Investigating the Correlation between Proliferative Diabetic Retinopathy (PDR) and the duration of diabetes mellitus

The objective of this study is to determine the correlation between proliferative diabetic and duration retinopathy and duration of diabetes mellitus. This study was conducted using a total of one hundred (100) diabetic patients from Trinidad Eye Hospital Diabetic Retinopathy Screening Program (DESP). An efficient screening along with fundus photographs was done prior to collection of data. All data received from TEH database were entered into IBM SPSS statistical software (version 6). Tests such as One-Way ANOVA as well as Chi square test was used to determine the correlation between duration of diabetes and progression of diabetic retinopathy through grading of photographs. From the results obtained in this study, there was a correlation between duration of diabetic retinopathy and the grade obtained therefore the objective of the study was answered. In conclusion, it can be stated that a longer duration of diabetes mellitus relates to an increase in the progression of diabetic retinopathy. Additionally, there was no associated correlation between ethnicity and the progression of diabetic retinopathy indicating that ethnicity is not a definite risk factor for the progression of the condition.

The creation of a strip test which can be used to monitor blood sugar levels in diabetics using tears

Objective: To develop an alternative means to test sugar levels in diabetics by using strips sensitive to tears. Design and Methodology: 50 diabetic and 50 non-diabetic, participated in this study. A sample of tears was collected from each subject's right eye using a microcapillary tube. Following tear collection, the blood glucose level of each subject was tested and recorded. The tear samples were then frozen and stored for lab analysis later on. At the end of sample collection, 100 samples of tears were tested for glucose concentration. The results were examined to determine the correlation of glucose in tears to that in blood. Results: Based on this study conducted, the average tear glucose (TG) concentration in non-diabetics was found to be 1.89 ± 0.54 mg/dL and in diabetics, 3.10 ± 0.55 mg/dL, whilst the post prandial blood glucose (PPBG) concentration in non-diabetics and diabetics was found to be 118.60 ± 4.67mg/dL and 233.98 ± 16.21 mg/dL respectively. Conclusion: There was a significant difference between the glucose concentration in tears and the glucose concentration in blood via non-parametric data analysis. There was a weak correlation between the two variables. The development of a non-invasive, convenient and patient-friendly method of monitoring glucose concentrations would give rise to improved patient compliance and disease control. Based on our findings at this point in time, the creation of a strip test to detect glucose concentration may not be possible but with advancements in technology, a glucose tear strip sensitive to low concentrations of glucose present in tears, can be developed.

The economic and social burden of insulin in a period of economic recession

Introduction: Type 2 diabetes (T2D) is a global public health crisis that threatens the economies of all nations, particularly developing countries. The growing demand for insulin therapy has created an economic burden thus impacting on equality. Objectives: The aim of the study is to determine the impact of the removal of Glargine U100 insulin (GI) due to an economic recession among patients with T2D attending a primary care in North Trinidad. Design and Methodology: A retrospective cohort study was conducted in Chronic Disease Clinics across the Arima Cluster of the North Central Regional Health Authority. All patients who were T2 diabetics on insulin therapy were eligible for entry. Patients were selected using systematic sampling to fulfill a sample size of 250. Demographic and clinical data were extracted from there medical records. Results: The major finding of the study was 75% of patients who started insulin therapy with GI while it was freely available elected to convert to premixed insulin (PMI) 70/30 by 2017. An important finding included a disproportionate number of women (72%) compared to men (28%) who advanced to insulin therapy. Conclusion: We provide evidence on the burden of a subgroup of patients with T2D as well as generating opportunities for debate on the rational allocation of resources.

