Evaluation of a home kit blood glucose monitoring device

A blood glucose monitoring device, the *Diascan, is commonly used in Trinidad and Tobago. A prospective study was conducted to examine the accuracy of a Diascan unit in measuring blood glucose levels in or capillary venous blood of patients in a hospital ward. The Diascan measurements were compared to those from two laboratories which independently measured the venous blood or the venous plasma glucose levels. Although there was reasonably good correlation between measurements from the two laboratories (r=0.85) results from the Diascan showed poor correlations with those from the laboratories, with Pearson's correlation coefficients ranging from 0.32 to 0.64. An error grid analysis showed that the Diascan measurements would have resulted in inappropriate decisions relating to treatment regimens in 26 percent of cases. The results suggest that, when crucial deisions have to be made with respect to patients' blood glucose levels, it may be risky to rely solely on measurements from the Diascan.(AU)

Ethnic composition, age and sex, together with location and standard of housing as determinants of HTLV-I infection in an urban Trinidadian community

The presence of antibody to human T-cell leukaemia virus (HTLV-I) has been assessed in 2,143 men and women who represent 83 percent of all adults aged 35 to 69 years resident in a defined urban community in Trinidad. Individuals of African descent had a higher sero-positivity rate (7.0 percent) than those originating from India (1.4 percent), Europe (0 percent) or of mixed descent (2.7 percent). Women were infected more frequently than men, and the prevalence of infection increased with age in both sexes. Sero-positivity rates were significantly increased in adults who lived in housing of poor quality (p less than 0.001) or close to water courses (p less than 0.025). These data and others raise the possibility that one route of HTLV-I transmission may be via insect vectors under particular domestic circumstances.(AU)

Nutritional status of first-year primary school students of Trinidad and Tobago: standardized prevalence of undernutrition - abstract

In Trinidad and Tobago, the Health Centre data base is inadequate to determine nutritional status of children under 5 years of age. However, nutritional status of children now entering primary school (4-6 years old) was expected to more accurately reflect the nutritonal history of children 0-4 years of age. Established anthropometric techniques and WHO recommendations for interpretation and presentation of such data were used in the study. A stratified randomized sample of children attending their first year at primary school was selected. Overall, 7.1 percent of 3,417 children were undernourished or wasted (>-2SD from median weight-for-height), while on the basis of height-for-age, 2.7 percent were stunted. Applying the correction factor recommended by WHO gave a "true" prevalence of wasting of 4.8 percent and of stunting of 0.48 percent. However, there were two area-pockets of chronic undernutrition/social deprivation where the "true" and 3.4 prevalence of wasting was 10.7 percent and 8.6 percent, respectively, and the "true" prevalence of stunting was 2.1 percent and 3.4 percent, respectively. First-year primary school children in Trinidad and Tobago are subject to short-term undernutrition which is more serious in some areas of the country than in others and more frequent among children 6 years of age and older (AU)

Ethnicity and other characteristics predictive of coronary heart disease in a developing community; principal results of the St. James survey, Trinidad

A ten year community survey was undertaken to investigate the high coronary heart (CHI) incidence among people of Indian (South Asian) descent in Trinidad, West Indies. Of 2491 individuals aged 35-69, 2215 (89 percent) were examined and 2069 (83 percent) found to be clinically free of CHD at baseline. After exclusion of 71 of minority ethnic groups, 786 African, 598 Indian, 147 European and 467 adults of mixed descent were followed for CHD morbidity and mortality. In both sexes, adults of Indian origin had higher prevalence rates of diabetes mellitus, a low concentration of high density lipoprotein(HDL) cholesterol, and recent abstinence from alcohol than other ethnic groups. Indian men also had larger skinfold thicknesses than other men. In participants free of CHD at entry, the age-adjusted relative risk of a cardiac event believed due to CHD, was at least twice as high in Indian men and women as in other ethnic groups. In men, blood pressure, diabetes mellitus and low-density lipoprotein(LDL) cholesterol concentration were positively and independently related to risk of CHD, wheras alcohol consumption and HDL cholesterol concentration were inversely associated with risk after allowing for age and ethnic group. The ethnic contrast in CHD persisted when these characteristics were taken into account. In the smaller sample of women, only ethnic groups were predictive of CHD as defined. The failure of point estimates of risk to explain the high CHD incidence in Indians calls for focus on age of onset of risk and examination of other potential risk factors such as insulin concentration. (AU)

