Diabetes and other chronic conditions are a growing public health problem in the Caribbean. IDF currently estimates the diabetes prevalence to range from a low of 5.9% in Anguilla to a high of 11.4% in Trinidad and Tobago. It is unclear how many children and young adults have diabetes, however, it is clear that both type 1 and type 2 diabetes are on an increase.Diabetes manifests itself differently in children than in adults, and the implications are different. It is therefore crucial to provide management, care and support tailored specifically to the needs of children and young adults. Currently, there are no culturally specific guidelines on the management of children with diabetes in the Caribbean.The aim of the project is to improve the treatment and wellbeing of children and youth living with type 1 or type 2 diabetes by providing quality standards of care and support, locally and regionally in the Caribbean.
The project is a pilot project to be implemented in Jamaica, Belize and St. Lucia. It is envisioned to be rolled out to the rest of the Caribbean region. The project is a collaboration between diabetes associations and ministries of health in the three countries.The project consists of four main components:1. Development of a registry of children and youth living with diabetes in the Caribbean region2. HbA1C monitoring of the children3. Development and implementation of protocols for the management of diabetes in children4. Formation of peer and family support groups and youth camps1. The first phase of the project involves the development of a registry of children with diabetes. Demographic and biomedical indicators of children with both type 1 and type 2 diabetes will be recorded. The purpose is twofold: Firstly, the registry will serve as a database for keeping track of the diabetes status of children in the three pilot countries and later in the entire Caribbean. Secondly, the registry will constitute a monitoring tool that will ensure continued follow up of the children, which will help improve disease management significantly.The registries will be handled by the diabetes associations and young people with diabetes will be recruited to the registry using data obtained from hospitals, different outpatient clinics, general practitioners and prescriptions from major hospital pharmacies.2. Initially, the diabetes associations of the pilot countries will be equipped to perform HbA1C monitoring of children with diabetes which will be recorded in the registry. The diabetes associations will perform outreach activities to fulfil this task. Subsequently, it is envisioned that HbA1C monitoring will take place in all the countries of the Caribbean. A nominal fee will be charged for the testing and exceptions will be made for poor children.3. It is essential that a uniform protocol unique to children, adolescents and young adults is developed since children require different care and support than adults.Initially, current practices with regard to diabetes management in children will be reviewed by a team of experts who will produce a culturally appropriate policy document specific to children. The screening guide issued by the Life for a Child programme will be used as inspiration. The experts will consist of representatives from ministries of health, endocrinologists, paediatricians and nutritionists. Initially, the protocols will be implemented in the three pilot countries, but they will gradually be disseminated to the remaining 18 countries of the region.Educational campaigns will be conducted with the purpose of sensitisation of all health care workers involved in the management of diabetes in children. In addition, quarterly workshops will be held with health care workers to provide them with the opportunity to provide input into the newly implemented guidelines and to review the effectiveness of the registry. Around 100 health care professionals of the pilot countries will be trained on the implementation of the protocols.4. During the first four months of the project focus group discussions will be conducted with patients, their families and health care workers to assess the needs of children with diabetes.The diabetes associations of the pilot countries will initiate the formation and assist in the monitoring of community support groups during their outreach activities. The support groups carry a dual purpose: firstly, to provide education and information about management of diabetes which will be guided by nutritionists and pharmacists. Secondly, create a platform for children with diabetes and their families to share experiences, difficulties and achievements with peers.Annual youth camps will be held without parent involvement. The purpose is for the children and youth to gain independence in the management of their disease while engaging in activities such as sports, educational games etc. Past participants of the camps will provide peer counselling. Furthermore, the children will do income-generating activities at the camps to generate revenue for the support groups and for the diabetes associations to ensure the sustainability of the camps after project completion. The camps will be free of charge for children with no ability to pay camp fees or transportation.
- Development of a register of youth with diabetes, 1159 youth registered- Development of standardized protocols for management of diabetes in youth- Over 250 health care professionals have been trained on the use of the guidelines- Focus groups conducted before and after the project- 20 Support groups created and sustained- Formation of youth camps for children with diabetes- Culturally appropriate pocket guidelines developed and distributed in 14 Caribbean countries