by Curlan Campbell
- 14 November is World Diabetes Day
- In Grenada, prevalence of diabetes in adults is as high as 13.3%
- Dr Matthias specialises in treating disorders of endocrine system
Endocrinologist Dr Dwight Matthias is of the view that the constant challenge in the management of both Type 1 and Type 2 diabetes in Grenada has been the lack of a streamlined approach towards treatment by medical physicians.
“We had physicians who were trained in the USA, physicians who were trained in Cuba, physicians who were trained in The University of West Indies, physician who was trained in England and everyone has a different approach to therapy management,” Dr Matthias said.
In Grenada, the prevalence of diabetes in adults is as high as 13.3% which translates to 10,100 adults diagnosed with the condition, according to the International Diabetes Federation. Of the total amount of patients with diabetes statistics show that 7% of patients completed haemoglobin A1C, which is a blood test that measures your average blood sugar levels over the past 3 months.
The Grenadian-born, Virginia-based endocrinologist for the past 13 years, has led no-cost pharmacological interventions in the diagnosis and treatment of hormone-related diseases such as diabetes in Grenada. He continues to return twice a year as part of the St George’s University Physician Humanitarian Network (SGU PHuN) programme to provide diabetes care to the Grenadian public, pro bono.
Dr Matthias, who is affiliated with Sentara CarePlex Hospital in Chesapeake, VA, specialises in treating disorders of the endocrine system, the network of hormone-producing glands in your body, therefore making him most qualified to diagnose and treat conditions like diabetes. He has attributed this lack of a streamlined approach to several reasons, one being the absence of continued medical education.
“It is through evidence-based medicine. It’s through what is published, not hearsay. And that approach is to have CME, continuing medical education, where you give lectures, letting the physicians be aware of what works. I am not saying they don’t know, but if you are trained in a specific area and your thought process or your management skill is towards that skill set. And here you hear that? No, I was not trained that way. This is always to be done. So that’s something that our Medical Association has to establish guidelines in approaching and it’s a major issue,” he explained.
Dr Matthias, in responding to questions regarding the status of diabetes care on the island, also outlined other barriers hindering the management of diabetes. “There are lots of shortfalls in that whole treatment regimen because you have to look at the cost of the drugs. You have to look at the availability of the medication. You have to look at the physician’s inertia, when you see that the physician is not willing to progress with the therapy, you have to look at the patient’s preference for therapy, because patients may prefer to use the local remedy rather than use the evidence-based medicine that we have to treat them. So you have to look at it as a whole. And those are some of the barriers.”
According to the World Health Organisation (WHO) 2022 Progress Monitor, 83% of deaths in Grenada are from NCDs, specifically Type 2 diabetes and hypertension. With the advent of technology streamlining diabetes management globally, Dr Matthias continues to be an advocate for the widespread use of the latest innovation in diabetic treatment, which includes new insulin pumps, infusion devices, continuous glucose monitors (CGM) and smartphone apps.
Global trends predict the rise of digital diabetes monitoring solutions at a compound annual growth rate of 21% by 2027. Sadly, Grenada continues to lag as the options for treatment of people living with Type 1 and Type 2 diabetes remain quite limited, since the close monitoring of blood sugar requires uncomfortable blood draws and needle pricks.
“Do you know that I have patients on the island that use modern technology in diabetes care for Type 1 diabetes? I have 4 patients on the island that are using the Medtronic insulin pump to control their blood [sugar],” he said. “In other words, technology is controlling [their] blood sugar. I have patients on the island who don’t have to prick their fingers to know what their sugars are. The technology reads their blood sugar every minute or 2, and sends it to the iPhone while they eat, while they work.”
“Insulin [medication] I’ve been designed to be patient-focused, lifestyle trying to follow the physiology of the body. Next year we’ll have once-a-week insulin and we have medication now that will control your appetite, delaying the emptying of food in your stomach, so you won’t need as much medication. In other words, we’re going to use precision medicine individualised therapy so you can identify patients early before the disease onset,” Dr Matthias added.
The endocrinologist dispelled certain myths that still exist about patients having to be on medication long-term. He referred to the status of one of his patients, who was able to be taken off insulin after he had undertaken a total lifestyle change. “I have evidence here of lifestyle change, that once you start a lifestyle change, that decreases your carbohydrate intake and increase in the level of physical activity. You stay on insulin because you have not made that lifestyle change or you have a total insulin production deficit. That’s why you’re on insulin. Right. So if you make that lifestyle change, you can be tapered off insulin,” he said.
“I saw a patient today. In August the patient had blood sugars in the 200- 300 range with an HbA1C of 10%. He changed his lifestyle. He came in with a weight of 205 pounds. He’s now 185, and his marker for diabetes went from 10 down to 5.6. That’s a remarkable accomplishment. Our goal is to be less than 6.5. He changed his life. He decreased his carbs, and he jogs 3 miles a week and has been able to get off his insulin and pills. But you must be monitoring your blood sugar.”
“Oftentimes patients don’t monitor so they don’t know, for example, what is my blood sugar before I eat? What is my blood sugar after I eat? Before you eat the meal? Let’s say the range of 79 to 110 mg/dL, 2 hours after you eat, you should be less than 140 mg/dL but if 2 hours after you eat your sugar is 200-300 and you are on medication then you know you overate. It’s not saying the medication is not working, it’s your portion of carbs is too much or the kind of carbs that you are eating. If you take your insulin before you eat, you eat and within an hour you drop, don’t say that you ate too little, say that the Insulin is too much, that is why the sugar dropped,” he explained.
The invaluable contribution of Dr Matthias towards diabetes care in Grenada did not go unnoticed by the Grenada Diabetes Association. He was awarded a plaque for introducing modern techniques towards strengthening the prevention, diagnosis, and treatment of diabetes.
World Diabetes Day is commemorated on 14 November each year and it is an opportunity to raise awareness about the impact of diabetes on the health sector and the lives of individuals diagnosed.
I too applaud Dr Matthias for giving back to Grenada. If we all could give just a little it would make a huge difference. The powers that be, in Grenada, must also be willing to facilitate those that are wanting to help. Create avenues which would make it easier. Grenada has lots of expatriates who have a wealth of knowledge and skills. Hopefully many more are willing to volunteer their expertise. Grenada needs to pave the way to make that happen. There is a lot of misinformation circulating about why more cannot be done. Hopefully this new government would pave the way for greater collaboration and action.
I commend Dr. Matthias on the invaluable service he has provided to our people without the prohibitive costs that can deter many in seeking help. I applaud him and his team for the ongoing care that has been made available to our population. This is a most dangerous disease and an all hands on board approach is needed to decrease complications and early death.