Effects of PCOS on the quality of life of women ages 18-45: A Systematic Review

Polycystic ovary syndrome (PCOS) is a common hormonal disorder with an unknown aetiology that manifests in women of reproductive age. ➢ Excessive insulin levels, genetic predisposition, inflammation, and excessive androgen levels are involved in its development. ➢ PCOS can affect the quality of life (QoL) of women through characteristics like amenorrhea, excess androgens, polycystic ovaries, infertility, hirsutism, acne, and drastic weight gain. ➢ Associated complications like endometrial cancer, abnormal uterine bleeding, miscarriages, gestational diabetes, type 2 diabetes, hypertension, eating disorders, and depression may also arise, which can further lower QoL.

Demographic and Lifestyle Factors that affect HbA1c awareness amongst type II diabetic patients in Trinidad

• Trinidad and Tobago is amongst the countries with the greatest burden of type II diabetes in the western hemisphere • Educating type II diabetic patients in controlling their glycosylated hemoglobin (HbA1c) are recommended as measures to reduce morbidity and mortality associated with type II diabetic complications • Measurement of HbA1c in type II diabetic patients represents their glycemic history for the former 8 ­ 12 weeks and should be tested every 3 months to monitor patients' metabolic control • This study is aimed at measuring HbA1c awareness amongst T2D population in Trinidad and making recommendations based on results

Knowledge and Practice of Self-Care Management of Persons with Type II Diabetes At a Health Centre in East Trinidad

Aim: The study was to determine the levels of knowledge and practice of self-care management of patients with type11 diabetes at Manzanilla Clinic in East Trinidad. Methods: A quantitative descriptive study was undertaken, using all attendees to the health center on a 5-week period. A researchers'-structured Likert-like questionnaire was developed and pretested for the study. Although 88 attendees were targeted, only 66 consented and therefore were recruited for the study. Data was analyzed with SPSS programme version 20. It was presented as frequencies in tables. Result: Results show that the clinic attendees are mostly literate, of Hindi and Christian faiths, with moderate to high level of knowledge on glucose monitoring test, medication compliance, and foot care. This knowledge is however not commensurate with the proficiency of self-care among the participants. Discussion: The result was discussed in relation to literature. The implication of the result was also presented particularly on the focus of health education strategies. Conclusion: Although the respondents showed sufficient knowledge (moderate to high levels), this seeming high knowledge does not reflect in the expected expert level proficiency of practice.

Reversing Type 2 Diabetes in the Caribbean: Preliminary findings from a feasibility study in Barbados

OBJECTIVE: In a high proportion of persons recently diagnosed with Type 2 diabetes, a short (2–3 months) very low calorie diet is able to restore normal glucose and insulin metabolism. The objective of this study is to determine the feasibility of this approach in Barbados. SUBJECTS AND METHODS: Twenty-five individuals aged 20to 69 years with Type 2 diabetes diagnosed within the past six years, not on insulin, and body mass index (BMI) > 27kg.m-2 were recruited. Hypoglycaemic medication was stopped on commencement of the eight-week liquid (760calorie) diet, during which participants were assessed weekly. Findings from the liquid diet phase and the following three months are presented. RESULTS: The study participants comprised 10 men and 15women (mean age 48 years, range 26–68 years). Mean(SD, range) BMI was 34.2 kg.m-2 (6.0, 27.0–52.8) and fasting plasma glucose (FPG) was 9.2 mmol.l-1 (2.2, 6.7–14.6). Over the eight-week intervention, mean weight loss was 10.1 kg (4.7, 1.5–20.8) and waist circumference loss10.9 cm (4.0, 5.1–20.8). Fasting plasma glucose fell by 2.2mmol.l-1 (range 1.5–7.9). At eight weeks, FPG was < 7mmol.l-1, the diagnostic cut point for diabetes, in 15 participants compared to three at baseline (p = 0.004). At three months post liquid diet, 17 had FPG < 7 mmol.l-1 (still off medication). CONCLUSION: There was substantial weight loss and fall inFPG in the majority of participants, sustained at three months follow-up. Data on changes in pancreatic function are being analysed. These findings will inform a larger, pragmatic, multi-centre Caribbean trial.