Patient related factors associated with glycaemic control in type II diabetic patients within the North Central Regional Health Authority, Trinidad

Background and Objectives: Preventative healthcare practices continues to be the basis for prevention of diabetes related complications. Established guidelines are likely to decrease the incidence of diabetes complications, however, patient related factors either perceived or real, prevent the utilization of medical services resulting in poorer health outcomes. The aim of this study was to identify the patient related factors leading to elevated HbA1c levels in type 2 diabetic patients at the health centres within the Northcentral Regional Health Authority, Trinidad and to determine the association between patient related factors and optimal glycaemic control as measured by HbA1c levels. Subjects and Methods: This was a cross-sectional study using convenience sampling of participants who were type II diabetics, over the age of 18 years, attending the chronic disease clinic for their usual appointment within selected health centres of the Northcentral Regional Health Authority during the period January 2018 to March 2018. After receiving ethical approvals and informed consent, a de novo, pretested self-administered and researcher-assisted survey was administered. Patients' barriers were determined by using the Independent Samples T test and Analysis of Variance in 2 groups of patients. Results: 254 subjects participated in this study with a response was 87.6% There were 7 patient related factors associated with glycaemic control identified based on the analysis of 200 patients with recorded HbA1c in this survey. The mean HbA1c was 8.360 with SD 2.062. Age (55-64years age group), use of insulin, emotional problems and anxiety were associated with higher mean HbA1c. Use of oral hypoglycaemic agents, personal responsibility for diabetes care and being retired were also associated with lower mean HbA1c. Conclusion: This study identified several patient related predictors of glycaemic control based on the mean HbA1c in the public health system in parts of North and Central Trinidad. Implementation of relevant interventional programs are needed to remove these factors and improve patient outcomes.

Depression and diabetic control amongst a chronic disease clinic in Trinidad

Objectives: The goals of this study were to evaluate the relationship between two outcomes; depression and uncontrolled diabetes as well as to determine the prevalence and associated factors of these two main outcomes amongst diabetics attending a chronic disease clinic in Trinidad. Research Design and Methods: A cross-sectional study utilizing a researcher-administered questionnaire with a sample of 239 diabetic patients from the St Joseph Enhanced Health Centre. The Patient Health Questionnaire was used to determine the presence of depression whilst history from patients and laboratory data from the files were used to determine the HbA1C and other factors. Results: Depressed patients had increased odds for uncontrolled diabetes (OR 8.24 95%CI 3.37-20.17 p <0.000). Mann-Whitney U testing showed significant differences between the median and variance of the HbA1C between the depressed and non-depressed group, with the depressed group having a median HbA1C 9.0% and the non-depressed group a median of 7.1%. Prevalence of depression was 23.4% in this population and 59.4% of patients had HbA1C >7.0%. Factors associated with increased odds for depression were females, unemployment, no exercise and treatment with insulin. Decreased odds for depression was associated with religious participation, frequent exercise, compliance with medication and Afro-Trinidadian ethnicity. With respect to uncontrolled diabetes, housewives and those on insulin had increased odds whilst single persons and those who comply with medications had decreased odds for uncontrolled diabetes. Conclusions: The presence of depression is associated with 8x increased odds of uncontrolled diabetes, with depressed persons having higher average HbA1Cs than non-depressed. Persons treated with insulin had increased odds of both depression and uncontrolled diabetes whilst those compliant with medication had lowered odds for both.

Evaluative research on pharmacist managed diabetes care: focus on self-monitoring of blood glucose

Diabetes, especially Type 2 Diabetes (90%) is an ongoing problem for many nations. The world-wide prevalence of diabetes estimated by World Health Organization was approximately 175 million in 2000 and is predicted to be at least 366 million by 2030 among adults ≥ 20 years of age. The WHO estimate for Trinidad and Tobago in 2000 was 60,000 and is projected to increase to 125,000 if current trends prevail. Recent data (unpublished) from the Ministry of Health indicate that the Chronic Disease Assistance Programme, since its inception in 2003 to 2009, has provided medicines for approximately 226,435 diabetic patients. The National Insurance Property Development Company procures and manages the distribution of medicines for Chronic Disease Assistance Programme on behalf of the Ministry of Health. The total cost of diabetes treatment amounted to 285 million USD, representing approximately 38% of the total patient population receiving treatment through the progamme in this period. Objective: The primary objective was to demonstrate that pharmacists can assist patients to achieve at least a 1% decrease in HbA1c. Methods: A randomized controlled Pharmacist Evaluative Research Study compared the efficacy of pharmacist managed care (the intervention), and routine standard management (control) of poorly controlled (abnormal glycosylated haemoglobin, blood pressure, blood glucose and lipid panel) adult diabetic patients. Participants in the intervention group met with the pharmacist at their respective primary care sites on a regular basis for an assessment of adherence to medications, barriers to adherence and education. Control group participants consisted of patients receiving routine care by their primary physician but, with no direct intervention by the pharmacist except for the filling of prescriptions. Results: Seventy-five (75) patients were initially recruited, of these forty-eight (48) [20 interventions and 28 control] met the inclusion criteria. It was only possible to analyse the result from twenty (20) patients: 14 (70%) intervention and 6 (21.4%) control because of incomplete collected data. A minimum decrease of at least 1% HbA1c was obtained by eight (57%) intervention participants compared to two (33%) in the control group; while HbA1c remained unchanged for two participants each in the intervention and control groups (14% and 33%, respectively). The patient cohort was too small, therefore better methods for recruitment needed to be explored. The failure of patients to document key measurements (SMGB, BP), as requested by the pharmacist, was responsible for the exclusion of these patients in the statistical analysis. All of these factors reinforced the importance of preventing patients from absconding in order to reduce the high attrition rate. Conclusion: The data supports the hypothesis that the use of pharmacists as adjunctive healthcare practitioners achieves better patient outcomes than the non-use of pharmacists.