Ethnicity and other characteristics predictive of coronary heart disease in a developing community: principal results of the St. James survey, Trinidad

A ten-year community survey was undertaken to investigate the high coronary heart disease(CHD) incidence among people of Indian(South Asian) descent in Trinidad, West Indies. Of 2491 individuals aged 35-69 years, 2215(89 percent) were examined and 2069(83 percent) found to be clinically free of CHD at baseline> After exclusion of 71 of minority ethnic groups, 786 African, 598 Indian, 147 European 467 adults of Mixed descent were followed for CHD morbidity and mortality. In both sexes, adults of Indian descent had higher prevalences rates of diabetes mellitus, a low concentration of high-density lipoprotein (HDL) cholesterol, and recent abstinence from alcohol than other ethnic groups. Indian men also had larger skinfold thickness than other men. In participants free of CHD at entry, the age adjusted relative risk of a cardiac event believed due to CHD was at least twice as high in Indian men and women as in other ethnic groups. In men , blood pressure, diabetes mellitus and low-density lipoprotein (LDL) cholesterol concentration were positively and independently related to risk of CHD, whereas alcohol consumption and HDL cholesterol concentration were inversely associated with risk after allowing for age and ethnic group. The ethnic contrasts in CHD persisted when these characteristics were taken into account. In the smaller sample of women, only ethnic group was predictive of CHD as defined. The failure of point estimates of risk to explain the high CHD incidence in Indians calls for focus on age of onset and examination of other potential risk factors such as insulin concentration (AU)

Adult male all-cause, cardiovascular and cerebrovascular mortality in relation to ethnic group, systolic blood pressure and blood glucose concentration in Trinidad, West Indies

In a prospective survey of 1342 Trinidadian men aged 35 to 69 years at recruitment, age-adjusted mean blood pressures were highest in those of African descent, intermediate in Indians and men of Mixed origin, and lowest in Europeans. Age-adjusted fasting blood glucose concentrations were highest in Indians and lowest in men of European descent. Relative risks of all-cause, cardiovascular and cerebrovascular mortality increased progressively with increasing systolic pressure, whereas for fasting blood glucose concentration the associations were U-shaped. No ethnic differences were apparent in relative risk. For systolic pressure, mortality from all-causes and cardiovascular diseases respectively were about two and three times higher at 180mmHg or more than at pressures below 130 mmHg. For blood glucose, all-cause and cardiovascular mortality were about four times higher at fasting concentrations greater than 7.7 mmol/l than in the lowest risk group (4.2-4.6 mmol/l), All-cause population attributable mortality rates for systolic pressures of 130 mmHg or more were 1.3 to 2.8 times higher in Indian men than in other groups. For blood glucose in excess of 4.6 mmol/l, population attributable mortality was between 2.9 and 6.9 times higher in Indians than in other groups. The findings emphasized the high mortality in men of Indian descent, partly due to an apparent underlying predisposition to cardiovascular disease, and partly to their high prevalence of diabetes mellitus. (AU)

Adult male all-cause, cardiovascular and cerebrovascular mortality in relation to ethnic group, systolic blood pressure and glucose concentration in Trinidad, West Indies