Population-based self-reported prevalence and management of Type 2 diabetes, hypertension and dyslipidaemia

OBJECTIVE: To estimate the prevalence of self-reported Type 2 diabetes mellitus, hypertension and dyslipidaemiain a nationally representative sample of adults aged ¡Ý 40years in Trinidad and Tobago. SUBJECTS AND METHODS: The National Eye Survey of Trinidad and Tobago (NESTT) was a population-based, nationally representative cross-sectional survey conductedin 2013¨C2014. Randomized multistage cluster sampling with probability-proportionate-to-size methods was used to select 4200 people aged ¡Ý 40 years from 120 clusters. A standardized interview included socio-economic and demographic variables. Comprehensive ophthalmic examination included anthropometry with measurement of fasting blood glucose, blood pressure, capillary blood glucose,HbA1c (if diabetic) and waist circumference. RESULTS: A total of 3592 (84.6%) adults aged ¡Ý 40 years participated in a basic screening interview and 2801 (61%)had a comprehensive clinic assessment. The demographic characteristics of participants were similar to the 2011 national census. The crude prevalence of self-reported hypertension was 34.4% (95% CI: 32.8, 36%), diabetes was 21.0% (95% CI: 19.72, 22.38%) and hypercholesterolaemiawas 21.2% (95% CI: 19.7, 22.7%). Combining self-reported and newly diagnosed diabetes, prevalence increased to 23.94% (95% CI: 22.57, 25.36%). The meanHbA1c in patients with diabetes was 8.25 (SD 2.25); 43% never had a retinal examination and about one-third was onlipid-lowering therapy. CONCLUSION: The self-reported prevalence of diabetes, hypertension and dyslipidaemia in Trinidad and Tobago remains high and acceptable targets for control of diabetes and hypertension are not currently being achieved. There is a strong case for improved screening for and treatmentof risk factors in the population ¡Ý 40 years

Diabetes and nutrition: factors affecting dietary choices

Aims: To determine the patient factors affecting dietary choices in patients with type 2 diabetes mellitus attending two health centres in County St. Patrick, Trinidad. To evaluate adherence to the desired diet through their practices and to identify any differences in practices between a centre receiving usual dietary care and one receiving supplemental care from a primary care physician. Methodology: Both centres serve communities along the southwestern coast of Trinidad and consist of individuals of both African and Indian descent. Usual dietary care, which is provided by a registered dietitian, was supplemented by group sessions given by a primary care physician in one of the health centres. A de novo survey, assessing knowledge, seven preferred dietary practices and barriers was formulated, pre-tested and administered to patients with type 2 diabetes attending both centres. To allow for comparison, a sample size of 288 was calculated for each centre using 75% as the prevalence of non-adherence. Data was analyzed using the Statistical Package for the Social Sciences where associations were assessed using chi-square and frequencies of factors analyzed. Results: A total of 350 persons, two thirds of which were women, with a mean age of 62.5 years participated in the study. All seven of the preferred practices was followed by only 2 participants. 'Eating whatever was available', 'fast foods being convenient' and 'lack of time to prepare appropriate foods' were the ii significant barriers identified. Both centres appeared to have similar rates of preferred practices throughout. Conclusion: A very low number of individuals followed all the preferred practices and barriers to appropriate choices was variable. Intervention led by a primary care physician did not have an apparent impact on the dietary choices of individuals.

An evaluation of psychological well-being and secular trends in the occurrence of type 2 diabetes 1993 – 2014 in outpatients in a community

