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Seanad Éireann debate -
Wednesday, 13 May 2009

Vol. 195 No. 7

Health Services.

I seek the Chair's indulgence to highlight a matter. On two occasions I raised in the House the issue of the Magilligan car ferry, or the Foyle ferry, and the status of Magilligan as an international port. I am pleased to inform the House that further to the push to address that issue by the Minister of State, Deputy Mansergh, and the Minister, Deputy Ahern, it has been resolved. Magilligan is no longer an international port. It is now a domestic port and that will lead to significant supports and assistance for the Foyle ferry.

I thank the Minister of State because he made an off the cuff comment on the previous occasion that I used copiously in making the case to many people, and it greatly supported the case. It was done in the best possible taste, as one comedian would say.

I wish to raise the issue of diabetes which will become a very serious problem, if not for this generation then for the next one. I hope I do not have diabetes. My last check was fine but I am aware of colleagues in my current employment and from my previous employment as a teacher who suffer from this disease.

Diabetes mellitus is a group of metabolic disorders characterised by too much glucose in the blood. Either the pancreas fails to produce enough insulin or the body cannot use the insulin it has. As a result, the glucose builds up in the blood causing the cells to be starved of energy and other complications. The condition is associated with a range of serious vascular complications such as heart attacks, kidney disease, nerve disease and eye disease. Type 1 diabetes is the more serious condition and it affects between 10% and 15% of people with diabetes in European countries. It is thought to be triggered by environmental factors in genetically susceptible individuals. Type 2 diabetes causes more concern. It usually occurs in older people but it is becoming more common among younger people, partly owing to lifestyle factors such as diet, lack of physical activity and obesity. It accounts for 85% to 90% of all cases of diabetes in Europe.

Last week I raised the issue of awareness of skin cancer and the dangers of melanoma. Today, representatives of the Irish Cancer Society appeared before a committee of the Oireachtas to outline the dangers of cancer, preventative measures that can be taken and symptoms to watch. This House previously discussed bowel cancer and Members managed to get through that debate without mentioning the symptoms and signals. It is important they would be put on the record in case somebody, somewhere might see what we said and realise they have a problem.

The symptoms of diabetes are often ignored. People are unaware of them, which often leads to the condition only being discovered when it is at the stage of causing complications in their lives. It is also far more dangerous than it would have been if caught earlier. The symptoms are frequent urination, excessive thirst, excessive hunger, unusual weight loss, increased fatigue, irritability and blurry vision. People with any one of those symptoms should immediately try to visit the doctor.

With regard to prevention, small dietary changes and exercise can help prevent type 2 diabetes from developing or slow its progress. According to the Diabetes Federation of Ireland, in 2005 it was estimated there were 141,064 adults in the republic or 4.7% of the population with diabetes, diagnosed and undiagnosed. In the republic, diabetes is more common among female adults than among male adults. The percentages are 5.5% for females and 4% for males.

It is a lifestyle issue. It is important some mechanism is found to direct young people. I have been examining dietary issues recently. Food is a science. Should we make food science an examination subject in schools? It is probably part of the domestic science course. We have seen the results of diabetes in terms of the lifestyle change it causes for sufferers. They must constantly watch their intake of carbohydrates, they must know what carbohydrates do to their blood sugars and they must know how to balance that with exercise. If there was greater awareness of food science and the amount of saturated fats, salt and sugars in processed foods and if people could use the information that is available on the products we buy, the children who will become the parents of the next generation would become far more familiar with what they put into their bodies and what exercise they must do to work it off. It would become second nature for them to opt for the healthier food option. Diabetics have the same nutritional needs as everybody else. If they exercise, take their medication and eat well-balanced, regular meals in correct amounts, there can be very good diabetes control.

We must try to prevent what is believed will be a disaster in the future. This issue is linked to many others, such as sport and its benefits for the person, what people are eating, what they should be eating and how to balance that. I succeeded in losing two and a half stone since July. It is not a case of denying oneself anything in particular but being aware that if one eats a packet of crisps, one must compensate by not having an extra slice of bread. Food science in school might be the way forward.

I thank the Senator for raising this matter on the Adjournment, to which I am replying on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

Diabetes is a chronic, progressive metabolic disease that impacts on almost every aspect of the person's life. There is a great deal of concern because diabetes is becoming more common throughout the developed world. There are two types of diabetes. Type 1 or insulin-dependent diabetes affects mainly young people and has a sudden onset. Type 2 diabetes is much more common and accounts for 90% of all cases. It usually has its onset in middle age. The prevalence of type 2 diabetes is increasing owing to a number of factors, including the ageing population and lifestyle factors such as obesity.

Diabetes can have a profound impact on lifestyle, work, well-being and life expectancy. It also causes significant morbidity. Studies have estimated that type 2 diabetes is present for an average of seven years prior to the diagnosis and that up to half of people at this stage may have evidence of complications of diabetes. These include eye, kidney and nerve damage, and vascular complications.

The Department of Health and Children policy on diabetes, Diabetes: Prevention and Model for Patient Care, was published in 2006. This identified a model of care which included shared care between primary care and acute services, retinopathy screening, patient education and empowerment and podiatry services as key areas for development.

The HSE established an expert advisory group, EAG, to take forward and implement the policy recommendations. The EAG framework document, which charts how this public health challenge can be addressed, was launched by the HSE in November 2008. The group's work represents the blueprint for the development of first-class services for people with diabetes. It is practical and patient-focused with a strong emphasis on prevention, service integration and community-based management supported by specialist services.

The EAG emphasised that real savings can be achieved in health care costs by preventing the complications of diabetes such as eye disease or retinopathy, kidney disease or cardiovascular disease. This will be achieved through patient education and empowerment, excellent primary care linked to specialist secondary care and special provisions for early detection and treatment of any complications that develop. A regional model of care is recommended for children and adolescents with diabetes.

The key recommendations include agreement of a core set of standards for diabetes care. A comprehensive set of clinical guidelines has been agreed for diabetes care. This is a significant development and included the Irish Council of General Practitioners and Irish Endocrine Society in the drawing up of these guidelines for an integrated care model between primary and hospital care. These will be of considerable clinical benefit, will advance patient care throughout the country and have the support of the Department of Health and Children.

The second key recommendation is education and empowerment which relates not only to education but empowering patients with diabetes to take greater control in the management of their condition. The third key recommendation is the development of information and communications technology to support diabetes care, especially in the primary care setting. The fourth key recommendation is the continuing roll-out of diabetic retinopathy screening. Diabetic retinopathy is one of the major causes of adult blindness. The fifth key recommendation is the prioritisation of podiatry services for patients with diabetes. With regard to capacity, the report includes recommendations on acute care service needs including consultant staff, diabetes nurse specialists, dieticians and other health care workers.

Current lifestyle patterns in Ireland are a major cause of concern as they play a significant part in the increase in type 2 diabetes. Prevention is key to halting the rise in incidence. Not many people realise that almost 60% of the disease burden in Europe is accounted for by seven leading risk factors, which we can influence: high blood pressure, tobacco, alcohol, high blood cholesterol, overweight, low fruit and vegetable intake, and physical inactivity.

Health care systems continue to focus on the treatment of diseases. However, prevention is a key issue in halting the rise in prevalence of type 2 diabetes. The Department of Health and Children will continue to focus on highlighting the risk factors which contribute to the development of chronic diseases such as this.

Perhaps the Minister of State would refer my specific question to the Department with regard to whether an examination subject on food science could be introduced in the first year of secondary school. Prevention is better than cure.

The Seanad adjourned at 8.10 p.m. until 10.30 a.m. on Thursday, 14 May 2009.
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