Changes in drug therapy and disease control in a subset of diabetic patients at public primary healthcare facilities in Trinidad

OBJECTIVE: To determine changes in drug treatment over a five-year period in a subset of diabetic patients who were either uncontrolled on monotherapy or required polypharmacy with or without insulin. These changes were assessed in their ability to be able to achieve glycaemic control.SUBJECTS AND METHOD: A cross-sectional survey was conducted between June and August 2015 at 24 primary healthcare facilities across Trinidad. Demographic details, drug use, blood glucose readings and self-reported adherence to drug therapy, dietary restrictions and exercise were collected. Additionally, patients’ files were reviewed for drug changes and blood glucose readings over the previous five-year period.RESULTS: A total of 236 patients were enrolled and 49% had random blood glucose greater than 180 mg/dL (uncontrolled). Most patients (91%) were prescribed metformin or gliclazide (67.5%) either singly or in combination; 92 patients (39%) were prescribed insulin. Over the five-year period, monotherapy declined from 26.9% to 8.4%; conversely, polypharmacy increased from 68.2% to 82.4%. Additionally, doses of all antidiabetic drugs increased. However, despite these changes, only modest decreases in random blood glucose were observed, ranging from 18 mg/dL to 43 mg/dL for the various drug combinations. On average, none of these combinations produced blood glucose levels below 180 mg/dL to achieve glycaemic control. CONCLUSION: Over the five-year period, there was a shift from monotherapy to polypharmacy, with increasing doses of individual drugs and further addition of insulin. Despitethese therapeutic changes, accompanied by moderate decreases in random blood glucose, they were insufficient to achieve glycaemic control in a significant number of patients.

Evaluation of vitamin D relationship with type 2 diabetes and systolic blood pressure

Objective: To investigate whether relationships existamong vitamin D, type 2 diabetes mellitus (T2DM), and blood pressure in Trinidadian subjects with T2DM. Research design and methods: This was a case­ controlled study to determine if vitamin D levels were lower in patients with T2DM. After data analysis, an exploratory hypothesis of vitamin D relationship to systolic blood pressure (SBP) was developed. Plasma calcifediol (25(OH)D) concentrations were used as a measurement for vitamin D levels and were determined by ELISA. Cholesterol levels were measured by an automated dry chemistry analyzer and blood pressure was measured using an automatic blood pressure monitor. Results: There was no significant difference ( p=0.139, n=76) in 25(OH)D levels between patients with T2DM and controls. Subjects with SBP above 130 mm Hg were 8 times more likely to have a 25(OH)D plasma concentration above 25 ng/mL (OR 7.9 (2.2 to 28.7)), and were 5 times (OR 4.7 (1.7 to 15.1)) more likely to have a 25(OH)D plasma concentration above 30 ng/mL (OR 7.5 (2.3­24.2)). Vitamin D levels moderately and positively correlated with SBP (rs=0.38, p=0.001). Conclusions: There was no significant difference in the 25(OH)D levels between patients with T2DM and controls ( p=0.139). Patients with SBP under 130 mm Hg were 8 times more likely to have a vitamin D level above 25 ng/mL (OR 7.9 (2.2 to 28.7)). Further investigations are required to examine the relationship between vitamin D and SBP.

