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 ± 0.4% vs. 7.8 ± 0.4%, P > 0.05) whereas the HbA 1c levels of the intervention patients reduced significantly from the baseline at 3 (9.2 ± 0.4% vs. 7.4 ± 0.3%, P <0.001) and 6 (9.2 ± 0.4% vs. 7.3 ± 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 ± 1.3% vs. 4.5 ± 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.

Glycated haemoglobin A1c measurement in stored whole blood sample is reliable for clinical use.

Glycated haemoglobin A1c (HbA1c) gives an integrated plasma glycaemia for the previous 2-3 months and its measurement is central in the management of diabetic patients. However in many developing countries because kits/regents or expertise for HbA1c measurement are not always available and the test must be conducted on fresh whole blood samples, HbA1c tests are not routinely performed Thus, this study aimed to determine if the degradation products from whole blood sample storage are significant enough to compromise the diagnostic value of HbA1c measurements. Two hundred and thirty-one fresh whole blood samples with pre-determined HbA1c values were stored at between 2-8 degrees C and using boronate affinity immunoassay technique, HbA1c values were then measured in the same whole blood samples after 20 days of storage. The results showed that there were no significant differences in the mean values of the initial HbA1c measurement and the values obtained after storage (7.5 +/- 2.0 vs. 7.5 +/- 2.1, p > 0.05) and this was irrespective of gender. Furthermore, irrespective of gender there were significant correlations between the HbA1c values measured in fresh whole blood samples and values obtained after storage (r = 0.83, p < 0.01). Therefore, based on these findings and other previous reports, the effect of storage degradation product was not significant enough to compromise the clinical or research use of HbA1c test results from stored whole blood samples. However, we recommend that diagnostic laboratories should evaluate their HbA1c measurement techniques for HbA1c determination in stored whole blood samples. Any persistent upward or downward bias in stored whole blood samples should be reported to guide the physician in interpreting HbA1c results from stored whole blood samples from that laboratory and/or technique.

A comparative study of the prevalence of the metabolic syndrome and its components in type 2 diabetic patients in two Caribbean islands using the new International Diabetes Federation definition.

BACKGROUND AND AIM: Tobago and Trinidad are two Caribbean islands with distinct genetic background and lifestyles; while Tobago is serene and a tourist centre, Trinidad is characterized by a hustling and bustling lifestyle. The study was aimed at determining and comparing the prevalence of the metabolic syndrome (MetS) and its critical components in type 2 diabetic patients using the new International Diabetes Federation (IDF) definition. METHODS: Four hundred and thirteen (166 Tobago, 247 Trinidad) type 2 diabetic patients visiting 10 lifestyle disease clinics were studied. Blood pressure, anthropometric parameters (height, weight, body mass index and waist circumference) and overnight fasting blood samples were taken. Plasma glucose and serum triglycerides, total cholesterol, LDL- and HDL-cholesterol, insulin, and adiponectin were determined. Insulin resistance (IR) was determined using the HOMA method. RESULTS: The patients in Tobago were significantly older than patients in Trinidad (p < 0.001) but the duration of diabetes (9.4 +/- 0.5 vs. 11.1 +/- 0.7 yr), medications, generalized (31.7 vs. 38.8%) and central (78.5 vs. 83.7%) obesity were similar (p > 0.05). In comparison with patients in Tobago, diabetic patients in Trinidad, irrespective of gender, had significantly higher prevalence of IDF critical components such as raised BP, raised triglycerides and reduced HDL-cholesterol (all, p < 0.001). Thus, while more patients in Trinidad were diagnosed with MetS based on three or four components, more patients in Tobago were diagnosed based on two components (p < 0.001). CONCLUSIONS: There were high prevalence rates of the components of the MetS in both the islands of Tobago and Trinidad. Quantitatively, the aggregation of the components is higher in patients in Trinidad, which constitute greater risk for adverse cardiovascular outcome. Controlling central obesity should be the target in preventing MetS in the two islands.

Serum adiponectin levels and enzyme markers of liver dysfunction in diabetic and non-diabetic Caribbean subjects.

