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
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
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
26% of medical wd admissions – DM 18% - complications (direct / indirect)
Hospital admissions & complications
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 …)
Sharp increase in diabetic cases
Poor public awareness
Are we really ready ?
Strategies to counter the challenges
ď Ž
ď Ž
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
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
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
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
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