Diabetes stats in territory show a frightening future for our children
Despite the lack of a local diabetes registry and ‘lack of sufficient data’ on the problem of diabetes in American Samoa, physicians and other health care providers continue to push for prevention efforts because statistics that are on hand have revealed that diabetes is so prevalent in the territory — and prevention should be the major local push.
Diabetes was a priority issue discussed at last Saturday’s inaugural Medical Symposium, which was hosted jointly by the LBJ Medical Center and the Department of Health with the goal to combat non-communicable diseases in American Samoa.
DIABETES EYE COMPLICATION
Among the presenters of the morning session on ‘Non-Communicable Disease focusing on Diabetes Type II’, was Dr. Ernest T. Oo, chief of the Ophthalmology Department at LBJ hospital.
He said there are 4,300 known cases of diabetes in the territory and suspects that there is about the same number who are diabetic, but undetected.
The doctor also said that about 40% of the adult population has diabetes, adding that most of the diabetic retinopathy patients were 45-50 years of age. Additionally, severe forms of diabetic retinopathy were detected among the newly diagnosed cases.
Dr. Oo highly recommended early screening for diabetes, adding that LBJ has worked in close collaboration over the years with the Lions Club Eye Care project, which provides screening that has proven effective in terms of early detection and early intervention.
He said diabetes is the major cause of blindness in the territory and pointed out that when he first arrived on island in 2001, there were about three cases of blindness at the time but that has changed to “zero” today due to early screening, which includes the work done by the Lions Club, with their Eye Care project.
Dr. O’o noted that among the challenges faced by American Samoa in addressing this problem is “we have no finances. That’s why we get assistance” from non-government organizations, like Lions Club and Rotary Club.
He also pointed out that another problem “is the fragmentation of services. Everywhere service is fragmented. We do not have a coherent, cooperative, same tone, same policy… we need to organize” and urged everyone to work together, such as DOH, LBJ, NGOs and anyone else who wants to join in.
DIABETIC FOOT INFECTION
According to written information provided at the symposium, foot infections are the most common problems in persons with diabetes and diabetics are predisposed to foot infection because of a compromised vascular supply secondary to diabetes.
It also says that LBJ data shows that about 20% to 30% of the work load by general surgeons at LBJ is dealing with diabetic foot infections and these have not seemed to change from the past two years.
As the number of diabetics in the territory increases, so will the complications, and the effort to reduce these complications should begin at the primary care level with education and community awareness and continued good diabetes control at the secondary level.
Dr. Kamlesh Kumar, chief of surgery for LBJ, said that national discharge data from 2006 put out by the Center for Disease Control and Prevention shows that the average length stay of a patient, who has ulcer and infection with diabetes is 60% longer than those without diabetes.
“Another alarming figure is 7% to 20% of the patients with a foot infection, actually end up getting an imputation — one of the major amputations — either below the knee or above the knee,” he told the audience.
He went on to explain that LBJ data for 2011 to 2013, shows that 60% of patients who actually stay for more than 14 days, were there because they had a diabetic foot infection. Additionally, LBJ data shows that about 15% of admission by general surgeons in 2011 to the surgical unit was due to diabetic foot infection.
However, in 2012 it was about 25% as well as in 2013, Dr. Kumar said and pointed out that as of last Friday, there were 18 patients in the surgical unit and 12 of them were related to diabetic food infection. He said it costs hundreds of thousands of dollars to treat these patients annually.
END STAGE RENAL DISEASE
LBJ’s vice-chief of surgery Dr. Robert Gayapa said there are 132 hemodialysis patents for the hospital, and “this is such a big number for a small population” with a gender ratio at 1:1 male to female ratio.
Patients ages range from 11 years old to 88 years old with most of the patient’s age between 51-60 years old (or 43%), he said and emphasized that the youngest patient is 11 years old.
Of these total number of patients, 75% are with diabetes alone, 42% with diabetes and hypertension, and 32% are with diabetes, hypertension and gout.
“We have an average of five to six new patients joining dialysis everyday and and we have pre dialysis patients waiting to start on their dialysis,” he said.
Among the problems faced by surgeons is that “we don’t have equipment” and have to borrow from another LBJ department. He also said the hospital needs a vascular surgeon because LBJ does not have one.
Dr. Faiese Roby with DOH said the main message to concentrate on — which is the DOH message — is: “prevention, prevention, prevention.” She added, “I think that’s the only thing that we have to do, to tackle these kinds of problems that we have. NCDs is quite a big problem in American Samoa.”
She also agreed with other physicians’ calls for tackling this issue with pre-diabetic patients, saying “we should concentrate on those people — pre-diabetes patients — our children, the youth and that is where we should concentrate on.”
“So we should concentrate on pre diabetes patients, bring this community in and we work on them. Prevent them from going into diabetes,” she said.
It was suggested by one of the attendees that the presentation during the symposium be made at the beginning of every school year to every school in the territory because the statistics “are really frightening” and “if you can make young people understand what might be ahead for them, if they don’t follow proper diet and exercise, it may make an impact, because I think those statistics are startling.”
Samoa News will continue to report on Saturday’s inaugural Medical Symposium throughout the week, highlighting key areas covered.