Low adiponectin levels are associated with elevated plasma alanine aminotransferase, a marker of reduced hepatic insulin sensitivity and a risk factor for type 2 diabetes. This study aims to determine the relationship between serum adiponectin level and alanine aminotransferase in diabetic and non-diabetic subjects. Fifty-six type 2 diabetic patients and 33 non-diabetic subjects participate in the study. Baseline plasma concentrations of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and glucose are measured on a chemistry analyser. Insulin and adiponectin are measured using enzyme-linked immunoassay techniques and insulin resistance is determined using the homeostatic model assessment method. Diabetic patients showed significantly lower levels of serum adiponectin than did the non-diabetic subjects, whereas levels of alanine aminotransferase and alkaline phosphatase were similar in both groups. While female non-diabetic subjects showed higher serum adiponectin levels than did female diabetic patients, alanine aminotransferase level did not differ (P>0.05). No significant relationship was seen between adiponectin and alanine aminotransferase in diabetic and non-diabetic subjects (P>0.05). Serum adiponectin levels were higher in non-diabetic subjects but there was no significant correlation between adiponectin and alanine aminotransferase in both groups of subjects. The data suggest that low serum adiponectin level may not be a suitable marker for impaired liver function in diabetic patients.

Caribbean female patients with type 2 diabetes mellitus have lower serum levels of adiponectin than nondiabetic subjects.

BACKGROUND: Previous studies in other populations suggest that low levels of serum adiponectin may be a cardiovascular risk factor. We aimed to determine the baseline concentration of serum adiponectin and its relationship with selected biochemical risk factors for coronary artery disease (CAD) in a cross-section of Caribbean patients with type 2 diabetes. METHODS: Anthropometric indices and fasting plasma concentrations of glucose, insulin, adiponectin, triglyceride, and total and HDL cholesterol were measured in 56 type 2 diabetic patients and 33 nondiabetic subjects. Insulin resistance (IR) was determined using the homeostatic model assessment (HOMA) method. RESULTS: Consistent with previous reports, Caribbean type 2 diabetic patients had significantly lower fasting serum adiponectin levels and higher mean levels of glucose, triglyceride and IR than the nondiabetic subjects (all, p < 0.01). The nondiabetic female subjects had significantly higher serum adiponectin levels than did the female diabetics or nondiabetic males (p < 0.01). Serum adiponectin level was negatively correlated with triglyceride or LDL cholesterol and positively related with HDL cholesterol among nondiabetic subjects, and the latter relationship persisted after adjusting for the effects of age, sex and BMI (r = 0.70, p < 0.01). CONCLUSION: Similar to reports from other populations, Caribbean patients with type 2 diabetes, particularly the females, have lower levels of serum adiponectin than their nondiabetic counterparts and this is an additional CVD risk factor for the patients.

The prevalence of insulin resistance and other cardiovascular disease risk factors in healthy elderly southwestern Nigerians.

We assessed the prevalence of coronary heart disease (CHD) risk factors including insulin resistance in 500 (205 males, 295 females) healthy elderly (age > 55 years) indigenous, low socioeconomic group Yorubas residents in either an urban slum (n = 240) or a rural town (n = 260) in southwestern Nigeria. Anthropometric indices, blood pressure and fasting plasma levels of glucose, lipids, insulin and insulin resistance were measured. The results indicated that: (i) gross obesity (4.4%), diabetes (1.6%), hyperlipidaemia (0.2%) and cigarette smoking (4.8%) were relatively uncommon in the population, although the prevalence of hypertension (30%) was higher than previously reported from this population; (ii). the subjects had a relatively high prevalence of multiple CHD risk factors (about 20% had > 4 risk factors), an observation considered paradoxical in view of the reportedly low CHD prevalence in this population; (iii) these CHD risk factors (increased body mass and blood pressure (BP), hyperinsulinaemia and insulin resistance) were more prevalent in the women and in urban residents; (iv) hyperinsulinaemia (20%) and insulin resistance (35%) were common in the population, and were associated, on regression analyses, to such other CHD risk factors as BP and body mass, particularly in women, suggesting, as in Caucasians, that insulin resistance could be an important index of CHD risk; and (v) the excess of multiple CHD risk factors in the women, is due at least in part, to their increased tendency to obesity (8%) and reduced physical activity (83%). This study concludes that: (i) despite the high prevalence of multiple risk factors in this population, CHD prevalence is low, indicating the supremacy of such major risk factors as diabetes and hyperlipidaemia (relatively uncommon here) in the development of CHD; and (ii) potentially the greatest CHD risk is in the elderly women especially if relatively overweight, physically inactive and resident in an urban centre. While further confirmatory studies are necessary in younger subjects and across societal socioeconomic strata, our results nonetheless suggest that attempts to maintain the CHD prevalence at low levels in this population should include efforts directed at reducing excess body weight particularly in women, and advice on maintenance of a traditional diet to keep lipid levels and diabetes prevalence low.