OBJECTIVE: To evaluate psychosocial well-being and secular trends among outpatient diabetics in community-dwelling Trinidadian patients. METHODS AND DESIGN: We used a cross-sectional study design. The population consisted of all adult patients (>18 years) with Type 2 diabetes (T2DM), receiving care at the main primary health care facility serving that community. The communities came from the North Central Regional Health Authority (RHA) and the Eastern RHA. The WHO-5 Well Being Index was used to determine quality of life and psychological wellbeing. Scores ranged from 0 (worst) to 100 (best). RESULTS: The sample comprised 301 participants. The mean age was 60.78 years (SD ñ11.5) with an inter-quartile range of 51-70 years with no significant age difference between males and females (73.8 versus 75.1, p = 0.235). Females outnumbered males, f:m 1.5:1. Sample participants consisted of 42% Africans and 33.2% South East Asians (SEA). Of the participants, 66% were found to be overweight or obese. One half of the participants scored <50 indicating they were not content with their quality of life, with 1.7% likely to be depressed. There was an increase in patients between the period 1990’s to 2004-14 and the occurrence of cases in younger age groups. For the first time in 2004-09 there were patients aged 29-30 years and there were patients aged 19 -28 years in 2010-14. CONCLUSION: We provide evidence that at the community T2DM is increasingly occurring and shifting towards younger age groups and there was significant dissatisfaction in the quality of their lives.

Evaluating the risk of obstructive sleep apnea in type 2 diabetic patients, and its associations

OBJECTIVE: To assess the prevalence of high risk of Obstructive Sleep Apnoea (OSA) in Type 2 diabetics. To identify risk associations of OSA with obesity, sleep quality, daytime sleepiness and Acanthosis Nigricans. DESIGN AND METHODS: A cross sectional study was done in the diabetic wards of health facilities governed by three Regional Health Authorities in Trinidad. OSA risk was assessed by the Snoring, Tiredness, Observed Apnea, high blood Pressure (STOP) – Body mass index, Age, Neck circumference and Gender (BANG) questionnaire. Sleep quality and daytime sleepiness were also assessed by the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale respectively. Bioimpedance analysis was also done using a stadiometer and standard bioimpedance scale. RESULTS: A total of 281 diabetic patients and 147 non-diabetic patients were interviewed throughout Trinidad. Females made up the majority of the sample, 67% of the diabetics and 66% of the non diabetics. The prevalence of OSA was found to be 73.2% in type 2 diabetics. Non diabetics had an OSA prevalence of 39.5%. Results from a binary regression showed that having diabetes increased the probability of “High Risk of OSA” by 93.1%. CONCLUSION: The prevalence of high risk of OSA in Trinidad was high in type 2 diabetic patients, and has strong correlations with obesity and Acanthosis Nigricans.

The impact self-monitoring of blood glucose (SMBG) on metabolic control in patients with type 2 diabetes: a developing country perspective

OBJECTIVES: The role of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes (T2DM) remains inconclusive. As part of the approach to improve glycaemic control in patients with T2DM in Trinidad, the Ministry of Heath distributed free glucometers and strips. The aim of this study was to evaluate the impact of SMBG on glycaemic control and to determine patients’ behaviors and responses. DESIGN AND METHODS: A large outpatient diabetes clinic was selected for the study where eligible clients were included using a systematic sampling technique. A structured pretested questionnaire was administered to all participants to collect all data including the use of a glucometer. HbA1c was measured, to assess glycaemic control. All data was stored, verified and analyzed with SPSS version 16. RESULTS: Of the 214 participants recruited, 85 (40%) were currently using SMBG. Using an HbA1c of ≤ 7 as an indicator of adequate glycemic control of T2DM, there was a significant difference (p=0.002) between the two groups in reaching this goal. Only 12 (14%) participants in the SMBG group had adequate control, whereas among the non-SMBG group 42 (32.6%) were well controlled. SMBG users felt using the glucometer helped them to achieve their blood sugar targets and were interested in continuing to use it. Most patients tested themselves (78.8%), however only 26.2% ever recorded the results. CONCLUSION: The study showed no direct benefits of self-monitoring of blood glucose in attaining optimal glycaemic control in patients with T2DM.

