Diabetes poses a great challenge worldwide. It is defined by the he World Health Organization (WHO) as a “chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar”. Hyperglycemia, or high blood sugar, is a common effect of untreated diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.
In 2011, United Nations members recognized this threat and adopted the Political Declaration on the Prevention and Control of Noncommunicable Diseases -cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases- which aims to address the prevention and control of these diseases. WHO projects that diabetes will be the 7th leading cause of death in 2030, and it is recognized as a major challenge to social and economic development in the 21st Century, having a particular impact in developing countries. More than 80% of diabetes deaths occur in countries of low and middle income, Nicaragua being in that classification.
According to International Diabetes Federation, in 2013 Nicaragua ranked number 43 in a list of countries with higher rates of diabetes. Diabetes Mellitus is one of the main causes of death in the adult population in Nicaragua, having a raw national prevalence of 10.2% and an estimation of 83,000 people with undiagnosed diabetes (aged 20-79).
Seeing the statistics, Project WOO’s Health Program realized the importance of identifying potential type 2 diabetes cases in Gigante, given that hispanic descent and high blood pressure (>140/90 mm Hg) are two major risk factors of this disease.
Through a collaborative effort between Project WOO and Comunidad Connect, the Gigante Community Health Center (GCHC) hosted its first ever “Diabetes Medical Brigade” from the 13th to the 21st of December 2014. The Medical Brigade was composed by students from the University of Kennesaw and the University of Oregon, who received the invaluable support of Gigante’s Youth Club and Community Volunteers, led by the local Committee, as well as technical support and the official approval from the Nicaraguan Ministry of Health (MINSA).
The objective of “Diabetes Week” was to identify community members who may be living with the disease without having a correct diagnosis or treatment. Without the the proper treatment, the main complications of diabetes include renal failure, stroke, myocardial infarction, and blindness. Instead, with early diagnosis and effective management, people with diabetes can live long, healthy, and productive lives.
During three full days, all the participants in Diabetes Week were divided into groups that went throughout Gigante executing door to door surveys, glucose tests and measuring blood pressure to those 18 years and older. Given the importance of nutrition and physical activity in preventing type 2 diabetes, sports events, trainings and nutrition awareness activities were held in addition to the door-to-door screenings. All of these achievements would not have been possible without the help of the students and volunteers who donated their time and skills.
The Health Center staff, under a strict confidentiality policy, analyzed the obtained data, concluding the following: out of 226 screened community members, 30 people were identified at risk of suffering from diabetes, classified by low, medium and high probability depending on their blood glucose level. 80% of these 30 people had no previous history of diabetes or never had a glucose test.
Identifying the potential diabetes cases were important, but success lies in the follow up and treatment strategy. During this last month, Dr Mariana -the GCHC’s doctor in residence-, supported by Maria -the HC’s Administrator and Assistant- have been doing home visits to the identified potential cases, inviting them to the GCHC for a fasting glucose test, a complete physical examination, taking vitals, and considering the risk factors.
After these follow up screenings, if the blood glucose levels are still considered high, the patient is prescribed with a treatment of oral hypoglycemic, which the GCHC’s pharmacy has thanks to some of our many generous donors. When the blood glucose levels are very high and the patient requires insulin treatment, patient information is passed along with their diagnosis and treatment to the Pilas-Coyol Health Center (which depends on MINSA) for the monthly medication withdrawal. The monthly follow ups, and the diabetes education sessions are held at the GCHC.
The Diabetes Week was a complete success, and it highlighted the importance of partnerships and collaborative participation. From the GCHC and Project WOO, we want to thank all of the people involved in the Medical Brigade, especially the students and teachers from the University of Kennesaw and the University of Oregon, who made their way down from the US, to help us in this important cause.