In a prospective survey of 1342 Trinidadian men aged 35 to 69 years at recruitment, aged-adjusted mean blood pressures were highest in those of African descent, intermediate in Indians and men of Mixed origin, and lowest in Europeans. Age-adjusted fasting blood glucose concentrations were highest in Indians and lowest in men of European descent. Relative risks all-cause cardiovascular and cerebrovascular mortality increased progressively with increasing systolic pressure, whereas for fasting blood glucose concentration the association were U-shaped. No ethnic difference were about two and three times higher at 180 mmHg or more than at pressures below 130 mmhg. For blood glucose, all cause and cardiovascular mortality were about four times higher at fasting concentrations.7.7 mmol/i than in the lowest risk group (4.2-4.6 mmol.l). All cause population attributable mortality rates for systolic pressures of 130 mmhg or more were 1.3 to 2.8 times higher in Indian men than in other groups. For blood glucose in excess of 4.6 mmol/l, population attributable mortality was between 2.9 and 6.9 times higher in Indians than in other groups. The findings emphasized the high mortality in men of Indian descent, partly due to an apparent underlying predisposition to cardiovascular disease, and partly to their high prevalence of diabetes mellitus. (AU)

Estimation of glycosylated haemoglobin by a procedure appropriate for general laboratory conditions in the Caribbean: the St. James Cardivasculary Survey - abstract

Glycosylation of haemoglobin was measured in 759 women who comprised a subsample of those that took part in the St. James Cardiovascular Survey. A colorimetric assay was utilized. The glucose moiety of glycosylated haemoglobin was converted to 5-hydroxymethylfurfural was then measured by reaction with 2-thiobarbituric acid. Glycosylation of haemoglobin was expressed as æmol/l of fructose. A mean concentration of 52.2 æmol/l (sd 8.4) was obtained for non-diabetic women while in diabetic women the mean concentration was 68 æmol/l (sd 14.8). There was a significant correlation between fasting blood glucose level and glycosylated haemoglobin (r = 0.74, p =.05). This procedure gave an inter-assay co-efficient of variation of 3.6 percent and an intra-assay co-efficient of variation of 2.4 percent. As a screening device for diabetes, the method has a sensitivity of 70 percent and a specificity of 96 percent (AU)

High total and cardiovascular disease mortality in adults of Indian descent in Trinidad, unexplained by major coronary risk factors

A prospective survey has been undertaken of a total community of 1343 men and 1149 women, aged 35-69 years at recruitment, living in Port-of Spain, Trinidad. By comparison with adults of African descent, age-adjusted relative risks of death from all causes and from cardiovascular diseases were significantly increased in those of Indian origin (0.5 and 0.3, respectively). Adults of European descent had an all-cause and cardiovascular mortality relative risk of 0.8 and 2.1, respectively. These ethnic differences in risk were not explained by systolic blood pressure, fasting blood glucose concentration, serum high-density lipoprotein or low-density lipoprotein concentration, or smoking habits. Differences in risk of cardiovascular death between Indian and European men seemed to be accounted for by the high prevalence of diabetes in Indians (19 percent) but other ethnic contrasts in mortality were unrelated to diabetes mellitus. (AU)

High total and cardiovascular disease mortality in adults of Indian descent in Trinidad, unexplained by major coronary risk factors

A prospective survey has been undertaken of a total community of 1343 men and 1149 women, aged 35-69 years at recruitment, living in Port-of-Spain, Trinidad. By comparison with adults of African descent, age-adjusted relative risks of death, from all causes and from cardiovascular diseases were significantly increased in those of Indian origin (1.5 and 2.6, respectively) and reduced in those of mixed descent (0.5 and 0.3, respectively). Adults of European descent had an all-cause and cardiovascular mortality relative risk of 0.8 and 2.1, respectively. These ethnic differences in risk were not explained by systolic blood pressure, fasting blood glucose concentration, serum high-density lipoprotein or low-density lipoprotein concentration, or smoking habits. Differences in risk of cardiovascular death between Indian and European men seemed to be accounted for by the high prevalence of diabetes in Indians (19 percent) but other ethnic contrasts in mortality were unrelated to diabetes mellitus (AU)