Increased risk of cardiovascular disease in newly diagnosed type 2 diabetic patients in a primary health care center in Trinidad.

The prevalence of cardiovascular diseases (CVD) has increased sharply in the developing countries and because Type 2 diabetic patients are at increased risk for CVD, we assessed CVD risk factors in newly diagnosed Type 2 diabetic patients presenting in a primary health care center in Trinidad. Fasting and 2 h postprandial blood samples were collected from 387 (269 females, 118 males) newly diagnosed Type 2 diabetic patients (mean age: 53.1+/-6.6 years) for the determination of plasma glucose, creatinine, cholesterol (chol), triglyceride (TG) and % glycated hemoglobin (HbA(1c)) concentrations. Blood pressure and anthropometric indices were also measured. There were high prevalence rates of obesity (37%), overweight (35%), hypertension (21%), hypercholesterolemia (25%) and hypertriglyceridemia (22.3%) among the patients and these were significantly higher in women than men (P<0.001). Patients of Indian descent had a significantly higher prevalence of diastolic hypertension and hypertriglyceridemia compared with patients of African origin or mixed race (P<0.001). In comparison with males, female diabetic patients were at greater risk of cardiovascular morbidity and mortality. Early detection of CVD risk factors and treatment, particularly in women, may be beneficial management strategy in all local diabetic clinics in Trinidad.

Glucose and insulin responses to intravenous glucose challenge in relatives of Nigerian patients with non-insulin-dependent diabetes mellitus.

We analysed blood insulin and glucose concentrations before and during frequently sampled intravenous glucose tolerance tests (FSIGT) in 2 groups of Nigerian subjects: (A) Control group (n = 18), without a positive family history of diabetes mellitus, and (B) Experimental group (n = 16), comprising age-, sex- and body mass-matched first-degree relatives of patients with non-insulin-dependent diabetes mellitus (NIDDM). In comparison with Group A subjects, those in Group B had: (i) higher fasting plasma glucose level (mean +/- S.E.M. 4.1 +/- 0.1 vs. 3.8 +/- 0.11 mmol/l, P < 0.05); (ii) similar fasting serum insulin levels (6.7 +/- 5.0 vs. 5.8 +/- 5.6 mU/l, P = NS); (iii) lower mean incremental area under the first-phase (t = 0-10 min) post-glucose challenge insulin curve (376.9 +/- 8.8 vs. 435.6 +/- 5.6 mU/min l-1, P < 0.05); (iv) increased incremental area under the second-phase (t = 10-182 min) post-glucose challenge insulin curve (432.9 +/- 11.5 vs. 161.3 +/- 8.7 mU/min l-1, P < 0.05); (v) reduced KG rate constant of glucose elimination (0.97 +/- 0.12 vs. 1.41 +/- 0.12%/min, P < 0.05). These results suggest that the subjects with a positive family history of NIDDM have a reduced beta-cell insulin secretory reserve (from reduced first-phase insulin response), tendency to rebound hyperinsulinemia during the latter phase of the insulin secretory response, a degree of tissue insulin insensitivity (as evident from high fasting plasma glucose despite similar insulin levels) and a diminished glucose disposal rate, in comparison with subjects without a family history of NIDDM. These features predict subsequent development of diabetes and suggest that as in Caucasians, first-degree relatives of Nigerian patients with NIDDM are at greater risk for future development of the disease.

Differences in glycemic control and cardiovascular risk in primary care patients with type 2 diabetes in West Indies.

