Are you diabetic?

I have had a few relatives die or suffer from diabetes. My dad’s mum’s two sisters – only an African would say that eh…… Anyway, two of my grandmothers sisters died of diabetes related complications. However, they were all at least 70 years old by the time they passed on. My dad’s brother also suffers from diabetes which because it was detected early, he was able to control before it got out of hand. On my father’s side, it appears that anyone who dares to put on some weight in their mid-life years, suffers from diabetes or dies from it.

 

My father’s side all have rather slender frames – they were not, it appears, designed to take on weight.

 

My mother’s siblings are more broad-bodied and the ladies are almost all apple-shaped – they tend to accumulate weight on their bellies – but they are active and you would not describe any of her siblings as overweight. My mum’s only brother was a big man, smoked those unrefined cigarettes called ‘roosters’ all his life. He died at 80 – from what we suspect to be prostrate cancer. I have not heard of anyone diagnosed with diabetes among my mother’s siblings.

 

So one side of our family have a high diabetes risk and the other does not. I am not telling you anything you didn’t know – that diabetes is very much a heritable disease.

 

However, heredity is not all. There are other things that increase diabetes risk. What are now called ‘lifestyle choices’ – a much misused word – but I shall use it here anyway. How much exercise you do, how healthy your diet is.

 

When you put all these factors into consideration (family illness, exercise or lack of it and diet) – what is the likelihood that you would suffer from diabetes? It is possible to have diabetes for a while and not know. So how would I, for example, know that I am at an increased risk of diabetes?

 

Merck are encouraging the use of an on-line questionnaire to raise diabetes awareness and Alexander Hoffmann, Project Manager at Merck is responsible for coordinating a campaign in Kenya. He is doing this using a website where you can answer a few questions that will help to determine whether you are at increased risk of diabetes and a screening test.

 

http://diabetes.merck-africa.com/

‘You are invited to answer a simple questionnaire in order to calculate their risk of having diabetes. For users with high risk, the website then recommends to do a free blood test at the closest pharmacy. For that purpose I have equipped more than 50 pharmacies in and around Nairobi with glucometers. The website and blood test is completely for free for all users and is accessible from desktop or mobile devices with an internet connection,’ said Mr Hoffmann.

 

The list of pharmacies where you can do a blood test is on the same website

 

‘To raise awareness and achieve a great impact, I already have won several institutions as a partner, like the DMI (http://www.dmi.or.ke/), and am still in discussions with the Ministry of Health. Since the launch of the website in early 2015, already more than 500 online tests have been made,’ he added.

 

I did attempt the questionnaire. I expected some questions on smoking and alcohol consumption which both are considered risk factors for diabetes in the questionnaire and I put the question to Mr Hoffmann.

 

‘We partnered with the researchers who created the Finnish Diabetes Risk Score (FINDRISC). This is known to be the most accurate risk assessment tool and we did not want to change it so we kept it as it was,’ said Mr Hoffmann.

 

Since Merck is a profit making pharmaceutical company, I was a bit suspicious about this generous offer for free screening and testing for diabetes. Was the company losing business in Europe and seeking an African market? So I put the question to Mr Hoffmann….. why the website?
‘Considering that up to 50% of diabetics don’t know they actually have diabetes, this service tries to fill this gap by providing the necessary tools to find out. Regarding the point you are making: we are a for-profit company and are therefore obviously keen on selling our products. However, there are no strings attached to this program – no pharmacist, no doctor and no patient is forced to sell, prescribe or take our medication just because they took part in this program. In the end this program is all about the patient and providing additional services for better detection and diagnosis of the disease,’ said Mr Hoffmann.

 

I asked a physician and clinical scientists Dr Anthony Etyang to comment about the test.

 

‘The site does not appear to work on mobile devices such as phones and tablets which are the main mode of accessing the web in Kenya, thus limiting its reach. Also the recommendation to only go to Merck pharmacies to get tested is not right. First I am unaware of exclusive Merck pharmacies in Kenya and even if they existed they are not the only place to get tested. Advertising gimmicks interfering with what would otherwise be a noble effort,’ said Dr Etyang.

 

Merck would do well to put out more information regarding the test, providing more information for clinicians to feel more confident about advising their patients to use the questionnaire. The questionnaire should also be accessible on any of our local devices so that it has wide coverage.

 

Nevertheless, the test is a super way of getting people to start talking more about diabetes in terms of personal risk and not something out there happening to ‘those’ people. Take the test and see how you perform.

 

When it comes to this slow-onset chronic diseases, there is no better public health option than screening. Breast cancer, prostrate cancer, cervical cancer, high blood pressure and diabetes are just some the main conditions for which adults should get regular testing to ensure that the condition is treated on time before we start to show clinical signs of illness.

 

Unfortunately, screening has not been taken on with as much gusto as other public health intervention like say vaccination or the use of bednets. However, screening can stop many adults from an early death by blocking the progression of the disease and allowing us not just a longer life, but a healthy long life.

 

Just for the nerds
By the way, it would be great if Kenyan researchers partnered with Merck to investigate the predictive value of this screening tool in our populations. It would make for a snazzy masters thesis.