Dr MJ Fran­cis

Di­a­betes can have many caus­es. 

I clear­ly re­mem­ber 32-year-old Maria, a gov­ern­ment clerk who came in for a check-up. Maria de­vel­oped di­a­betes while preg­nant with her third child. She was slight­ly over­weight but con­sid­ered her­self very dis­ci­plined; she con­sumed every­thing in mod­er­a­tion, didn’t smoke, and on­ly oc­ca­sion­al­ly had al­co­hol. She was alarmed to learn her blood sug­ar lev­els were high.  

She told me, “I try to buy healthy lunch­es, but fries and chick­en are usu­al­ly the cheap­est. I know wa­ter is best, but soft drinks are typ­i­cal choic­es. I of­ten run late for work, so I take a taxi when the minibus drops me down­town. Some­times my luck is in, and my hus­band drops me to work. I have a desk job and sit for long hours.” 

She shared re­cent chal­lenges; fruits and veg­eta­bles are more ex­pen­sive and scarcer. All fruits have sea­sons, but cli­mate change is chang­ing every­thing. There is no cit­rus sea­son now, just pricey fruits all year round. She had a fam­i­ly his­to­ry of di­a­betes and had less time for every­thing. A long com­mute to work meant less time to pre­pare health­i­er home-cooked meals us­ing lo­cal in­gre­di­ents.  

Though Trin­bag­o­ni­ans have ‘a weak­ness for sweet­ness’ and sug­ar-sweet­ened bev­er­ages alone con­tribute to near­ly 30% of di­a­betes cas­es, it’s clear from Maria’s sto­ry – sweet­ness isn’t the on­ly cause for di­a­betes.  

World Di­a­betes Day 2025 is ob­served on No­vem­ber 14. This year’s theme is Di­a­betes and Well­be­ing, stress­ing the im­por­tance of holis­tic care where we live, work and play, par­tic­u­lar­ly in work­places and schools where peo­ple and stu­dents spend the most time.   

For T&T, di­a­betes isn’t just a per­son­al is­sue; it’s a ma­jor pub­lic health is­sue, one made worse by cli­mate change.   

In 2021, the In­ter­na­tion­al Di­a­betes Fed­er­a­tion es­ti­mat­ed that 12.7% of the pop­u­la­tion of T&T (148,900 peo­ple) was liv­ing with Type 2 di­a­betes (non-in­sulin de­pen­dent) and that 2,365 deaths that year were due to di­a­betes. By 2045, the num­ber of peo­ple with di­a­betes is ex­pect­ed to rise to over 175,000. The coun­try spends mil­lions man­ag­ing com­pli­ca­tions like di­a­bet­ic foot and eye dis­ease, and costs are ex­pect­ed to rise.  

T&T faces a sig­nif­i­cant di­a­betes bur­den, but how does cli­mate change make things worse?  

In­creased tem­per­a­tures and air pol­lu­tion re­duce mo­ti­va­tion for ex­er­cise and make it po­ten­tial­ly dan­ger­ous, as peo­ple can eas­i­ly end up de­hy­drat­ed or hav­ing dif­fi­cul­ty breath­ing.

Those with di­a­betes are at even high­er risk for de­hy­dra­tion due to treat­ment with med­ica­tions that make them lose flu­ids eas­i­ly. Not ex­er­cis­ing can make di­a­betes worse or in­crease the pos­si­bil­i­ty of de­vel­op­ing the dis­ease, as Maria dis­cov­ered. 

Tor­ren­tial rain­fall, hur­ri­canes, and flash flood­ing can pre­vent ac­cess to health ser­vices, sweep away pa­per med­ical records or cut pow­er sup­plies, de­stroy­ing life­sav­ing med­ica­tions like in­sulin, which need con­tin­u­ous re­frig­er­a­tion.    

These same ex­treme weath­er events al­so ru­in crops, dri­ving fruit and veg­etable prices up as they be­come scarcer. Many, like Maria, are then forced to choose be­tween cheap­er, un­healthy meals and more ex­pen­sive, health­i­er op­tions. As with too lit­tle ex­er­cise, choos­ing un­healthy foods can wors­en di­a­betes or raise one’s chances of de­vel­op­ing it.    

All these things con­tribute to re­duc­ing our peo­ple’s well-be­ing and qual­i­ty of life.  

Un­der­stand­ing the con­nec­tions be­tween di­a­betes and cli­mate change is cru­cial, as is aware­ness of di­a­betes’s caus­es and com­pli­ca­tions, es­pe­cial­ly if you have a fam­i­ly his­to­ry.

Reg­u­lar screen­ings, ear­ly de­tec­tion, and ask­ing your doc­tor ques­tions are equal­ly vi­tal.  

If you de­vel­op di­a­betes, how­ev­er, be­sides fam­i­ly and com­mu­ni­ty sup­port, many ser­vices are avail­able to help you. The Di­a­betes As­so­ci­a­tion of Trinidad and To­ba­go (DATT), the Na­tion­al

Di­a­betes Cen­tre, and Di­a­betes Well­ness Clin­ics (DWC) all of­fer ed­u­ca­tion, mon­i­tor­ing and sup­port ser­vices. Peo­ple at­tend­ing the DWCs in 2024 who had poor­ly man­aged type 2 di­a­betes be­fore join­ing re­port­ed im­prove­ments with fo­cused sup­port.  

The gov­ern­ment can al­so re­duce the strain on those with di­a­betes and oth­er chron­ic ill­ness­es made worse by cli­mate change by fight­ing against it.  

De­creas­ing our fos­sil fu­el use (the main dri­ver of cli­mate change) by in­creas­ing mass tran­sit op­tions, build­ing re­silient hos­pi­tals so that med­ical ser­vices can keep run­ning, even with­out mains pow­er, cre­at­ing green spaces and traf­fic-free zones for pedes­tri­ans and cy­clists to safe­ly trav­el and ex­er­cise (good for us and the en­vi­ron­ment!), are just some of the ways our lead­er­ship can help. 

Poli­cies should al­so be im­ple­ment­ed to sub­sidise healthy food, not just chron­ic dis­ease med­ica­tions, and to tax sug­ary bev­er­ages like sev­er­al oth­er Caribbean coun­tries. 

With cli­mate dis­rup­tion fu­el­ing a shift from tra­di­tion­al meals rich in lo­cal pro­duce to un­healthy processed foods high in sug­ar, fat and salt, and many not get­ting enough ex­er­cise at work or in school, it’s no won­der that the num­ber of peo­ple with di­a­betes has risen. So, this World Di­a­betes Day, let’s spread aware­ness and come to­geth­er to pro­mote pre­ven­tion, health­i­er di­ets, ex­er­cise, and sup­port sys­tems to im­prove the health and well-be­ing of all.