There are limited resources and facilities at primary care clinics in most developing countries. Medical professionals are often faced with the challenges of providing standard health care delivery in the absence of adequate resources. We aimed to evaluate the long-term glycemic control and risk of cardiovascular disease in multi-ethnic groups of diabetic patients attending primary care clinics in Trinidad. One hundred and ninety-one (127 females, 64 males, mean age 56.6 years) patients with type 2 diabetes (mean duration 9.2 years) attending primary care clinics in Trinidad were studied after a 12 to 14-h overnight fast. Weight, height, waist and hip circumferences, and blood pressure were measured, and a blood sample was taken for glucose, glycated hemoglobin, total cholesterol, triglycerides, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol. and creatinine determinations. About 85% of patients had glycated hemoglobin levels >7.0%, 31% had central obesity, 49% had diastolic blood pressure >83 mmHg, while 40% had a total-cholesterol/high-density lipoprotein-cholesterol ratio greater than 6. In comparison with males, female patients had significantly higher levels of total-cholesterol and low-density lipoprotein-cholesterol independent of obesity (P<0.01) while male patients of East Indian descent had the highest risk of cardiovascular disease compared with males of any other ethnic group (P<0.01). In conclusion patients with type 2 diabetes attending primary care clinics in Trinidad had poor glycemic control. Female and male patients of Indian ethnic group were at the highest risk of cardiovascular disease. Efforts at strict glycemic control and protection against microvascular complications should be intensified at primary care levels.

Patients' health education and diabetes control in a developing country.

We previously reported poor metabolic control in type 2 diabetic patients attending 2 primary care clinics in Trinidad. In an attempt to explain the poor metabolic control, we assessed primary care patients' theoretical knowledge of diabetes control and risk factors. Two hundred fifty-four diabetic out-patients recruited consecutively were asked by questionnaire: (i) if they were aware that family history of diabetes, obesity, physical inactivity and cigarette smoking were diabetes risk factors; (ii) if they knew the benefits of weight loss, exercise and healthy diet in diabetes management, and (iii) what where their common sources of diabetes health information. Although the majority of the patients (81.1%) were unaware that cigarette smoking is a diabetes risk factor, a majority were aware that obesity (66.3%), physical inactivity (73.5%) and being a relative of a diabetic patient (78.7%) constitute diabetes risk factors. Again, the majority of the patients were aware that healthy diet (94.9%), exercise (94.5%) and weight loss (87.4%) are beneficial in diabetes control. While media (48.6%) was the commonest source of diabetes information, doctors and nurses were consulted by 39.9% and 11.0% of patients, respectively. Type 2 diabetic patients in these clinics were well informed about diabetes risk factors and benefits of healthy lifestyle. Given our recent reports on poor metabolic control, application of this theoretical knowledge in controlling their diabetes remains doubtful.

Studies on plasma lipids in industrial workers in central Trinidad and Tobago.

We assessed the plasma lipid profiles and other cardiovascular disease (CVD) risk factors in 187 (147 men, 47 women) apparently healthy employees of the Caribbean ISPAT industry in Trinidad and Tobago. Anthropometric indices and fasting plasma levels of total cholesterol (T-chol), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were measured. The results indicate that: there was increased body mass and relative hyperlipidemia in the population studied, these CVD risk factors (increased body mass, increased blood T-chol, TG, and LDL) were more prevalent in men than women (p < 0.05), and these parameters did not differ significantly (p < 0.05) when compared among the three ethnic groups (African and Indian descendants and mixed descents). These features suggest a greater risk of CVD in men than in women. It is likely that this observation in the industrial workers might reflect the situation in the general population especially in men. Although further confirmatory studies are necessary across societal socioeconomic strata within Trinidad, we suggest that efforts should be directed at reducing excess body weight among the workers, and providing advice on increased complex carbohydrate diet in place of saturated fat.

Differences in cardiovascular disease risk factors in elderly and younger patients with type 2 diabetes in the West Indies.