The social determinants of diabetes and cardiovascular disease risk factors in Barbados: findings from the health of the nation study

OBJECTIVE: To describe the distribution of diabetes, hypertension and related behavioural and biological risk factors in adults in Barbados by sex, education and occupation. DESIGN AND METHODS: Multistage probability sampling was used to select a representative sample of the adult population (> 25 years). Participants were interviewed using standard questionnaires, underwent anthropometric and blood pressure measurements, and provided fasting blood for glucose and cholesterol measurements. Standard WHO Definitions were used. Data were weighted for sampling and non-response and age-adjusted for group comparisons. RESULTS: Study participation rate was 55%, with 764 women, 470 men. Prevalence of obesity was 33.8%, hypertension 40.6%, and diabetes 17.9%. Compared with women, men were less likely to be obese (prevalence ratio 0.53; 95%CI 0.42–0.67), diabetic (0.77; 0.61–0.98), or physically inactive (0.47; 0.39–0.57), but more likely to smoke tobacco (4.08; 2.48–6.69) and binge drink alcohol (4.53; 2.70–7.58). In women, higher educational level was significantly related to higher fruit and vegetable intake, more physical activity, less diabetes and less hypercholesterolaemia (p values: 0.01 – 0.04). In men, higher education was significantly related only to less smoking. Differences by occupational category were limited to smoking in men and hypercholesterolaemia in women. CONCLUSIONS: In this population, unlike in most high-income countries, sex appears to be a much stronger determinant of behavioural risk factors, and consequent obesity and diabetes, than education or occupation. These findings have major implications for meeting the commitments made in the 2011 Rio Political Declaration, to reduce health inequities.

Health inequities in diabetes, its risk factors, and adverse outcomes in populations living in the Caribbean: a systematic review

OBJECTIVES: Following the WHO Commission on the Social Determinants of Health, Caribbean countries committed to identifying and reducing health inequities (Rio Political Declaration 2011). We undertook a systematic review to determine what is known about the social distribution of diabetes (DM), its risk factors and major complications in the Caribbean. This paper describes findings on the distribution by ethnicity, education, occupation and income. DESIGN AND METHODS: We searched Medline, Embase and the Virtual Health Library for Caribbean studies published between 2007 and 2013 that described the distribution by ethnicity, income, education and occupation of: known risk factors for type 2 DM, prevalence of DM, DM control or complications. Only quantitative studies were included; each was assessed for risk of bias. RESULTS: Out of 2796 unique records, 81 articles required full text review, and 29 articles met the inclusion criteria. Few studies examined DM, its risk factors or complications by education (4), income (2) or occupation (1). None described significant relationships but all had a high risk of bias. Statistically significant findings were described from Barbados, Cuba and Trinidad on the distribution of diabetes by ethnicity: higher in Blacks than Whites, and in South Asians in Trinidad compared to other groups (OR 1.87, 95% CI 1.14, 3.05). CONCLUSION: Published data in the Caribbean on the social distribution of diabetes, its risk factors and complications were very limited and of overall low quality. Work to better identify health inequities in the Caribbean is required if governments are to meet their commitment to addressing them.

The importance of gender as a social determinant of diabetes in the Caribbean: a systematic review and meta-analysis

OBJECTIVES: We undertook a systematic review to determine the social distribution of diabetes (DM) its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender. DESIGN AND METHODS: We searched Medline, Embase and the Virtual Health Library for Caribbean studies published between 2007 and 2013 that described the distribution by gender of: known risk factors for Type 2 DM, prevalence of DM, and DM control or complications. Only quantitative studies (n>50) were included; each was assessed for risk of bias. Meta-analyses were performed, where appropriate, on studies with a low or medium risk of bias, using random effects models. RESULTS: We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes. Women were more likely to have DM, obesity, be less physically active but less likely to smoke. In meta-analyses of good quality population based studies odds ratios for women vs. men for DM, obesity and smoking were: 1.65 (95% CI 1.43, 1.91), 3.10 (2.43, 3.94), and 0.24 (0.17, 0.34). Three studies found men more likely to have better glycaemic control but only one achieved statistical significance. CONCLUSION: Female gender is a determinant of DM prevalence in the Caribbean. In the vast majority of world regions women are at a similar or lower risk of type 2 diabetes than men, even when obesity is higher in women. Caribbean female excess of diabetes may be due to a much greater excess of risk factors in women, especially obesity and physical inactivity.

