Diabetes, one of the most destructive non-communicable diseases, has been eating away at the structure of Dominica's health and economy for decades but apart from glib talk, we have not been doing much about it.

There are not even available statistics to inform us of how much the disease has eaten into the fabric of our population. For instance, a simple internet search provides a 2016 (five years old) World Health Organisation (WHO) diabetic profile of the country. According to that WHO document, there's no data on the number of diabetes deaths per total population, no operational policy or strategy for diabetes, no plan to reduce overweight or obesity, no plan to decrease the level of inactivity among the population, and no diabetes registry.

In other words, we are sailing on the wide, blue NCD's sea without a map or even a compass- yes, were going but we don't know where we're going. So, the impending tsunami that Dr. Carissa Etienne, the director of the Pan American Health Organisation (PAHO) warned about a few years ago may be here soon, or may already be upon us but we will not know.

On World Diabetes Day, observed worldwide on Sunday, November 14th, the International Diabetes Association (IDA) informed us of some alarming statistics. For example, we now know that diabetes is a silent killer that sends one person to his grave every six seconds.

463 million adults (1-in-11) were living with diabetes in 2019. The number of people living with diabetes is expected to rise to 578 million by 2030. One in two adults with diabetes remains undiagnosed (232 million). The majority have type 2 diabetes. More than three in four people with diabetes live in low and middle-income countries. One in six live births (20 million) is affected by high blood glucose (hyperglycemia) in pregnancy. Two-thirds of people with diabetes live in urban areas and three-quarters are of working age. One in five people with diabetes (136 million) is above 65 years old. Diabetes caused 4.2 million deaths in 2019. Diabetes was responsible for at least $760 billion in health expenditure in 2019 – 10% of the global total spent on healthcare.

But there are more frightening statistics.

Type 1 diabetes, which predominately affects youth, is rising alarmingly worldwide, at a rate of 3% per year. Some 70,000 children are expected to develop Type 1 diabetes annually. On the other hand, Type 2 diabetes is responsible for 90 -95% of diabetes cases and is increasing at frightening rates globally as a result of urbanization, high rates of obesity, sedentary lifestyles, and stress. So the statement that we used in 2011(when we wrote an editorial about diabetes): "I'm diabetic, are you", borrowed from an old Discover Dominica campaign, in some respects is absolutely relevant to the diabetes epidemic.

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 percent of Dominica's population has 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. For instance, as we have mentioned previously, the Sir George Alleyne Commission on Health and Development in CARICOM concluded 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". The commission felt that obesity belongs to a family of chronic diseases which includes diabetes.

Now the current Covid-19 pandemic has seriously complicated the issue of diabetes. According to the American Diabetes Association (ADA) people with diabetes are more likely to have serious complications from COVID-19. In general, people with diabetes are more likely to have more severe symptoms and complications when infected with any virus.

"Your risk of getting very sick from COVID-19 is likely to be lower if your diabetes is well-managed," the ADA said on its website. "Having heart disease or other complications in addition to diabetes could worsen the chance of getting seriously ill from COVID-19, like other viral infections, because more than one condition makes it harder for your body to fight the infection".

So the United Nations have correctly declared that the theme of WDD 2021 should be "Access to Diabetes Care" to highlight the fact that millions of people with diabetes around the world do not have access to diabetes care and that people with diabetes require ongoing care and support to manage their condition and avoid complications. And that insulin and that cost of nutritious food have hit the roof. "We cannot wait any longer for medicine, technologies, support and care to be made available to all people with diabetes that require them," the UN said. "Governments (must) increase investment in diabetes care and prevention".

If not now, when?