OBJECTIVE: To assess the cardiovascular disease (CVD) risk factors in elderly (> or = 60 years) and younger patients with Type 2 diabetes visiting two primary care clinics in Trinidad. MATERIALS AND METHODS: Fasting blood samples were taken from one hundred and ninety-one (127 females, 64 males) patients with Type 2 diabetes visiting two primary care clinics between 1 January and 30 April 2000. Anthropometric indices, blood pressure, plasma glucose, serum lipids and insulin were measured. Homeostasis Model Assessment (HOMA) was used to assess basal insulin resistance (IR). RESULTS: Of the 191 patients studied, 58.6% were <60 years old while 41.4% were > or = 60 years old. The younger patients had higher prevalence rates of cigarette smoking and use of alcoholic drinks (p < 0.05). The female younger patients had significantly higher mean body mass index (BMI), glycated haemoglobin (HbA1c), triglyceride, total-cholesterol, fasting plasma glucose and IR than the elderly female patients (p < 0.05). Similarly, the younger male patients had significantly higher mean HbA1c, creatinine, fasting plasma glucose, IR and lower HDL-cholesterol levels than the elderly male patients (p < 0.05). Generally, the younger patients had significantly higher prevalence rates of hypertriglyceridaemia, obesity, poorer glycaemia and blood pressure control. CONCLUSION: The results indicate that younger patients withType 2 diabetes had poorer metabolic control and higher prevalence rates of CVD risk factors than the elderly patients. The greater risk of CVD in younger patients was not independent of gender and ethnicity.

Metabolic control of type-2 diabetic patients commonly treated with sulphonylureas in a developing country.

BACKGROUND: Previous reports suggest that currently available drugs used in the treatment of type 2 diabetes do not sustain glycaemic control. OBJECTIVE: To assess metabolic control in type 2 diabetic patients predominantly treated with sulphonylurea drugs at primary care clinics in a developing country. DESIGN: Descriptive. SETTING: Two primary care clinics in Trinidad, West Indies. SUBJECTS: One hundred and seventy nine (117 females and 62 males), randomly selected, type 2 diabetic patients. PROTOCOL: Body weight, height, blood pressure (BP), waist and hip circumferences were measured and fasting blood samples taken for glycated haemoglobin (HbA1c, glucose, insulin and lipids determinations. Fasting insulin and glucose concentrations were used to assess insulin resistance and sensitivity (%S) using Homeostasis model assessment (HOMA) method. RESULTS: Of the 179 patients studied, 87% of male and 92% of female patients were treated with sulphonylurea drugs whereas 13% and 9% of male and female patients respectively were managed on diet and/or exercise. Female patients had significantly higher prevalence of obesity than males, and despite similar fasting glucose and HbA1c, levels, the females and patients of East Indian ethnic group had significantly higher prevalence rates of insulin resistance, hypercholesterolaemia, hypertriglyceridaemia and reduced HDL-cholesterol than the males and patients of African origin respectively. CONCLUSION: Consistent with previous reports, the results showed indications of poor metabolic control among the patients particularly females and patients of East Indian ethnic group.

A preliminary study of the indices of obesity among a select group of apparently healthy Caribbean subjects.

The purpose of this study was to assess the anthropometric indices of obesity among apparently healthy Caribbean subjects who have the potentials of living an affluent lifestyle. One hundred and eleven (38 males, 73 females) young adults aged between 17 and 38 years participated in the study. Subjects provided information on age, ethnic group, educational attainment, occupation, and previous record of body mass index (BMI) and family history of diabetes mellitus in a self-administered research questionnaire. Waist and hip circumferences (cm), weight (kg) and height (m) were measured. Subsequently, BMI and waist-to-hip ratio (W/H) were calculated. The majority of the subjects (83%) had never measured their BMI. Although the male subjects were significantly taller and heavier than the females (p < 0.01), there was no significant difference in the prevalence rates of obesity between the male and female subjects (p > 0.05). In this preliminary study there was a trend for more females than males to be underweight (BMI < 20 kg/m2). The male subjects had significantly higher waist circumference than the females (p < 0.01), but both genders had a similar percentage of male and female subjects with increased waist circumference (p > 0.05). The limitations of this study are its small size and self selection bias and hence the results obtained must be interpreted with caution. We suggest that assessment of body mass index should be incorporated in the routine clinical measurements of all patients to facilitate early identification, evaluation and treatment of overweight and obesity.

Classical cardiovascular risk factors in Trinidadian patients with type 2 diabetes mellitus are not influenced by the level of plasma glycaemia.

