Clinical aspects in medicine

Dealing with Diabetes – experiences from war torn Jaffna By: Dr. S. Sivansuthan

Silent killer & a major cause of disability

Sharp increase in diabetic cases observed in Jaffna

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Sharp increase in diabetic cases observed in jaffna 

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Consumption of cheap energy dense food ( CHO ) Lack of physical activity & exercise.

Aging population / more people at the stage where they get DM ? stress

DM in jaffna    

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JTH JTH PGH Private

Adults Children Adults A&C

Defaulted treatment Undiagnosed cases

6946 + 842 11 1907 7000 - 9000

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Hospital admissions & complications ď Ž ď Ž

128 amputations - 2006 557 surgical management for DM wounds - 2006

Hospital admissions & complications 

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26% of medical wd admissions – DM 18% - complications (direct / indirect)

Hospital admissions & complications

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104 laser treatment - 2006 63 diabetic nephropathy with CRF ACS  85 – 95 / month. 26 % of the pts are diabetic

Challenges     

Shortage of staff Lack of lab facilities at hospital Shortage of equipments Shortage of medicines Cost factor ( lipid profile, HbA1c, urine for microalbuminuria, statins pios …)

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Sharp increase in diabetic cases

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Poor public awareness

Are we really ready ?

Strategies to counter the challenges

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Documentaries, audio visual cds Getting medical students help

Strategies to counter the challenges

Strategies to counter the challenges Training of staff

Strategies to counter the challenges Special clinic book introduced for DM

Present situation at the medical clinic

1000 - 1100 pt / day ( including DM ), Rev by 7 Doctors X 8 hours ďƒ¨ 2 – 3 min / pt Difficult to give proper care and advice to diabetic Pts.

Measures to be adopted Plan for diabetic centre

Ministry of Health - Floor space modification – .

SL Rs. 2.9 million - Basic equipments and materials – ? SL Rs. 2.1 million

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DIABETIC CEHTRE,TEACHING HOSPITAL JAFFNA

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Measures to be adopted 9.3 W1

Activities of diabetic centre Patient assessment, looking for micro & macro vascular complications, foot examination, BMI, waist hip circumferences.

Eye examination & retinal photography

Activities of diabetic centre 

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Assessment of diabetic control FBS, PPBS & HbA1c Carrying out other special investigations - Lipid profile, Urine micro albumin ..

Providing appropriate advice to patients & family

Activities of diabetic centre 

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Providing suggestions & recommendations to the relevant medical teams Referring to other sub specialties if necessary Follow up after 3/6/12 months depending on patient condition Maintaining a database consisting all necessary information regarding the patients

Expected Outcome 

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Improvement in the care of DM Pt & Minimized / prevented complications.

Early detection of complications & better care to Pts with diabetic complications.

Reduction in hospital admissions Enhanced public awareness, better compliance & early detection of DM Reduction in morbidity & mortality Facilitation of future studies

Conclusion  

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Moral and financial support of IMHO Contribution and allocation from ministry of health Dedicated service of our staff

Establishment of a model diabetic centre in Sri Lanka 