High prevalence of diabetes mellitus in a cohort of Trinidadian patients with chronic obstructive pulmonary disease

OBJECTIVE: To define the prevalence of diabetes mellitus (DM) in a cohort of Trinidadian chronic obstructive pulmonary disease (COPD) patients, and investigate its relationship to lung function, quality of life, and depression. DESIGN AND METHODS: Anthropometric and spirometric data were obtained from 108 COPD (91 males) patients from Trinidad chest clinics, who also had HbA1c test results. Questionnaires on quality of life St. George’s Respiratory questionnaire ({SGRQ} and COPD Assessment Test {CAT}) and depression (Center for Epidemiologic Studies Depression Scale {CES-D & CESD-R}) were administered, and an interview conducted. RESULTS: Mean (SD) age: 67.4 (11.0) years. Median (IQR) HbA1c: 6.1 (5.7, 6.7) %. HbA1c values were obtained for 105 patients of whom 40% had diabetes, and 40% pre-diabetes. Diabetics had a greater (p=0.001) median (IQR) BMI [27.3 (24.1, 30.4)] than non-diabetics [24.2 (21.2, 27.2)]. Patients with at least one chest infection/exacerbation in the past year had increasing CAT & SGRQ Total (p<0.001), and CES-D & CESD-R (p≤0.013) scores. CAT and SGRQ total scores were negatively related to lung function and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages (p<0.001). All lung function parameters, except Forced expiratory volume/Forced vital capacity (FEV1/FVC), decreased with increasing CES-D and CESD-R scores (p<0.05). CAT & SGRQ correlated well with CES-D & CESD-R scores (p<0.001). Intravenous corticosteroid use was positively associated with HbA1c (p=0.043). Dosage of inhaled corticosteroids was associated with lower FEV1 (p=0.034) and higher SGRQ & CAT (p≤0.048). FVC % predicted was negatively related to HbA1c (p=0.033). CONCLUSION: The prevalence of DM in the COPD patients was 40%; however no significant correlations of DM to outcome measures were observed. Patients with worse quality of life due poor lung function were more depressed.

Prevalence and profile of herbal medicine use in persons with diabetes and hypertension: data from the Barbados risk factor survey 2007

BACKGROUND: This paper seeks to determine the prevalence of herbal medicine use in persons with diabetes and hypertension; and to identify the demographic and socioeconomic profile of persons using such therapies. DESIGN AND METHODS: Secondary data analysis was done using the Barbados Behaviour Risk Factor Survey 2007. The prevalence of herbal medicine use was determined. Crude and adjusted odds ratios were generated for the relationship between these outcomes and age, sex, employment status; marital status; educational level and ethnicity. RESULTS: Herbal use was found to be 7.4% (2.9% to 11.9%) among diabetics, 4.5% (2.3% to 6.7%) among hypertensive persons, and 5.5% (3.2% to 7.8%) among all persons who were either diabetic and or hypertensive. A statistically significant association was seen between herbal use and age only (age 60 years and over compared to age < 60 years adjusted OR 4.0 95%CI 1.3 to 12.3). CONCLUSIONS: Though older persons were more likely to use herbal medicines, this study suggests a rather low prevalence of such practices. A more comprehensive assessment of socioeconomic status and of herbal medicine use is warranted.

