Diabetes Screening 1st Edition @Kariba

Diabetes is a highly prevalent health condition in the aging population. An estimated number of 537 million adults aged 20–79 years are currently living with diabetes and an estimated number of 240 million people are living with undiagnosed diabetes worldwide, meaning almost one-in-two adults with diabetes are unaware they have the condition, as was suggested by the 10^th edition, IDF Atlas 2021. Worse off, the African Region has the highest proportion of undiagnosed diabetes at 53.6%, as compared to the other six Regions of the International Diabetes Federation, and the number of people with diabetes in the IDF Africa Region is expected to increase by 129% by 2045, the highest predicted increase of all regions.

It should be noted that diabetes management in older adults requires regular assessment of medical, psychological, functional, and social domains. Furthermore, older adults with diabetes have higher rates of premature death, functional disability, accelerated muscle loss, and coexisting illnesses, such as hypertension, coronary heart disease, and stroke, than those without diabetes, as was postulated by the American Diabetes Federation, 2022. Diabetes screening is thus crucial in that it promotes, but is not limited to the following:

• Early detection of T2DM is likely associated with better outcome(s);
• Early screening provides an initial step to identifying racial and ethnic disparities that exist in the prevalence of undiagnosed diabetes so that they can begin to be addressed.

Hence this free Diabetes screening programme was conducted at Nyamhunga Clinic, in Kariba under the directive of Tinotenda Dzikiti (Ambassador-Zimbabwe Diabetes Association), Sister Gwenzi (Public Health Nurse), Mr. Masendu (Kariba Mayor), Ruvimbo Chabayanzara (Projects Coordinator-Face of Kariba), Edith Takura (Patient Advocate), Wedzerai Kambudzi (Program Coordinator), Richard Chabikwa (Leo Lion-Lions Club International), Chikomborero Jaiwa (CEO-Shark Cruises), Mr. Mapfigo and Willia Tendai Gwanzura (Manager and Human Resources Officer- Carribea Bay).

An initiative that involves health matters, is always a difficult one and the diabetes-free testing event was not an exception, especially when taking it into the community, consisting of people of different backgrounds. However, the programme was a success regardless of all the circumstances faced. A total of 63 people were tested. The results would either confirm the prediabetes/diabetes status of people who related to the signs and symptoms (blurry vision, weight loss, slow healing, frequent urination, fatigue, extreme thirst) or present that one is safe (however, we would recommend that people should always take healthy sources of fibres, proteins, carbohydrates, and fats are all recommended as part of a healthy diet; doing physical exercises and why exercise important, and at a higher level visit the clinics/pharmacies for a blood sugar screening).

This exercise proves that indeed, Africa is the Region with the highest proportion of undiagnosed diabetes, with 60% of adults currently living with diabetes unaware of their condition, as suggested by (International Diabetes Federation, 2019). Thus, the screening process was extremely emotional and yet impactful as people were sharing their experiences and showed how grateful they were for the initiative we conducted “freely”. Above all, the people with extreme cases would need intense follow-ups, until we are rest assured of their status quo.

Living a healthy lifestyle means taking care of all aspects of your health, and visiting your doctor regularly to prevent Diabetes-related complications. T1International (2021) recommended that, if possible, people living with diabetes should receive the following medical tests: HbA1c and fasting blood glucose (every 3-6 months); Feet examination (every 3-6 months); Blood pressure and weight (every 3-6 months); Eye check (every year); Kidney function (blood test- every year); Vaccinations (check with your doctor).

Recommendations by the American Diabetes Association 2022 and ISPAD 2018 Clinical Guidelines:

• OGTT screening for pre-existing diabetes should be done before or immediately after the onset of pregnancy, and screening for gestational diabetes is recommended at the end of both the first and second trimesters;
• Screening for prediabetes and type 2 diabetes with an informal assessment of risk factors or validated risk calculator should be done in asymptomatic adults;
• Testing for prediabetes and/or type 2 diabetes in asymptomatic people should be considered in adults of any age with overweight or obesity, who have one or more risk factors;
• Prediabetes is associated with heightened cardiovascular risk; therefore, screening for and treatment of modifiable risk factors (including hypertension and dyslipidaemia) for cardiovascular disease are suggested;
• For all people, screening should begin at age 35 years;
• If tests are normal, repeat screening recommended at a minimum of 3-year intervals is reasonable, sooner with symptoms or change in risk (i.e., weight gain);
• To screen for prediabetes and type 2 diabetes, fasting plasma glucose, 2-h plasma glucose during 75-g oral glucose tolerance test, and A1C are each appropriate;
• In people with prediabetes and type 2 diabetes, identify and treat cardiovascular disease risk factors;
• Women with a history of gestational diabetes mellitus should have lifelong screening for the development of diabetes or prediabetes at least every 3 years;
• Women with a history of gestational diabetes mellitus found to have prediabetes should receive intensive lifestyle interventions and/or metformin to prevent diabetes;

Screening for diabetes complications in older adults should be individualized and periodically revisited, as the results of screening tests may impact targets and therapeutic approaches (3–5). At the same time, older adults with diabetes are also at greater risk than other older adults for several common geriatric syndromes, such as polypharmacy, cognitive impairment, depression, urinary incontinence, injurious falls, persistent pain, and frailty (1). These conditions may impact older adults’ diabetes self-management abilities and quality of life if left unaddressed. 

A huge thanks to every person that made this outreach a success: from the participants; to donors (which I will not mention by names, their efforts are greatly appreciated). Above all, this screening session was the beginning of many outreaches to be done across the provinces of Zimbabwe, and giveaways to the local clinics in question would be done, in a way to capacitate them to continue screening their communities.