The global burden of diabetes
A royal handshake for Prof. Chandrika Wijeyaratne from Princess Benedikte
It was a high-level advocacy breakfast meeting on Gestational Diabetes Mellitus (GDM) in Copenhagen graced by none other than Princess Benedikte, younger sister of the reigning Queen of Denmark, Margrethe II, on May 17.
Titled ‘Women and Diabetes: Breaking the Chain for Future Generations through Investment in Women’s Health’ and organised by the World Diabetes Foundation (WDF) and Women Deliver, the meeting addressed the global burden of diabetes and its impact through a maternal and child health perspective; discussed hyperglycaemia in pregnancy and the new guidelines from the International Federation of Gynaecology and Obstetrics (FIGO) for its detection and treatment; highlighted how the WDF works with local partners to improve the quality and delivery of diabetes prevention and care services; and explored opportunities to raise awareness about hyperglycaemia in pregnancy and advocate for the integration of prevention, screening and care into maternal and child health services.
The three-member panel featured the Professor in Reproductive Medicine, Faculty of Medicine, University of Colombo, Prof. Chandrika Wijeyaratne from Sri Lanka; WDF Board Chairman, Dr. Anil Kapur; and WDF Managing Director Dr. Anders Dejgaard. The moderator was the Director of Policy and Advocacy at Women Deliver, Susan Papp. The Patron of WDF is Princess Benedikte.
It was as ‘A voice from the field’ that Prof. Wijeyaratne explored how diabetes affects female health rights and the wellbeing of children and families and highlighted the challenges that women living with chronic diseases in developing countries face, including stigmatization and barriers to healthy food and exercise.
“Women in developing countries are vulnerable,” she said, stressing that “we need to do a lot of work in both the health and non-health sectors.” The central role in the family – as cooks, care-givers and mothers – make women the key to the health of entire societies. “Empowering women is an investment in the health of nations.”
Explaining that the state-driven mother and child health (MCH) service in Sri Lanka has an excellent track record in tackling maternal and neonatal mortality, Prof. Wijeyaratne pointed out that the country has taken note of GDM (defined as any degree of glucose intolerance with onset or first recognition during pregnancy). So Sri Lanka has a huge potential as a pioneer driver in South Asia. The NIROGI Maatha Project of the Sri Lanka Medical Association, launched in 2009 with funding from WDF, which has focused on this aspect in conjunction with the Family Health Bureau has achieved some things thus far. However, there is a need to strengthen primary care focus as a core ingredient for the control and prevention of GDM across generations.
Referring to advocacy within the health sector, she said that the NIROGI Maatha Project engaged with policymakers and planners in health with “quite a satisfactory response” in terms of pragmatic planning for universal screening for GDM through the existing service for MCH. Advocacy in the non-health sector, however, requires a much greater leadership, with an overarching outreach to sectors in education, youth affairs, planning & finance, agriculture & food, sports, women’s groups and the media.
With regard to major gaps and missed opportunities in advocacy currently around GDM, Prof. Wijeyaratne pointed out that in the light of high literacy among women in Sri Lanka, a stronger integration between policymakers in the health and education sectors could overcome much of the lifestyle issues of non-communicable diseases (NCDs) chiefly obesity and metabolic risks by creating a greater awareness and societal response. “Sri Lanka has an in-built strength in safe motherhood but the diabetes/GDM related aspects of safe motherhood have not yet permeated adequately.
Reiterating that there is much potential at primary care level and grassroots level to stem the tide of the diabetes and cardiovascular disease (CVD) epidemic, she underscored the fact that it can be achieved at little cost through greater awareness on behavioural modifications for a healthy lifestyle. The agents of change who have been missing, in stemming this epidemic, according to Prof. Wijeyaratne are schoolgirls and young pre-marital women and men with a sound understanding that health is their right and ownership. In the educational sector, the messengers should be teachers, parents and children with the beneficiaries being the public. The advocacy tools which could be used to target the wider community would be the media — print, electronic and social/mobile networks.
When asked about major barriers to universal screening for GDM in Sri Lanka, Prof. Wijeyaratne saw no issues as more than 95% of pregnant women booked an antenatal checkup in the first trimester, as a rule of thumb. This was the ideal timing for screening for missed pre-pregnancy diabetes/pre-diabetes. The Family Health Bureau, the official pivotal point for this free service, is convinced and committed.
To overcome barriers in treatment and improved access, Prof. Wijeyaratne urged the empowerment of the affected women and their families to achieve good outcomes through diet and physical activity, without falling victim to societal impacts such as unhealthy advertisements and cultural myths and misconceptions. “We need to empower the allied health system nurses, field-level midwives along with basic medical doctors at primary care to think and work along the same lines to benefit the mothers and their offspring. The public also needs to be convinced that diabetes is a life-long threat that can be prevented and controlled. Even presumably healthy-looking mothers and babies have to subject themselves to risk assessment at least annually, with the perception that this is their best life insurance.
She explained that the approaches in advocacy and communication should avoid medicalising the issue. The start should be addressing the current epidemics of diabetes and CVD at an early age and how it can be prevented among children and the next generation.
The breakfast meeting, attended by about 150, was sponsored by the WDF during the three-day 4th Global Women Deliver Conference held from May 17-19. The WDF’s message to the conference was simple – to stop diabetes, the world must invest in maternal health. Women Deliver is a leading global advocate for girls’ and women’s health, rights and wellbeing.