Adherence to chronic disease management among diabetic and hypertensive patients in Trinidad

OBJECTIVES: Adherence to treatment strategies is critical for disease control and long-term clinical outcomes in patients with chronic diseases, such as diabetes and hypertension. Noncompliance is strongly correlated with lack of disease control and progression to life-threatening outcomes, including end-organ damage such as kidney failure. This study sought to determine the extent of adherence to disease management strategies, including drug compliance and lifestyle modification, among diabetic and hypertensive patients in Trinidad. DESIGN AND METHODS: A cross-sectional survey was conducted using an interviewer-administered pilot-tested de novo questionnaire during the period June to August 2013 at 22 randomly selected primary health centers throughout Trinidad. Data was analyzed using χ 2 and binary logistic regression. RESULTS: Four hundred and thirty-nine patients (439) were recruited; 179 were hypertensive only, 89 were diabetic only, and 171 had both conditions. Mean age and BMI were 61.2 + 10.7 years and 29.2 + 5.99 kg/m2 respectively. One hundred and six out of 350 hypertensive patients (or 30.1%) were controlled, whilst 108 out of 260 diabetic patients (or 41.5%) were controlled. Age (p = 0.015) and body mass index (BMI) (p = 0.028) were the only significant predictors for blood pressure control. Factors such as forgetfulness, adverse drug reactions, and symptoms negatively impacted adherence to drug therapy. CONCLUSIONS: Most hypertensive and diabetic patients attending primary healthcare facilities in Trinidad were not well controlled, which has serious implications for their long-term clinical outcomes. An approach is urgently needed to ensure higher rates of disease control to prevent progression to irreversible end-organ damage.

Level of adherence among diabetics in the Bahamas admitted to the Princess Margaret Hospital

OBJECTIVE: To determine the level of adherence, using a validated tool, among diabetics at the Princess Margaret Hospital. DESIGN AND METHODS: A cross-sectional observational study design was used. There were 150 participants, who were admitted to the Princess Margaret Hospital, with diabetes mellitus from May to July 2014. Patients were of either gender, 18 years or older, taking at least one hypoglycaemic medication. Random sampling was used to endeavor that the sample represented the population. The identified patients gave informed consent and then were given self-administered questionnaires on knowledge, compliance and depression. They were assessed through Modified Morisky Scale, and Self -Care habits form. RESULTS: The mean total number of drugs taken daily was 4.77 (+ 2.7). The mean duration on current medications was 8.08(+ 8.12) years. The mean number of changes to medications was 0.87(+ 1.82). The mean number of days in a week participants spaced carbohydrates was 4.09 + 2.365 days. Participants did 30 minutes of physical activity at a mean of 2.21 + 2.6 days a week. The mean previous Morisky score was 1.80 (+ 1.35). The mean of current modified Morisky score was 1.88 (+ 1.32). The mean current motivation score was 1.44 (+ 1.05). The mean of current knowledge score was 2 (+0 .94). The mean score on the Patient Health Questionnaire (PHQ9) depression screening questionnaire was 3.91 (+ 4.21). CONCLUSIONS: The modified Morisky Score showed a medium level of adherence amongst diabetics in the Bahamas.

An evaluation of the burden of diabetes in Grenada

OBJECTIVE: To assess the burden of diabetes in Grenada in terms of changes in quality of life and trends of incidence, amputation and gender. DESIGN AND METHODS: A mixed methods approach was used in which statistical retrospective analysis determined trends of diabetic related amputations based on secondary data for the period 2008-2012. A qualitative approach was also used to assess perceptions of quality of life of diabetic related amputees using interviews. RESULTS: There were no statistically significant differences or trends (relationships) found between number of amputations and incidences of diabetes with respect to time. The quality of life of diabetics decreased after receiving an amputation surgery as a result of multifactorial issues such as feelings of loneliness and financial instability. CONCLUSION: The decreasing trend of diabetes in Grenada was found to be statistically insignificant while quality of life of amputees was shown to be lowered. Decreasing the incidence of amputations should involve focus on the role of peripheral neuropathy. Policy development to increase benefits to disabled citizens is recommended to improve quality of life of Grenadians.

The association between indices of obesity and common clinical measures in adults with and without type 2 diabetes

