By Janelle Riley-Thornhill
Millions worldwide are affected by chronic non-communicable diseases (NCDs), including diabetes. Barbados is no exception, with diabetes affecting one in ten individuals and posing a significant health burden. To shed light on this prevalent condition, Diabetes Today had the privilege of sitting down with Dr. Carlisle Goddard, a renowned Endocrinologist, to discuss the nuances of diabetes management and prevention in Barbados.
According to Dr. Goddard, the incidence of diabetes in Barbados is on the rise. While genetics, the prevalence of a Westernised diet, and the lack of exercise are contributing factors, the hidden “black horse” that must engage all our attention, he insists, is ageing. It has been reported that one in four people in Barbados is over 60, and by 2049, the statistic will rise to one in two.
“Barbados has an ageing population, and the older people are, the more at risk they become of developing diabetes. Our pyramid of life shows that we are very much top-heavy with the elderly, and very low on the middle age group and the lower age group, which means that as Barbados continues on this trajectory, we will have far more old people than young people, and the prevalence of non-communicable diseases will be higher.”
Diabetes is a multifaceted disease
With years of experience treating patients with diabetes, Dr. Goddard emphasizes the importance of understanding the disease’s multifaceted nature. The Medical Director of The Endocrine Centre Inc. said that diabetes is more than just about high blood sugar levels; it impacts every aspect of a person’s physical health and mental well-being.
“Diabetes is the number one chronic disease. It is the ultimate cause of death, claiming more lives than COVID and HIV. Diabetes essentially hits every organ in the body. There is a high incidence of kidney failure because of diabetes and hypertension. We have more heart disease, we have more heart attacks and more strokes because of having diabetes. We have foot disorders, increased foot infections, poor arches and callouses, and more vaginal infections in women because of excess sugar in the groin and vaginal secretions, becasue wherever blood flows, sugar will follow,” Dr. Goddard opined.
Too much sugar, not the only culprit
When asked about the most common misconceptions regarding diabetes, Dr. Goddard notes that high on that list is the belief that diabetes is solely caused by sugar intake.
“The standard risk factors, yes, are being overweight, hypertensive, and high cholesterol. Also, having a first-degree relative (parent or sibling) with diabetes and having a sedentary lifestyle; likewise, being over 35 in America and 40 in the Caribbean are all big players. Parallel to that now is obesity in children. Obesity in children is leading to increased pre-diabetes. And if you have kids 9, 10, or 11 with pre-diabetes, their onset of type 2 diabetes will be much earlier now in the Caribbean. So rather than saying people over 40 are at risk of diabetes, you now must change that to say people over 20 are at risk, which doesn’t augur well for the health budget.”
Proper diabetes management is vital
Regarding diabetes management, Dr. Goddard stresses the importance of personalized treatment plans tailored to each patient’s needs. He notes that there is no one-size-fits-all approach to managing diabetes, emphasizing that it is about finding the right balance of medication, diet, exercise, and lifestyle modifications to achieve optimal blood sugar control.
“We can’t fight our genetics or our ageing, but we can definitely fight how much and what we eat, and we can fight diabetes with exercise. People diagnosed with diabetes must drink more water, follow the diet plan, eat smaller amounts, and keep moving. If you have a diagnosis of diabetes, you cannot sit in your office all day because that increases your insulin resistance, your risk of obesity, and your risk of blood clots.”
The Endocrinologist discussed the rise in diabetes cases but also mentioned some positive news regarding diabetic neuropathy. He noted that the efforts to change the perception of Barbados as the amputation capital of the world have been reaping success. However, with both men and women wearing more ill-fitting shoes, they have an increased risk of developing blisters, calluses, and ulcers.
All is not lost
Contrary to popular belief, a diagnosis of diabetes is not a death sentence. People with diabetes can still live long, healthy lives, according to Dr. Goddard. “Yes, the diagnosis will be a challenge, but you can conquer it by digging deep and, as I said, eating better and moving”. He also dismissed the notion that medication is a “ball and chain” that a person diagnosed with diabetes must endure for life.
“Some people believe once you go on the medication, you can’t come off. That’s all lies because if you do what you’re supposed to do, follow the rules and get back in charge, your body goes through a reparatory phase and starts to recover. As your body recovers, the doctor can adjust the medication. But people need to believe and trust in their doctors.”
When asked about the role of technology in diabetes management, Dr. Goddard expresses enthusiasm for recent advancements. “Continuous Glucose Monitors, for instance, have revolutionized how we manage diabetes,” he stated. “These devices provide real-time data and ultimately improve patient outcomes and quality of life. These devices tell you what happens if you decide to eat ten mangoes, or fast for an extended period of time.”
Prevention is key
However, Dr. Goddard is quick to point out that prevention is equally, if not more, critical than management. He notes that type 2 diabetes, in particular, is largely preventable through healthy lifestyle choices. He asserts that regular physical activity, a balanced diet rich in fruits and vegetables, and maintaining a healthy weight can significantly reduce the risk of developing diabetes.
Dr. Goddard has a powerful message for anyone affected by diabetes, whether directly or indirectly. “Living with diabetes may present challenges, but with the right support system, education, and proactive management, individuals with diabetes can lead fulfilling and healthy lives.”
