World diabetes day was created in 1991 by the International Diabetes Federation and the World Health Organization in response to growing concerns about the escalating health threat that diabetes poses. Diabetes which affects mostly the low and middle income families has reached epidemic levels in almost all developing countries such as India and China.

Mauritius ranks among the countries with the highest prevalence of diabetes. The government of Mauritius along with the ministry of Health has made great efforts to reduce the prevalence and death from diabetes. However for the past thirty years there has not been any signifi cant improvement.

At 5 yearly intervals, with the help of diabetologists from various continents, reports of surveys have been published to help understand the prevalence and associated risk factors of diabetes which includes obesity, high level of fats in the blood, life’s style including diet and exercise habits. Various committees, sub-committees and new non communicable disease clinics have been established. However the expected improvements have not ensued, as shown by official figures in the statistical report of the ministry of Health.

In brief, diabetes is a chronic illness affecting all age groups - though mostly the middle aged ones. Caused by a lack of insulin or a resistance to its actions, there are basically two types of diabetes: Type 1 and Type 2. The former affects mostly the young ones who will need a daily injection of insulin and the latter affects the older age group. The type 2 diabetes can be prevented in obese patients by weight reduction and increase in physical activities. The treatment consists of having a good diet or a combination of diet with oral tablets or a combination of the latter with insulin.

Poorly controlled diabetes can lead to serious and dramatic consequences, especially when the brain, heart, kidneys and eyes are affected. Treating these complications is very costly. During the past fifteen years, there has been a constant rise in the number of patients with chronic renal failure, reaching a staggering number of over 1000 patients in 2013. Over 60 % of these patients with chronic renal failure result from poorly controlled diabetes.

Patients with chronic renal failure undergo palliative treatment with thrice weekly dialysis in both government hospitals and private clinics, costing over one hundred million rupees of tax payers’ money every year.

The government of Mauritius and the ministry of Health ought to consider providing glucometers and subsidized clinistix (reagent strips used to test glucose in urine) to all diabetic patients. In the long term, there will be great economic benefi ts to the country and a reduction in the huge costs to treat the complications.

Given the persisting and dramatic situation as regard to diabetes and cardiovascular diseases, there is no place for complacency. Our approach in the management of diabetes need a new strategy as the previous one has not been successful.

COMPLIANCE AND INVOLVEMENT

The following approach should be envisaged as health education does not seem to produce expected outcomes. Hence there is a need to review our approach towards a more effective health education and communication. Compliance and involvement of the patient to control his illness is more than a necessity and should be stressed. Dietary habits which have been inherited through generations will prove difficult to be modified in the first instance. Each individual patient is a unique case - as it involves his level of education, the socio-economic conditions and his family environment.

Most Mauritian patients are unwilling to have injections and more so when it has to be administered more than once daily. However when there is a precious and priceless reward - as is the case with diabetic pregnant patients, there is more than a willingness to do so. Therefore with mild but firm assertion, one must inform patients of the tragic consequences resulting in poorly controlled diabetes - namely loss of vision, heart diseases, damage to the brain resulting in paralysis of the limbs, kidney failure and poor blood circulation ending in amputation of the limbs. There is a need to encourage treating doctors to transmit the right information to their patients.

Elimination of symptoms indicating poor control should be easy and accessible criteria to be used by the patient himself. Provision of free glucometers will prove a further boost and an incentive to patients. Patients predisposed to developing diabetes, such as a family history, increased weight at birth, should be identified and closely monitored.

In conclusion, I have enumerated a few concepts regarding a new strategy. Diabetes accounts for more than 50% of deaths in Mauritius and reducing the mortality rate should be the main concern of Health providers.