recent blood transfusion, severe liver or kidney disease.
For example, A1C test results may not be valid with someone with sickle cell disease. Also, A1C is not recommended for diagnostic purposes in children, pregnant women, adolescent, or those with suspected Type 1 diabetes. Furthermore, physicians must note that A1C levels are also affected by age, rising by up to 0.1 per cent per decade of life.
Kathy pointed out that the CPG calls attention to ethno-specific differences and disparities. For example, the CPG refers to recent studies that African-Americans, American Indians, Hispanics and Asians have A1C values that are up to 0.4 per cent higher compared to Caucasian patients at similar levels of glycaemia.
Furthermore, the frequency of retinopathy (a type of eye disorder) begins to increase at a lower A1C level in American Blacks than American Whites, which suggest a lower A1C threshold for diagnosis of Type 2 diabetes.
The CPG concludes research may be required to determine if A1C levels differ in African-Canadians or Canadian First Nations compared to Caucasian Canadians. There may well be a need for more research to determine if age and ethnic-specific adjusted A1C thresholds are required for more accurate diabetes diagnosis.
I have been involved in the Black Diabetes Expo since its inception in 2010. It is a successful event, attracting several hundred people throughout the day each year. The Expo provides valuable diabetes information for our community.
Education has been and continues to be our best defence and tool in which to protect and preserve our health and well-being. Always strive to be better informed and proactive in using the information you have learned.
See you at the Black Diabetes Expo.
For more information about the Black Diabetes Expo, call 416-408-7190 or visit diabetes.ca/get-involved/events/4th-annual-black-diabetes-expo.
For information about the Caribbean Chapter of CDA, call Kathy at 416-987-0339. The next Caribbean Chapter Meeting will be held on Tuesday, May 28 at the Anglican Church of the Nativity in Malvern. The topic will be “Kidney Disease and Diabetes,” presented by Jill Campbell of the African-Canadian Kidney Association.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto and the former President of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the Black community. He can be reached at 416-447-7600 or email@example.com.