When Dr. Carissa Etienne, the director of the Pan American Health Organisation (PAHO) warned a few years ago that Dominica is being seriously threatened by a tsunami of non-communicable diseases, like diabetes, she had not anticipated the catastrophic arrival of the coronavirus at the beginning of 2020. Not in her wildest dreams.

With the existence and rapid spread of COVID-19 in Dominica and all over the world, Dr. Etienne's forecast has assumed frightening dimensions because COVID-19, the respiratory disease caused by the new coronavirus, is deadly and even deadlier to victims of COVID-19 with underlying health conditions such as cancer, high blood pressure, asthma and diabetes.

Said the medical journal, the Lancet, in an article in October 2020 entitled "COVID-19 and diabetes: a co-conspiracy?":

"Patients with diabetes have been in the spotlight since the early stages of the pandemic, as growing epidemiological data have revealed they are at higher risk of severe clinical outcomes of COVID-19".

Lancet added: "In light of these findings, several diabetes federations around the world have issued statements and provided resources to help patients with diabetes to better understand their risk of COVID-19 and how to more efficiently manage their condition."

That's where nurses and doctors come in, especially nurses who are the focus of World Diabetes Day (WDD) in 2020, WDD promotional literature states.

The theme of WDD 2020 is "The Nurse and Diabetes". The campaign aims to raise awareness around the crucial role that nurses play in supporting people living with diabetes. According to the World Health Organization (WHO) Nurses accounts for 59% of health professionals. The global nursing workforce is 27.9 million, of which 19.3 million are professional nurses. The global shortage of nurses in 2018 was 5.9 million. 89% of that shortage is concentrated in low- and middle-income countries. The number of nurses trained and employed needs to grow by 8% a year to overcome alarming shortfalls in the profession by 2030.

WHO estimates that the total investment required to achieve the targets outlined in the Social Development Goals (SDGs) by 2030 stand at 3.9 trillion USD – 40% of which should be dedicated to remunerating the health workforce.

As a highly valued member of the community, nurses do outstanding work to support people living with a wide range of health concerns. People who either live with diabetes or are at risk of developing the condition need their support too.

People living with diabetes face a number of challenges, and education is vital to equip nurses with the skills to support them.

As the number of people with diabetes continues to rise across the world, the role of nurses and other health professional support staff is becoming increasingly important in managing the impact of the condition. Nurses are often the first and sometimes only health professional that a person interacts with and so the quality of their initial assessment, care and treatment is vital.

On WDD, to be observed here on November 14th, the International Diabetes Association (IDA) is to make us aware of some alarming statistics. For example, we now know that diabetes is a silent killer that sends six persons to their graves every minute. COVID-19 has made that problem more acute.

Here are the alarming statistics on the world-wide problem. In 2019, approximately 463 million adults (20-79 years) were living with diabetes; by 2045 this will rise to 700 million. The proportion of people with type 2 diabetes is increasing in most countries and 79% of adults with diabetes were living in low- and middle-income countries. One in 5 of the people who are above 65 years old have diabetes; one in two (232 million) people with diabetes were undiagnosed; Diabetes caused 4.2 million deaths; Diabetes caused at least USD 760 billion dollars in health expenditure in 2019 – 10% of total spending on adults; More than 1.1 million children and adolescents are living with type 1 diabetes; More than 20 million live births (1 in 6 live births) are affected by diabetes during pregnancy; 374 million people are at increased risk of developing type 2 diabetes.

The facts show that in many countries in Asia, the Middle East, Oceania and the Caribbean, diabetes affects up to 20% of the adult population. These countries bear the brunt of the major increase in diabetes prevalence but also the burden of the costs. Indigenous populations face genocide because of their high genetic predisposition for Type 2 diabetes. The IDA estimates that 11.5 per cent of Dominica's population have been affected by diabetes, a chronic disease marked by elevated blood glucose levels.

Though the Caribbean has generally taken the diabetes epidemic quite lightly, health officials have persistently warned of the problem. And the cost of managing diabetes could be too much for a country that's waking up from the most severe effects of climate change. An analysis by the World Health Organisation (WHO) in 2003 indicated that countries of Latin America and the Caribbean spent US$3 billion (US$ 353 per person) per year on the management and control of diabetes. Direct costs were higher: US$10.7 billion or $701 per person.

Obesity, the major cause of diabetes, is the challenge that all Caribbean countries have to overcome. Undoubtedly, that the problem of obesity in the Caribbean poses "a major threat" to the economic survival of the region and that efforts at curtailing this problem must be pursued "with vigor".

As a result of the scale of the problem, no single government or region is equipped to tackle it and countries with the least resources are expected to bear the brunt of the increase in diabetes cases including the burden of the associated costs. The humanitarian, social and economic costs are immense. But there is hope in this environment of gloom.

We have the knowledge to tackle the diabetes epidemic and reduce the suffering and deaths. All we need is the will to tackle diabetes head-on.