A leading endocrinologist at the Queen Elizabeth Hospital has described diabetes as a “scourge that is plaguing our nation”, crippling the healthcare system.
With nearly half of the hospital’s patients admitted due to diabetes-related complications, Dr Michael Krimholtz, painted a dire picture of a national crisis exacerbated by unhealthy lifestyles and economic constraints. Despite the challenges, he advocated for simple yet effective lifestyle changes and improved access to medication to combat the disease.
Speaking on the hospital’s Pulse Radio Show, Dr Krimholtz described the situation as a national crisis, emphasising that most of these hospitalisations are due to unhealthy eating habits and sedentary lifestyles, which could be prevented with better choices.
He said: “Last time we counted, which was about ten years ago, we published a paper showing that between a third and half of the patients in the hospital were there for diabetes. The vast majority of those were there for complications related to diabetic foot. All of this should never be in a hospital. Diabetes should be managed and can be managed outside of hospital. So when it’s dominating our workload as an inpatient speciality, which is the most expensive way to treat people, they say $1 500 a day to be an inpatient, and patients are spending weeks and even months there with complications.
He pointed to diabetic foot and kidney disease, and other associated problems with diabetes, such as strokes and heart attacks, and even heart failure, causing the hospital to be past capacity.
“Diabetes should be managed in outpatient clinics and primary care, but instead, it is dominating our hospital workload,” he said.
Dr Krimholtz, a consultant at the QEH for 21 years, recalled that there was no structured diabetes service at the hospital when he first arrived. He established the programme from scratch, training a dedicated team—including diabetes specialist nurse Deborah Knight—to provide care for patients.
Nurse Knight, who works closely with diabetes patients at the outpatient clinic, stressed that a major challenge in controlling the disease is behaviour change. She said: “A lot of people tend not to listen, and that’s why they end up back at your doors, apologising for not following the regimen.”
Both specialists acknowledged that while lifestyle modification is crucial, economic and social factors often make it difficult for patients to adopt healthier habits.
Dr Krimholtz said: “So when we tell them to eat healthy, we have to look at that from the perspective that healthy incorporates not only diet and exercise but also other variables that prevent them from getting there. If you can’t afford to pay your bill, if you can’t afford to pay your rent, how can you then think about eating healthy? If you can’t afford to send your child to school, how can you think about eating healthy?”
Despite these challenges, he insisted that simple changes could significantly reduce the burden of diabetes.
The endocrinologist stressed the need for patients to take their medication regularly and the role of diet in managing diabetes.
“Take your medication. It works. It’s been proven in huge clinical studies with tens of thousands of people, and it’s embarrassing how many people we see who, for one reason or another, are not taking their medication. Yes, you feel well, and we’re asking you to take medications which may very well have side effects, to take them on a regular basis to stop you getting unwell,” urged Dr Krimholtz.
He acknowledged the difficulties associated with accessing affordable medication and presented some solutions that could soon benefit patients who visit the hospital to access their medication.
“There are mechanisms, but nobody uses them. They do exist; if I start a medication, it can be continued in the polyclinic using a system called the Category B drug. Nobody I know can remember the last time a Category B drug was dispensed in polyclinics. But I am working with the pharmacy at the hospital to see if we can reinvigorate that process so you don’t have to be coming to hospital for your medications because that’s wrong.”
He added: “If we start medication, you should be able to get it at any public clinic. And most of the medicines we use, let’s be honest, are widely available and inexpensive.”
He also recommends dietary changes that include reducing meat intake, increasing beans and pulses, and avoiding ultra-processed foods. He also suggests walking for at least ten minutes a day.
Dr Krimholtz said: “Meat is our highest form of calories. It’s also where we get our cholesterol from. It’s also the most expensive thing we eat. And if you just want to add an extra one, it’s the most environmentally unfriendly food that we eat. Get your calories from vegetables. Get your proteins from beans and pulses. You’ve got no cholesterol. You save money, you save the planet, and you get better yourself. It’s a win-win.”
He challenged Barbadians to use ground provisions instead of purchasing expensive foods labelled as healthy: “Get your vegetables, go to your local market. You don’t even need to go to the supermarket. You’ll get fresh, well-priced, affordable produce. I really encourage you to do that. I don’t agree with that statement that it (healthy food) is more expensive.
“Walk more. It’s not that hard. You’d be amazed how little exercise you need to do to keep yourself out of the clutches of people like Deborah and me. A 10-minute walk every day can literally halve your chance of getting diabetes if you have pre-diabetes.”
Both Dr Krimholtz and Nurse Knight reiterated the importance of being proactive about managing diabetes. “We want to help you win the battle against diabetes,” Dr Krimholtz said. “But we need you to listen and make these changes.”
(LG)
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