The aim of this study is to assess the plasma glycaemia of patients attending the diabetes mellitus outpatients' clinics in Trinidad and to determine how different plasma glycaemia would affect cardiovascular disease (CVD) risk factors. One hundred and ninety-one patients (64 males, 127 females, mean age 56.6 +/- 0.8 yr) with Type 2 diabetes mellitus (mean duration 9.2 +/- 0.6 yr) attending diabetes mellitus clinics from January to April 2000 participated in the study. Anthropometric indices (weight, height, waist and hip circumferences) and blood pressure were measured and overnight fasting blood samples were collected for glycated haemoglobin (HbA1c), glucose, lipids (triglyceride, total cholesterol, LDL-cholesterol, HDL-cholesterol) and creatinine determinations. The patients were categorized into Group 1 ('well controlled'; HbA1c < 7.0%) and Group 2 ('poorly controlled'; HbA1c > 7.0%). Although the majority (85%) of patients were poorly controlled', there were no significant differences in the age, duration of diabetes mellitus, body mass index and waist/hip ratios between the two groups of patients (p > 0.05). Similarly, the blood pressure and lipid (total cholesterol, HDL-cholesterol, LDL-cholesterol) levels did not differ between the two groups (p > 0.05) although triglyceride (1.4 +/- 0.1 vs. 2.2 +/- 0.1 mmol/L) levels were higher in patients in Group 2 compared with Group 1 (p < 0.05). Multiple linear regression analysis indicates that the levels of blood pressure, lipid and anthropometric parameters were not significantly dependent on the plasma glycaemia of the patients (p > 0.05). Analysis of the data has shown that the majority of patients with Type 2 diabetes mellitus attending primary care clinics in Trinidad had poor glycaemic control. The poorly controlled patients had similar levels of CVD risk factors to 'well controlled' patients although the former were potentially at greater risk of progressing to cardiovascular disorder than 'well controlled' patients.

Postprandial glucose control in Type 2 diabetic patients visiting two different primary care clinics in Trinidad, West Indies.

The aim of this study was to determine the differences in postprandial glucose levels between Type 2 diabetic patients visiting two different primary care clinics after ingestion of three carbohydrate test foods. Thirty-eight Type 2 diabetic patients visiting the Chaguanas and Arima Lifestyle Disease Clinics and 27 healthy non-diabetic subjects were studied on three different occasions, seven days apart, after an overnight fast. On each day of the study, anthropometric indices were measured and after collecting fasting blood samples, subjects randomly consumed three pre-selected carbohydrate test foods: bread, roti or rice within 10 minutes and water taken as wished. Subsequently, seven millimetres of venous blood samples were collected at 60, 90, 120 and 150 minutes for insulin, glucose and lipid determinations. Age, body weight, body mass index, waist and hip circumferences did not differ between the healthy subjects and diabetic patients or between patients of the two clinics (p > 0.05). The mean fasting and 2.5-hour postprandial glucose values for the patients visiting the Chaguanas clinic were higher, after consuming at least one test food, than those of patients visiting the Arima clinic (p < 0.05). The mean HbA1c, and 2.5-hour glucose levels for the diabetic patients visiting either of the two clinics exceeded the internationally recommended cut-off values; this is worst in patients visiting the Chaguanas clinic. It is suggested that primary care physicians should start by targeting glycaemic control based on international standards while a more aggressive diabetes dietary education should be reinforced at the clinics, especially Chaguanas.

Early metabolic defects for developing diabetes mellitus among offspring of patients with type 2 diabetes are independent of gender.

