A Caribbean Certified Diabetes Educator’s Perspective on Diabetes Care in Trinidad
Anica Sanoir, a Caribbean Certified Diabetes Educators (CCDE) and owner of the Caribbean Lifestyle Diabetes Centre, chatted with Beyond Type 2 about her work as a CCDE in Trinidad and Tobago, the differences in diabetes care in the Caribbean versus the United States, United Kingdom and Canada, and how she helps her clients make sustainable behavior changes to get their blood sugar under control. Read our conversation with Anica and learn how you can connect with her.
What inspired you to help people with type 2 diabetes? What’s the rate of type 2 diabetes in Trinidad and Tobago?
I saw the growing need for diabetes education and awareness because it was extremely lacking. In the Caribbean, we are called Caribbean Certified Diabetes Educators (CCDE). My main focus is to educate and counsel people with diabetes and prediabetes, including their family, friends and caregivers. I help empower them with the knowledge and skills to manage their condition. According to the Diabetes Association of Trinidad and Tobago, at the end of 2017, there were 200,000 people with diabetes at a prevalence rate of 18 percent.
Does diabetes run in your family? Do you have friends who have type 2 diabetes?
I have first-hand experience in witnessing how diabetes can affect families and friends. Diabetes runs in my family on my mother’s side. Two of my aunts died from complications of diabetes. Both of them also had parts of their legs amputated as well. I also have a living aunt with diabetes and also have friends with type 2 diabetes.
Tell us about your business: Caribbean Diabetes Lifestyle Centre. What do you usually encounter in your day-to-day work?
Caribbean Lifestyle Diabetes Centre provides diabetes self-management education (DSME) and other engaging activities by offering the latest diabetes health information for people with diabetes and prediabetes. We believe that through patient empowerment, people with diabetes and prediabetes will gain the necessary tools, knowledge and skills to become efficient at self-management which would lead to optimal health and improved quality of life.
In my day-to-day work, I see people who have had diabetes for over 15-20 years and have no idea what an A1c is, have never had a retinal eye exam, or a foot examination. Some only test their blood sugar once a week due to the fact the strips are expensive, even when they can tell when their blood sugar is high. Sometimes, they haven’t taken their medication because when they tested their blood sugar, it was fine.
What habits do you see in people with diabetes who don’t manage it well?
In people who have had diabetes for years, I see a lot of regrets when the reality of complications set in. All the shoulda, coulda, if only I managed it well and monitored my blood sugar as I was supposed to. The loss of independence is the main psychological issue that most people deal with.
How do you get your clients to start making behavior changes after a diabetes diagnosis? What achievements have your clients made?
First, I allow them to discuss any and all concerns, issues and feelings about being diagnosed. Then, I make an overall assessment of what they understand about their diagnosis and make a simple plan that includes their preferences for food and exercise. I also emphasize the importance of monitoring and recording blood glucose at home. My clients are also free to call, WhatsApp, text and email me anytime if they have any issues—I am always available to them.
I’ve seen my clients make a lot of progress. They effectively demonstrate what they’ve learned by making the necessary behavior changes in their lives to maintain their blood glucose. They’re even inspiring some of their family members to live a healthy lifestyle and are educating other family members and friends who have diabetes.
What are some of the cultural differences between the U.S. and Trinidad/Caribbean in regards to diabetes education and counseling? How easy or difficult is it to see a CDE in Trinidad or even receive care from a general practitioner?
Unfortunately, people, as well as some physicians, don’t see the need for diabetes education and counseling. This makes it extremely challenging to see diabetes professionals like me. In my country, diabetes educators are not recognized as necessary, unlike the U.S., UK and Canada. Some physicians have told me they don’t need my services because they can provide diabetes education themselves during their 10-minute patient visits. They also don’t understand the importance and benefits of having a multidisciplinary team help a patient with diabetes. To make matters worse, people have to pay out of pocket to see me. Because they’d be spending extra money, they may choose not to get the specialized care they need.
Sadly, we don’t have a lot of CCDE’s in my country. There are probably 25 of us and the majority don’t function or work in the same capacity as a registered nurse (RN) in a hospital. We are also not financially supported despite our certifications for our specialties. However, we have local health centers throughout the entire country that are free and accessible to all or people can pay out of pocket and see a general practitioner privately if they choose.
How do you keep up with the latest diabetes research and apply it to your practice?
I usually attend two international conferences a year and attend webinars and online programs. The conferences I attend are the annual American Diabetes Association (ADA) Clinical Conference on Diabetes every May and the annual American Association of Diabetes Educators (AADE) conference in August. In the words of Nelson Mandela, “education is the most powerful weapon which you can use to change the world.” Diabetes management techniques, technology and medications are evolving every day and I have to remain up to date so I can educate and empower my clients.
What advice do you have for people who have been newly diagnosed who don’t know where to start, as well as people who have had diabetes for quite some time and don’t know how to address their condition?
Being diagnosed with diabetes is not the end of the world! You can continue to live and enjoy life the same way you were before being diagnosed. It’s only natural to go through the stages of grief such as bargaining, denial and acceptance after a diagnosis. Express how you feel and talk to people who are also living with it. Join a support group and speak to your diabetes team. You’re not alone and there is nothing to be ashamed of. You are part of a team and there is no “I” in team.
What do you think are the biggest misconceptions about type 2 diabetes?
That people think they have the worst type of diabetes and that it’s a death sentence and the end of the world. Another misconception is people with diabetes can’t enjoy and do all the activities they were doing before being diagnosed. They don’t understand that even though its a common chronic disease, it can be controlled with healthy eating, regular exercise, taking medication as prescribed and blood glucose monitoring.
Tell our audience where they can connect with you.
Facebook: Caribbean Lifestyle Diabetes Centre