Albumin/creatinine ratio as an indicator of diabetic foot in a Barbados population

OBJECTIVE: High levels of circulating glucose affect the vasculature in diabetes leading to complications such as retinopathy, nephropathy and diabetic foot. In diabetic nephropathy, the elevated glucose levels also serve to alter the physiology of the glomerulus resulting in elevated albumin excretion. In this case-control study, we examined the Albumin/Creatinine ratio in persons with self-reported type II diabetes, with and without non-healing foot wounds (failure to heal <30 days). DESIGN AND METHODS: Fasting EDTA blood (2ml) samples and urine samples (15ml) were obtained from 90 persons self reported as living with diabetes. Cases were described as persons with non healing foot wounds and controls as persons with no current foot wounds or history of non healing foot wounds. HbA1c levels and Albumin/Creatinine ratios were assessed using a Bayer DCA2000+ Analyser. Fasting glucose levels were determined using a Roche Reflotron+ Analyser. Results were compiled and analysis performed using STATA SE 12.1 (Stata Corporation). RESULTS: Mean HbA1c in cases was 9.1% (ñ2.1 SD) and in controls was 8.3% (ñ1.9 SD) (p=0.05). Mean fasting glucose in cases was 142.19mg/dL (ñ50.76 SD) and in controls 134.57mg/dL (ñ60.10 SD) (p=0.52). Mean Albumin/Creatinine ratio in cases was 210.23 mg/g (ñ275.44 SD) and in controls 42.62 mg/g (ñ103.49 SD) (p<0.001). CONCLUSIONS: In this diabetic case control study, Albumin/Creatinine ratio was markedly higher in persons with diabetes and non-healing foot wounds. This may be a marker of interest as an early indicator of the diabetic foot.

Association of genetic variants in the HNF4A and HNF1B genes with early onset Type 2 diabetes mellitus in the Indo and Afro-Trinidadian populations

OBJECTIVE: To determine if variation in HNF4A, HNF1B and PAX4 genes is associated with increased risk of early onset Type 2 diabetes mellitus (T2DM) in Indo and Afro-Trinidadians. DESIGN AND METHODS: The promoter, exons and flanking intronic regions of the HFN4A, HNF1B and PAX4 genes were sequenced in 167 T2DM and 61 non-diabetic subjects of South Asian Indian ancestry, and 66 T2DM and 59 non- diabetic subjects of African ancestry. Differences in SNP allele and haplotype frequency between T2DM patients and non-diabetic subjects were calculated, and pairwise linkage disequilibrium was also assessed for regions within these genes. RESULTS: Three variants identified in intron 4 of the HNF4A gene, demonstrated association with early onset T2DM in the Indo-Trinidadian population, rs11574739, P = 0.0032, OR 2.99 (95% CI 1.44-6.22), rs3212194, P = 0.02, OR 2.57 (95% CI 1.17-5.65), rs321219, P = 0.0083, OR 2.72 (95% CI 1.29-5.71). In the HNF1B gene, an intron 7 SNP, rs2269842, was associated with early onset T2DM in both the Indo and Afro-Trinidadian groups, P = 0.012, OR 0.42 (95% CI 0.20-0.87) and, P = 0.012, OR 0.44(95% CI 0.23-0.86) respectively. Both findings are previously unreported. No association was demonstrated with variants typed within the PAX4 gene. CONCLUSIONS: Variants in the HNF4A and HNF1B genes may contribute to increased risk of early onset T2DM in Indo-Trinidadians. HNF1B variants may similarly influence diabetes susceptibility in Afro-Trinidadians. However, further studies are required to fully elucidate the contribution of such variants to the prevalence of diabetes in the Trinidadian population.

Prevalence of elevated levels of alanine aminotransferase (ALT) and gamma-glutylmyltransferase (GGT) in patients with type 2 diabetes mellitus (T2DM)) at the Georgetown Public Hospital Cooperation (GPHC) Diabetic Clinic

