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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

Relationship between adiponectin and metabolic variables in Caribbean offspring of patients with type 2 diabetes mellitus.

AIM: To examine the relationship between adiponectin and metabolic variables in the offspring of patients with type 2 diabetes mellitus. METHODS: Fasting blood samples and anthropometric indices were taken from 34 subjects, offspring of patients with type 2 diabetes, and 24 healthy control subjects without any immediate family history of diabetes. Plasma glucose and serum adiponectin, insulin, triglycerides, total cholesterol, HDL and LDL cholesterol levels were measured, and insulin resistance (IR) was calculated based on the homeostasis model assessment (HOMA) method. RESULTS: Offspring and control subjects were sex-matched, but the offspring were older and had higher body mass index and waist circumference than the control subjects (p < 0.05). The offspring had significantly higher mean fasting plasma glucose concentrations; however, their mean serum insulin, adiponectin, triglyceride, total cholesterol, HDL and LDL cholesterol and HOMA-derived IR levels did not significantly differ from those of the control subjects (p > 0.05). While the negative correlation between serum adiponectin and HDL cholesterol levels in the offspring remained statistically significant after adjusting for the effect of age, sex and BMI (r = -0.37, p < 0.05), the negative correlation between adiponectin and serum triglyceride, LDL cholesterol or IR levels became non-significant after controlling for the above variables (p > 0.05 in all cases). CONCLUSION: The correlation between adiponectin and some known biochemical risk factors for developing diabetes and cardiovascular disease in the offspring of patients with diabetes warrants further study to evaluate its potential in assessing the risk of developing these disorders.

Relationship between adiponectin and metabolic variables in Caribbean offspring of patients with type 2 diabetes mellitus.

AIM: To examine the relationship between adiponectin and metabolic variables in the offspring of patients with type 2 diabetes mellitus. METHODS: Fasting blood samples and anthropometric indices were taken from 34 subjects, offspring of patients with type 2 diabetes, and 24 healthy control subjects without any immediate family history of diabetes. Plasma glucose and serum adiponectin, insulin, triglycerides, total cholesterol, HDL and LDL cholesterol levels were measured, and insulin resistance (IR) was calculated based on the homeostasis model assessment (HOMA) method. RESULTS: Offspring and control subjects were sex-matched, but the offspring were older and had higher body mass index and waist circumference than the control subjects (p < 0.05). The offspring had significantly higher mean fasting plasma glucose concentrations; however, their mean serum insulin, adiponectin, triglyceride, total cholesterol, HDL and LDL cholesterol and HOMA-derived IR levels did not significantly differ from those of the control subjects (p > 0.05). While the negative correlation between serum adiponectin and HDL cholesterol levels in the offspring remained statistically significant after adjusting for the effect of age, sex and BMI (r = - 0.37, p < 0.05), the negative correlation between adiponectin and serum triglyceride, LDL cholesterol or IR levels became non-significant after controlling for the above variables (p > 0.05 in all cases). CONCLUSION: The correlation between adiponectin and some known biochemical risk factors for developing diabetes and cardiovascular disease in the offspring of patients with diabetes warrants further study to evaluate its potential in assessing the risk of developing these disorders.

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.

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.

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.