OBJECTIVE: To determine if there are any differences in anthropometric measurements, lipid profile, blood pressure and body shape between diabetics and non-diabetics. DESIGN AND METHODS: This cross-sectional study comprised 309 subjects with 91 males and 218 females; there were 217 diabetics and 92 non-diabetics. The sample was taken from three hospitals in Trinidad. Lipid profile and blood pressure were taken from each facility’s physicians’ notes while anthropometric measurements were taken from the patients themselves. RESULTS: The diabetic group had elevated body mass index, and waist to hip ratios were significantly higher (p<0.05) when compared to non-diabetics. There was no significant difference in lipid profile and blood pressure between diabetics and non-diabetics. As age increased, the prevalence of type 2 diabetes mellitus was higher. Of the 217 diabetics, 173 were of East Indian descent. With regards to gender, more males were found to be diabetics resulting from having an android body shape as compared to females (gynoid body shape). It was deduced that waist to hip ratio was the best indicator of type 2 diabetes mellitus based on the area under the curve analysis. CONCLUSION: Of all the anthropometric measurements used, waist to hip ratio was found to be the most effective indicator of type 2 diabetes mellitus in Trinidadians, while body mass index was found to be the least.

What proportion of hypertensive diabetics at Macoya Health Centre are achieving the JNC VII recommended blood target 130/80 mmHg?

INTRODUCTION :Despite widespread dissemination of guidelines advocating tight control, many patients with diabetes continue to have uncontrolled hypertension. We set out to determine what percentage of diabetics are achieving the target blood pressure of <130/80 at The Macoya Health Centre. METHOD: The standard criteria for this audit was adopted from the American Diabetes Association with some modifications according to the most updated evidence- based clinical guideline. JNCVII. From the period July 22nd to August 26th, 2010, all patients, records in the chronic disease clinic were examined. Inclusion criteria included: Diabetic patients with hypertension included in the nurses' diabetic register, patients' records without target organ damage must show that their blood pressure was recorded at least two different occasion before the drug therapy was commenced and patients' records show that the assessments for control of blood pressure were done within 3 consultations after diagnosis with hypertension. RESULTS: of the 342 records examined, 209 were found to be both diabetic and hypertensive. 199 were eventually selected for data analysis with 10 rejected since they did not fulfill the inclusion criteria. the average age of patients was 62.7 years. the were 87 female patients and 112 male patients. A total of 75 (37.7%) of all diabetics achieved this ideal control of 130/80mmHg. this made up 44 (39%) males and 31 (35.6%) females. Discussion: The NHS Diabetics Audit for 2007-2008 showed that only 30% of the people who had their blood pressure checked during the audit period achieved the desired target blood pressure. Standards of Hypertension care for diabetics patients at the Macoya Health Centre are definitely not optimal although they are as good as those reported by other audits. However with implementation of audit recommendations and greater awareness of physicians this can improve .....

When sugar causes pain

Sometimes we use scary terms to define diseases. At other times, we use euphemisms that can take away from their gravity, like replacing 'diabetes' with 'sugar'. It is the renaming of diabetes mellitus, perhaps rising out of the fact that it is caused by the body's inability to regulate the amount of sugar (specifically glucose) in the blood, that caused some level of confusion in the mind of a four year old boy when the subject was raised by adults in his presence.

Hypoglycemic and Hepatoprotective activity of fermented fruit juice of Morinda citrifolia (Noni) in diabetic rats

Morinda citrifolia is a medicinal plant used to treat diabetes and liver diseases. The fermented fruit juice of the M. Citrifolia (optical density = 1.25) was used to study the hypoglycemic and hepatoprotective properties in diabetes-induced rats. The rats were randomly distributed into 4 groups (control, diabetic experimental, diabetic standard, and diabetic untreated) of 6 each. Diabetes was induced by administering Streptozotocin (50 mg/kg body weight). Fasting blood glucose, body mass, liver tissue glycogen content, and the extent of liver degeneration were assessed. Diabetic experimental animals were treated with M. citrifolia juice (2 ml/kg, twice a day) and diabetic standard with reference hypoglycemic drug, glibenclamide orally for 20 days. Both the groups exhibited a significant reduction in blood glucose level of 150 mg/dl ñ15.88 and 125 mg/dl ñ3.89, respectively, as compared to diabetic untreated with FBS = 360.0 mg/dl ñ15.81, (P < .003). On 10th day of experiment, diabetic experimental animals exhibited a decrease in body mass (10.2 g, 5.11%) which increased significantly by the 20th day (6 g, 3.0%, P < .022). Histological study of liver tissue obtained from untreated diabetic animals revealed significant fatty degeneration as compared to other three groups. The data of this study proved the hypoglycemic and hepatoprotective activity of M. citrifolia.