OBJECTIVE: To determine the prevalence of ALT and GGT abnormalities and contributing factors in adult patients with T2DM that attend GPHC diabetic clinic. DESIGN AND METHODS: A prospective study was carried out on sixty (60) randomly selected diabetic patients from the GPHC Diabetic Clinic. Patients were included in the study based on the selected tests (ALT and GGT) on their request form from the physician and their informed consent. Patients were further coded and data collected from the GPHC medical laboratory. Analysis was done using SPSS (version 20). RESULTS: Of the study population, 72% were females. The 51-60 y age range had the highest frequency. Indo-Guyanese accounted for 58% of the total sample population. 42% of patients were on metformin while 57% were on other drugs other than metformin, statin, fibrate and thiazolidiliones. 78% of patients showed elevated ALT with the highest frequencies in the 40-50 y and 51-60 y age range while for GGT 83% of patients showed and elevated level with the highest frequency in the 61-70 y age range. Metformin, ethnicity and those with a duration of 5 – 10 years T2DM had a positive correlation to elevated ALT and GGT. CONCLUSION: The research showed a prevalence of elevated levels of ALT and GGT in type 2 diabetic patients and strong association to metformin and ethnicity in particular those of Indian decent. Therefore, further research within a controlled environment should be done in order to evaluate the efficacy of the action of metformin as compared to other diabetic drugs in concert with other contributing factors.

Investigating the impact of the local health care system in controlling blood glucose levels and preventing complications in patients with type 2 diabetes

OBJECTIVES: To determine if the local health-care system controls blood glucose levels and prevents complications in Trinidadian type 2 diabetic subjects. This study also focused on assessing the structures that are established to monitor blood glucose levels of type 2 diabetics in the public health facilities. DESIGN AND METHODS: This study was a cross-sectional retrospective study of 388 adult type 2 diabetic participants. Participants were taken from all four Regional Health Authorities (RHAs) in Trinidad. RESULTS: The mean and SD of fasting blood glucose of participants, over the 3 year monitoring period, was 197ñ61.67 and a standard error of ñ3.13. The blood glucose levels of the participants did not change significantly (p = 0.848). Results showed that the higher the fasting blood sugar values, the more complications a patient presented. Fasting blood sugar values were the standard for monitoring blood glucose levels, however HbA1c and other measures mandated under protocol were absent. CONCLUSIONS: Across all Regional Health Authorities in Trinidad, fasting blood sugar values were found to be out of control and remained high. It was noted that the higher a patient’s fasting blood sugar values, the more complications they presented.

Prevalence of anxiety in an outpatient clinic sample of type 2 diabetics in Trinidad

OBJECTIVE: To examine the prevalence of anxiety in an outpatient clinic sample type 2 diabetics in Trinidad. Additionally, this study aims to examine gender differences in anxiety, whether anxiety levels differed among age groups and whether anxiety was related to hyperglycemia and having a coexisting medical complication such as hypertension and heart disease. DESIGN AND METHODS: 128 type 2 diabetics attending outpatient clinics on designated clinic days for their routine appointment were surveyed. Their demographics, levels of anxiety, blood glucose levels and coexisting medical complications were measured. Pearson’s correlations and t-tests were used to analyse the data. RESULTS: 19.5% of the sample population had mild to moderate levels of anxiety. The analyses indicated that diabetics with coexisting medical conditions had higher anxiety levels (p = .038); and women were more likely to have higher levels of anxiety than men (p = .002). CONCLUSION: Anxiety may potentially exacerbate the complications associated with diabetes. Attention should be given to the psychological symptoms associated with type 2 diabetes and the implementation of screening for anxiety at health clinics in an effort to effectively treat type 2 diabetes in Trinidad.

Self-monitoring of blood glucose improved glycemic control and the 10-year coronary heart disease risk profile of female type 2 diabetes patients in Trinidad and Tobago