HLA antigens in diabetics of African descent in Trinidad - abstract

The pattern of HLA distribution was studied in one hundred and fifteen Trinidadian diabetics of African ancestry. Insulin-dependent diabetes (IDDM) patients showed a positive association with HLA - A11 and B5 antigens (p<0.05) with relative risks of 5.9 and 3.2 respectively. In addition, HLA -B8 showed a positive but not statistically significant deviation, while HLA - B12 showed a negative association (relative risk 0.27). There was no association found between HLA -B15 and IDDM. Maturity-onset diabetics (MODM) showed positive association with HLA - B5 (p <0.025 and relative risk 2.93), and a significant negative association with HLA - A2, A3 and A9. In most populations, strong associations may be found between certain HLA antigens and IDDM, the associations" varying depending on the ethnicity of the population. Interestingly, no association has been observed between HLA antigens and MODM in Caucasian populations. However, several workers have observed significant deviations of HLA antigens in indigenous African MODM patients. In addition, the inconsistency of HLA antigen associations with IDDM in persons of African ancestry compared to that in Caucasians has led to the suggestion that diabetes mellitus in native Africans is genetically different from that in Caucasians. Our findings would tend to support this view (AU)

Ethnic differences in all-cause and cause-specific mortality among adults in Trinidad: The St. James Cardiovascular Survey - abstract

The St. James Cardiovascular Survey was established in 1977 to examine the relations of conventional risk factors to subsequent all-cause and cause-specific morbidiy and mortality among adults aged 35-69 years at recruitment. Up to April 30, 1985, 178 deaths were recorded among 1,343 male subjects and 80 deaths among 1,079 female subjects. After adjusting for age differences, risk of death from all causes was significantly associated with ethnic group in men (xý of 3 = 16.8, p<0.001) and women (xý of 3 = 13.2, p < .005). Risk was 55 percent and 45 percent higher for Indian men women relative to African men and women. Risk for Mixed subjects was lowest compared to African (40 percent lower in males, 60 percent lower in females). Cardiovasular diseases and malignant neoplasms were the major causes of death in men (70 percent) of total deaths) and women (62 percent of total deaths). Among men, cardiovascular disease was the principal cause of death in all ethnic groups but made a greater contribution to total mortality amon Indian (60 percent) and European (70 percent) men than in the African and Mixed (37 percent) men than in Indians (9 percent) and Europeans (7 percent). A similar pattern was observed in women. After adjusting for age, risk of death from heart disease was more than twice as high for Indian men as for African. Ethnic group was not associated with mortality from either cerebrovascular disease or malignant (AU)

Efficacy and safety of medium term indapamide treatment in hypertensive diabetic patients

To assess the efficacy and safety of Indapamide, 33 maturity onset diabetics with essential hypertension were treated with Indapamide for 90 days at the single daily dose of 2.5 mg. These patients responded well to treatment: as early as the tenth day, the diastolic blood pressure decreased by 10 mm Hg (p<0.01). At the second month, blood pressure on average was normalized. At the third month, the blood pressure decrease was 16 mm Hg for diastolic and 25.5 mm Hg for systolic. The two-hour post-breakfast blood sugar level was not significantly modified, nor were the other biological parameters monitored: serum creatinine, serum uric acid and serum potassium levels. Indapamide at 2.5 mg per day is effective and safe in hypertensive diabetic patients (AU)

Obesity in women in an urban Trinidad community: prevalence and associated characteristics

Triceps skinfold, body mass index (BMI), blood pressure, blood/glucose concentration and serum lipoprotein concentrations were measured in 590 (80 percent) of 738 women aged 35-69 years resident within a defined area of Port of Spain, Trinidad. A triceps skinfold of 32 mm or more (the 70th percentile of overall distribution) was found in 36 percent of women of African descent and 28 percent of women of other ethnic origin. Respective figures for a BMI of 30.0 kg/mý or more were 32 percent and 27 percent at ages 46 to 64 years. Obesity was associated with an increase in blood pressure, increased fasting blood glucose, LDL cholesterol and VLDL triglyceride concentrations, and a reduction in HDL cholesterol concentration. Obese women had an increased tendency to a history of early menarche, multiparity and children of high birth weight. These findings suggested that, irrespective of ethnic origins, the effects of obesity on health in this female population resembled those in white North American women. (AU)