COVID-19 has been one of the worst pandemics in the last 100 years. This year, the world celebrates also the 100th anniversary of the discovery of insulin. In the centenary year for insulin, a remarkable treatment for this chronic disease, the number of people living with diabetes, the number of people suffering from various complications because of diabetes and the number of people dying from diabetes have increased significantly.

Worst, this several decade-long diabetes pandemic has served as a vehicle to aid and abet the new COVID-19 pandemic, making the COVID-19 pandemic even deadlier. A disproportionately larger number of persons living with diabetes have died because of COVID-19, compared to persons without diabetes. We observe World Diabetes Day 2021 with the backdrop of two other global crises – COVID-19 continues to navigate a deadly path around the world and climate change is more explicitly presenting itself with a doomsday picture.

The world is called to action on many fronts – we do not have time; we do not have the luxury of waiting for a more appropriate time to act. We must act NOW. Like our call to action to combat climate change, our call to action to combat diabetes forces us to ask: IF NOT NOW, WHEN? It has been more than 100 years since insulin has been in use and yet insulin, other medicines and other supplies needed for control of diabetes remain elusive for many people living with diabetes around the world.

We must end this major gap in diabetes control. At the same time, the world remains in deficit for diabetes prevention efforts. There is absolutely no excuse for this travesty. One area we are guilty for is the failure to promote better diets.

Governments and society are abrogating their responsibilities as we not only continue, but we empower the distribution and use of ultra-processed diets, high in sugar, salt and trans-fat to dominate diets around the world. Guyana is on the wrong side of the debate with our vote at CROSQ against front-of-the-package labeling to warn consumers about high sugar, salt and trans-fat in food.

On World Diabetes Day 2021, we do call for more discoveries and newer technology to prevent and fight diabetes. There are many revolutionary technological innovations on the horizon. But more importantly, on World Diabetes Day, we call for more fair and equitable distribution of medicines and technology which are already available today to stem the morbidity and mortality linked to diabetes.

For World Diabetes Day 2021, we must acknowledge that full use of the many tools available to us in public health to prevent and control diabetes have not been optimally utilised. There are still too many persons who need insulin and other medicines to control their diabetes who are unable to access such life-saving medicines. There are still persons who cannot monitor their blood glucose and HBA1C levels and, therefore, cannot optimally control their diabetes.

In an age where self-monitoring is a critical element of self-care for diabetes, far, far too many people are unable to effectively contribute to their own care. We believe that every person living with diabetes should have access to self-monitoring blood glucose levels. Unfortunately, even at the level of health centres in Guyana and in many developing countries, people’s access to blood sugar monitoring is deficient, uneven and unreliable. Even worse, poor people are almost invariably unable to include self-monitoring as part of their care.

In Guyana, children living with Type 1 diabetes, regardless of their economic status, are fortunate to receive regular supplies of self-care packages that include a glucometer and related supplies and insulin pens. The government of Guyana, while they must be commended for this initiative, must be diligent to ensure that these children have reliable supplies of these lifesaving supplies. But the government must ensure more reliable supplies of medicines and testing kits are available in the public health sector.

In the last year, commendable improvement in availability and access to insulin and other medicines and in testing reagents have been achieved. Still there are too many glitches that prevent continuous supply of medicines and testing in public health settings. There must be continued improvement to eliminate the glitches. For example, the present situation in the public health system of unavailability of HBA1C testing reagents is unacceptable.

The Presidential Commission urges that people living with diabetes be empowered to play a greater role in their self-care. This includes the ability to self-monitor their blood glucose levels at home. A concerted effort must be made to empower people to own and use home-use glucometers. While there are citizens who can purchase and support their own home-use blood glucose monitoring, most Guyanese families are not in a position at this time to include self-monitoring for blood glucose level.

The commission has embarked on a process to support more use of glucometers for self-monitoring of blood glucose levels. In this regard, the commission has been able to procure 320 glucometers with 50 glucose test strips each for distribution among people living with diabetes in Guyana. With the distribution of these glucometers, we expect to ensure all persons with an amputation because of diabetes, is able to monitor their glucose at home. We also want to ensure that all women who are diabetic and are pregnant have their own glucometers for self-monitoring. We will also be pushing for all pensioners who live with diabetes to be able to own their own glucometers.

This is a big undertaking, but we believe that if civil society and government work together that this is one aspect of the fight against diabetes that we can win. Thus, with the theme for World Diabetes Day 2021-2023 focusing on access to care, we have started this initiative to improve blood glucose self-monitoring, but also encouraging the use of point-of-care HBA1C. We urge government to ensure that every health centre and hospital in Guyana is able to provide regular point-of-care HBA1C for all persons living with diabetes.

Indeed, Guyana and countries around the world must ensure timely diagnosis, regular monitoring of blood glucose and HBA1C, and uninterrupted access to medicines, including insulin. With Diabetes continuing to increase in Guyana and around the world, with about 60,000 adults living with type 2 diabetes (between eight and 10 per cent of the adult population) and about 150 children living with type 1 diabetes, Guyana is called to action. If not NOW, When?

Dr. Leslie Ramsammy
Chairman
The Presidential Commission on the Prevention and control of NCDS