BACKGROUND and AIM: The risk of death from coronary heart disease (CHD) in women with diabetes is more than three times that of non-diabetic women. We assessed the difference in CHD risk levels of Afro-Caribbean diabetic women provided with facilities for self-monitoring of blood glucose and their counterparts without such facilities. MATERIALS and METHODS: Forty-nine patients who never used gluco-meters were studied as intervention (23) and control (26) groups. The intervention group was trained on self-monitoring of blood glucose. At baseline, BP, anthropometric indices, and fasting blood glucose of all patients were measured. Subsequently, the intervention patients were provided with gluco-meters, testing strips, and advised to self-monitor fasting and postprandial blood glucose every other day for 6 months. CHD risk was determined with the United Kingdom Prospective Diabetes Study risk engine calculator. RESULTS: The age, duration of diagnosis of diabetes, BP, and anthropometric indices were similar in the two groups (all, P > 0.05). The majority of the patients were unemployed or retired with only primary education. After 3 months, the HbA 1c levels of the control patients did not change (8.3 ñ 0.4% vs. 7.8 ñ 0.4%, P > 0.05) whereas the HbA 1c levels of the intervention patients reduced significantly from the baseline at 3 (9.2 ñ 0.4% vs. 7.4 ñ 0.3%, P <0.001) and 6 (9.2 ñ 0.4% vs. 7.3 ñ 0.3%, P <0.001) months. The 10-year CHD risk level of the intervention group was remarkably reduced from the baseline level after 6 months (7.4 ñ 1.3% vs. 4.5 ñ 0.9%) of the study. CONCLUSION: Provision of facilities for self-monitoring of blood glucose in Afro-Caribbean women with type 2 diabetes improves both their glycemic control and CHD risk profile.

Plasma adiponectin levels are related to obesity, inflammation, blood lipids and insulin in type 2 diabetic and non-diabetic Trinidadians

AIMS: To determine the relationship between plasma adiponectin levels and obesity, inflammation, blood lipids and insulin resistance in type 2 diabetics (T2DM) and non-diabetics in a patient population in Trinidad. METHODS: A cohort study of a total of 126 type 2 diabetic (42 males and 84 females) and 140 (43 males and 97 females) non-diabetic public clinic attendees were assessed between December 2008 and July 2009. Along with clinical history and anthropometry, adiponectin, TNF-α, IL-6, CRP, lipid profile, glucose, and insulin were measured in fasting blood samples and insulin resistance (HOMA-IR) was calculated. RESULTS: Diabetics had higher (p<0.05) glucose, insulin, HOMA-IR, triglycerides (TG), VLDL and systolic blood pressure than non-diabetics, but lower (p<0.05) HDL and adiponectin levels. Adiponectin levels were lower (p<0.05) in obese than in non-obese individuals regardless of diabetic status. There were significant gender differences in HDL, LDL and TG. Among non-obese persons, adiponectin correlated negatively with triglycerides (r=-0.280; adiponectin), IL-6 (r=-0.216; p<0.005), HOMA-IR (r=-0.373; p=000) and positively correlated with HDL (r=0.355; p=0.000). Diabetic status (p=0.025), TNF-α (p=0.048) and BMI (p=0.027) were identified as useful predictors of adiponectin by multiple linear regression methods. In addition binary logistic regression analysis found glucose (p=0.001) and adiponectin (p=0.047) to be useful indicators of type 2 diabetes. CONCLUSIONS: Adiponectin decreases with increasing adiposity and insulin resistance. Adiponectin and TNF-α appear to be related to differences in the insulin mediated glucose turnover.

Sodium glucose Co transporter 2 (SGLT2) inhibitors: a new sword for the treatment of Type 2 Diabetes Mellitus

The low affinity sodium glucose cotransporter (SGLT2) plays a major role in physiology of glucose re-absorption from proximal part of kidney. Almost all glucose excreted through glomerular filtration, is re-absorbed via SGLT2 until blood glucose level reaches to its threshold value for glucose excretion i.e. - 180mg/dl. Increasing the glucose excretion by inhibiting the SGLT2 is the novel approach for the treatment of diabetes. Safe and normal life of patients having familial renal glucosuria due to SLC5A2 gene mutation is accelerating the development of SGLT2 inhibitors. Weight loss and very low risk of hypoglycemia are the potential benefits of these inhibitors. There are number of molecules in this class under the stage of development.