The aim of the study was to investigate if the female offspring of patients with Type 2 diabetes have more metabolic defects for developing diabetes mellitus than their male counterparts. Thirty-four offspring (10 males, 24 females) of patients with Type 2 diabetes mellitus aged 28.9 +/- 1.5 years (mean +/- SEM) underwent a standard oral glucose tolerance tests (OGTT; 75 g glucose in 300 ml water). Anthropometric indices, plasma lipids and blood pressure were measured while insulin resistance (IR) and sensitivity (%S) were assessed using the Homeostasis Model Assessment (HOMA) method. All the offspring had normal glucose tolerance but high HOMA-derived IR values (27.2 +/- 4.2 vs. 22.5 +/- 2.7 pmol/mmol/l, p > 0.05) and low %S (48.1 +/- 5.1 vs. 50.6 +/- 3.9%, p > 0.05), all of which did not differ on gender comparisons. Multiple linear regression analyses suggest that gender had no influence on the outcome of the result (p = 0.37). Again, body mass index (BMI), fasting serum insulin, plasma glucose, triglyceride, total cholesterol, HDL-cholesterol and LDL-cholesterol were all similar in both genders (p > 0.05). The results suggest that though the offspring manifested metabolic defects for developing diabetes in later life, this susceptibility is independent of gender in the population studied. Further studies with a larger sample size are warranted to confirm these findings in this population.

Pattern of adrenocortical response to the stress of severe illness in Nigerians.

Twenty-eight severely ill, hospitalized Nigerian patients, 18 males and 10 females with a median age of 41 years (group I) and 20 stable ambulatory patients, 11 males and 9 females with a median age of 42.5 years (group II), had early morning plasma cortisol measurements. Ten healthy young Nigerian males with a mean age of 22.1 years (group III) had plasma cortisol estimations during insulin tolerance test. The mean (+/- SD) cortisol values for the three groups in nmols/l were as follows: group I--389.3 (202.4), group II--267.1 (67.4), group III-624.5 (81.1). The results for the group III healthy controls represent the peak (60 mins) value during insulin induced hypoglycemic stress. A one way analysis of variance (ANOVA) demonstrated a statistically significant difference between the three mean cortisol values, P < 0.001. A pair-wise comparison using the t-test also showed significant differences between the groups, P < 0.05 in each case. An important observation was the variable pattern of cortisol stress response in different types of illnesses. Cases of stroke appeared to be associated with increased cortisol stress values (Z-score + 5.67) while patients with hypotension (B.P. < or = 90/60) and those on Rifampicin had reduced cortisol responses (Z-scores - 3.66 and 3.51 respectively). However, no firm recommendations can as yet be made regarding the usefulness of corticosteroids in life-threatening illnesses among Nigerians, other than those for which steroids are known to beneficial.

Is diabetes patients' knowledge of laboratory tests for monitoring blood glucose levels associated with better glycaemic control?

AIM: To determine if there is any difference in indices of glycaemic control between type-2 diabetes patients who knew the laboratory tests for monitoring blood glucose and their peers who did not know. METHODS: Eighty-nine type-2 diabetes patients were studied after an overnight fast. The patients' bio-data, blood pressure, anthropometric indices and baseline biochemical parameters and glycated haemoglobin A1c (HbA1c) were measured. After a breakfast of stewed boiled rice, a 2-hour postprandial blood glucose was measured and a questionnaire administered. RESULTS: The patients' mean ± SD HbA1c level was 8.6 ± 2.4% and none of the patients knew about HbA1c test for monitoring glycaemic control. Interestingly, patients who knew about fasting blood glucose test had significantly lower HbA1c values than their counterparts who did not know (8.1 ± 2.2 vs. 9.1 ± 2.5%, p < 0.05). CONCLUSION: Diabetes self-management education incorporating laboratory-based information may assist to prevent poor glycaemic control in developing countries with increasing reports of hyperglycaemic emergencies.

Perceptions of Caribbean type 2 diabetes patients on self-monitoring of blood glucose.

CONTEXT: The views of type 2 diabetes (T2DM) patients have not been considered in the debate on the role of self-monitoring of blood glucose (SMBG) in the management of T2DM. OBJECTIVE: To assess the views of T2DM patients on SMBG. METHODS: Two previously trained research assistants used a structured pre-tested questionnaire to interview 416 T2DM patients practising SMBG in out-patient clinics in the privacy of the patients after they have consented to be interviewed. RESULTS: 79% of patients were unemployed with mean duration of diabetes of 11.8 ± 0.5 year. 94% of patients did not have health insurance policies while 86% did not belong to any diabetes support group. Although 70% of the patients identified SMBG as expensive, 94% believed it assists glycaemic control, while 89% thought it was worth the expense. CONCLUSION: Caribbean T2DM patients believe SMBG was beneficial for the management of their diabetes and empowering them may reduce diabetes complications.