1. Diabetes in Trinidad and Tobago HEU, Centre for Health Economics November 15 th, 2011

2. Prevalence Data Different sources show prevalence of diabetes in Trinidad and Tobago at between 102,000 – 145,000. Official figures: Of 1.3 million people, an estimated 143,000 persons (13%) have diabetes. 2 Source (next few slides) Kenwyn Nicholls, M.D., M.P.H., “The Diabetes Epidemic In Trinidad & Tobago”A Report for the Ministry of Health, 2010

3. Some Key Facts (1) A growing concern that the average age of diabetic patients is falling – more and more younger persons are being diagnosed with Type 2 diabetes. 1,000 new cases were diagnosed in persons aged 20 years or older in 2007. For 2008 more than 450 children in T&T were diagnosed with Type 1 diabetes. 3

4. Key Facts(2) Policy makers are aware that T&T has one of the highest prevalence of diabetes in the Western Hemisphere. PAHO data for 2007 showed: ▫Barbados – 16.4% ▫Trinidad and Tobago – 12.7% ▫Jamaica – 12.6% ▫USA – 9.3% ▫Brazil – 7.6% 4

5. A Very Serious Disease One in four hospital admissions is attributed to diabetes and diabetes was the second most common cause of death listed in Trinidad and Tobago (2007). Partly because of the complications it causes, diabetes is very likely to be underreported as a cause of death. It is known that diabetes is the leading cause of blindness in Trinidad and Tobago. In 2010 diabetes was the cause of more than 450 non- traumatic lower limb amputations. 5

6. Diabetic Foot Problems Foot problems account for approximately 14% of admissions and 29% of bed occupancy at public hospitals. 50% of persons who have lower limb amputations go into depression and 20% die within two years. One worry here is that there is a high rate of conversion from simpler amputations to more complex ones – a clear need for better disease management 6

7. Link with Dental Disease The link between diabetes and Dental Disease is not well documented in Trinidad and Tobago. It is known that among young adults, those with diabetes have about twice the risk of periodontal disease. Almost one third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5mm or more. 7

8. Economic Burden of Diabetes in T&T There is no question that the economic burden of diabetes in Trinidad and Tobago is likely to be very significant. Extrapolating from International Diabetes Federation (IDF) 2007 estimate health expenditure in Trinidad and Tobago for diabetes is currently close to $US50 million. This means that spending on each diabetic is about $350, or just over 2% of the country’s per capita income. Since this excludes data on personal expenditure by individuals or households, this is clearly an underestimate of national spending 8

9. Estimates of Economic Burden A 2009 study by Abdulkadri, Cunningham- Myrie and Forrester using data for 2001. 9

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11. Ongoing Research At the present there is an ongoing research effort to estimate the economic impact of diabetes and other chronic diseases. Prevalence data as well as data on treatment and prevention costs are being pulled together. The research is a joint effort between a Faculty of Medicine team led by Prof Surujpaul Teelucksingh and an HEU, Centre for Health Economics team led by Prof. Karl Theodore. Results from this work will begin to flow from about mid 2012. 11