Pharmacy practice in the diabetes care team - a quality and economic approach for the Caribbean

As the number of people with diabetes increases, the disease with it's complications takes an ever-increasing toll on health care budgets. It is projected to become one of the world's main disablers and killers by 2025. In the Caribbean the rates of diabetes are also projected to continue to climb rapidly. Immediate action is needed to prevent the rise of new diabetics and instill cost-effective interventions in patients with established diabetes. A multidisciplinary team approach is recommended in the provision of diabetes care. The benefits of this approach to diabetes management are well established globally. A "pharmacist-managed" diabetic clinic operating in collaboration with health care team has extended quality and cost-effective services to diabetic population. In the Caribbean, the multidisciplinary team needs an improved collaborative approach within which the vital role of pharmacy practitioner can be defined. The objective of this study is to recommend evidence-based approaches that Caribbean pharmacists as members of diabetes multidisciplinary team, can adopt in order to develop pharmacist-managed diabetes practice. A literature search was conducted from 1995 to present. Of the 49 studies identified only 14 met the inclusion criteria. There were no published studies on diabetes disease management by pharmacists in the Caribbean. The selected studies were reviewed to determine the primary care functions that Caribbean pharmacists should opt to introduce in a pharmacist managed diabetes practice and thereby assist with quality of care and cost effectiveness. Studies from several countries have confirmed the improved quality of health care and positive impact on costs that pharmacists' involvement had on the management of diabetic patients. A Caribbean pharmacist-managed diabetic practice can result in a meaningful and sustained impact on the diabetes epidemic and its escalating cost to regional health systems.

Prediction of 10-year coronary heart disease risk in Caribbean type 2 diabetic patients using the UKPDS risk engine

OBJECTIVE: Primary prevention of Coronary Heart Disease (CHD) in diabetic patients should be based on absolute CHD risk calculation. This study was aimed to determine the levels of 10-year CHD risk in Caribbean type 2 diabetic patients using the diabetes specific United Kingdom Prospective Diabetes Study (UKPDS) risk engine calculator. SUBJECTS AND METHODS: Three hundred and twenty-five (106 males, 219 females) type 2 diabetic patients resident in two Caribbean Islands of Tobago and Trinidad met the UKPDS risk engine inclusion criteria. Records of their sex, age, ethnicity, smoking habit, diabetes duration, systolic blood pressure, total cholesterol, HDL-cholesterol and glycated haemoglobin were entered into the UKPDS risk engine calculator programme and the absolute 10-year CHD and stroke risk levels were computed. The 10-year CHD and stroke risks were statistically stratified into <15%, 15-30% and >30% CHD risk levels and differences between patients of African and Asian-Indian origin were compared. RESULTS: In comparison with patients in Tobago, type 2 diabetic patients in Trinidad, irrespective of gender, had higher proportion of 10-year CHD risk (10.4 vs. 23.6%, P<0.001) whereas the overall 10-year stroke risk prediction was higher in patients resident in Tobago (16.9 vs. 11.4%, P<0.001). Ethnicity-based analysis revealed that irrespective of gender, higher proportion of patients of Indian origin scored >30% of absolute 10-year CHD risk compared with patients of African descent (3.2 vs. 28.2%, P<0.001). CONCLUSIONS: The results of the study identified diabetic patients resident in Trinidad and patients of Indian origin as the most vulnerable groups for CHD. These groups of diabetic patients should have priority in primary or secondary prevention of coronary heart disease.

Insulin resistance, leptin and monocyte chemotactic protein-1 levels in diabetic and non-diabetic Afro-Caribbean subjects

AIM: To determine how the levels of leptin and monocyte chemotactic protein-1 (MCP-1) are associated with insulin resistance (IR) in obese, non-obese, diabetic and non-diabetic subjects. METHODS: 112 type 2 diabetics and 43 non-diabetics were studied fasting. Anthropometric indices were measured and glucose, insulin, leptin and MCP-1 were measured in blood. IR was calculated. RESULTS: MCP-1 level was significantly higher in diabetics than non-diabetics irrespective of gender (p < 0.05). Irrespective of diabetes status, the serum leptin concentration was significantly higher (p < 0.05) in obese and females subjects than in non-obese and male subjects respectively. There were no significant correlations between IR and MCP-1 or leptin in all subgroups of subjects studied. General linear modelling analysis showed that only diabetes state significantly predicted MCP-1 levels (p < 0.05) whereas non of the factors predicted leptin levels (p > 0.05). CONCLUSION: Routine measurement of leptin and MCP-1 would be potentially useful in assessment of patients for the metabolic syndrome or coronary heart disease especially in black population.