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

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

Breast Cancer in the Bahamas in 2009-2011.

BACKGROUND: Breast cancer is the most common form of cancer affecting women in the Bahamas, which consists of many islands. This is the first attempt to identify which island has the highest occurrence of breast cancer. OBJECTIVE: The aim of this study was to describe the sociodemographical and spatial features of breast cancer in the Bahamas in 2009-2011. METHODS: A review of the medical records of all women with a confirmed diagnosis of breast cancer during the period January 1, 2009-December 31, 2011, was undertaken. Data were first obtained from the National Oncology Board of the Bahamas and validated by a review of the medical records. The patient address was geocoded and mapped using ArcGIS 10.0 Environmental Systems Research Institute (ESRI) to satellite images obtained from The Nature Conservancy in the Bahamas. RESULTS: We recruited 270 patients who satisfied the entry criteria. The cumulative incidences of breast cancer for the years 2009-2011 were 51.4, 45.4, and 51.4, respectively. Breast cancer occurred most often in women of African origin with a mean age at diagnosis of 56.6 ± 13.8 years. Ductal carcinoma was the most common histological type observed with most cancers occurring in Grade II or higher and presenting as late stage (≥ Stage II). Surgery was the preferred method of treatment with modified radical mastectomy being the procedure of choice. Spatial distribution of cases across the Bahamas revealed one cluster, which is present on the island of New Providence. Further analysis of New Providence showed a consistently skewed kernel density in the central and eastern regions, compared with a scattered distribution in the southern and western regions. CONCLUSION: The island of New Providence had the highest occurrence of breast cancer among all the islands of the Bahamas. The increasing incidence of breast cancer in young women is likely to impose a significant burden on the future of Bahamian health care.

Detecting alcoholism in primary care among Trinidadians: using the CAGE and AUDIT-C screening tools

OBJECTIVES: To measure the proportion of attendees in a primary care setting consuming alcohol at levels which put them at risk of alcohol-related harm using the CAGE and AUDIT-C Screening tools. DESIGN AND METHODS: A cross-sectional study was used. The population consisted of all adults ≥18 years in a primary care setting. The CAGE and Alcohol Use Disorders Identification Test (AUDIT-C) screening tools were administered to 865 randomly selected participants. RESULTS: Of the 865 participants entered into this study, 514 participants drank alcoholic beverages. Furthermore, 142 (27.6%) were found to be CAGE positive (≥2) where more men (100, 11.5%) than women (42, 4.9%) were CAGE positive. A larger proportion of South-East Asians 60 (11.7%) were found to be CAGE positive than Africans 51 (9.9%) (ρ = 0.6221). For the AUDIT-C, 460 individuals participated with a response rate of 89.5%. With the score ≥ 4 in men, among the male drinkers 150 (32.6%) of the AUDIT-C screens were positive. For women, with the score ≥ 4, 100 (21.7%) of those who drank alcohol, screened positive. A larger proportion of South East Asians 101 (39.2%) were found to be AUDIT-C positive than Africans 105 (42%) (ρ = 0.7893). The Cronbach Alpha values for AUDIT-C and CAGE were 0.792 and 0.636 respectively. CONCLUSION: The CAGE screening tool identified 27.6% of the participants attending primary care facilities to be at risk of developing alcohol related disorders (ARDS). AUDIT-C identified 48.6% of participants to be at risk of developing an ARDS.

The distribution of CY2PC19*2 allele in a Trinidadian population. Is Clopidogrel the right choice?

OBJECTIVE: To determine the distribution of the CYP2C19*2 allele among Trinidadians. DESIGN AND METHODS: This is a cross sectional study among 100 patients attending primary health centers within the North Central Region of Trinidad. A stratified sampling technique was used in which there were three mutually exclusive subgroups: those of South Asian descent (Indo-Trinidadians), African descent (Afro-Trinidadians) and mixed ethnicity. Subsequently, systematic sampling was applied to each stratum to improve the representativeness of the sample. Hence, the 100 subjects recruited for the study were 40 Indo-Trinidadians, 40 Afro-Trinidadians and 20 of mixed descent. Apart from baseline data which included age, gender and ethnicity, DNA was assessed for the CYP2C19*2 allelic variant using a PCR method. RESULTS: There was a high allelic frequency (37%) for CYP2C19*2 which was found to be more common among Indo-Trinidadians (47.5%, 95% CI 32.0-63.0) compared to Afro-Trinidadians (22.5%, 95% CI 9.6-35.4) or people of mixed origin (45%, 95% CI 23.2-66.8). There was a significant difference (p=0.019) between CYP2C19*2 frequencies for Indo-Trinidadians and Afro-Trinidadians. CONCLUSION: We provided evidence that the prevalence of CYP2C19*2 mutation was high in our setting.

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.

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.

Screening for chronic kidney disease in East Trinidad using the National Kidney Foundation guidelines

OBJECTIVE: To screen high risk patients ≥ 45 years attending primary care facilities who have undiagnosed chronic kidney disease (CKD) and identify this group for further intervention. DESIGN AND METHODS: A cross-sectional study design was used, the population consisted of all adults 45 years and older in a primary care setting. A validated questionnaire was administered to all eligible participants. RESULTS: A total of 227 participants were recruited to the study. No participant refused to participate resulting in a 100% response rate. One hundred and five participants (105, 46.3%) were classified as normal and one hundred and twenty two (122, 53.7%) were classified as having Stages 1-3 CKD. Further, 22 (18.0%) participants were found to be in Stage 3 of CKD. CONCLUSION: We provide evidence that screening can detect as much as 18.0% of asymptomatic individuals with Stage 3 CKD.

The occurrence of prediabetes among patients in a PrimaryCare setting in Trinidad

OBJECTICE: To determine the occurrence of pre-diabetes inpatients in a primary care setting in Trinidad and to identifythe risk factors associated with its development. DESIGN AND METHODS: Using a prospective cross-sectionalstudy, 44 patients who met the eligibility criteria where randomlyselected to enter the study. After a 12 hour fast, HbA1c, fastingplasma glucose, HDL and LDL cholesterol were measured, aswell as BMI and waist circumference. RESULTS: Of the 44 sampled participants, 77.3 % (n=34) werefemales and 22.7% (n=10) were males. 23 of the sampledfemales were over the normal weight for their height, and ofthe 8 pre-diabetic females, 75% had a waist circumference of>102cm, signifying abdominal obesity.A higher mean value was obtained for the lipid profile (excludingthe HLDL values) and HbA1c in the pre-diabetic population. CONCLUSION: The proportion of patients with prediabetes was25%. (95% CI 14.6-39.4) BMI, Triglycerides and LDL werefound to have a significant association with pre-diabetes(p=0.014, p=0.004 respectively). There needs to be a higherindex of suspicion for concomitant cardiovascular disease inpre-diabetics. Future interventions for monitoring this high riskgroup should include assessment of cardiometabolic risk factors.

The changing face of death in Trinidad and Tobago, before and after independence.

OBJECTIVES: The aim of this study is to compare the changing patterns of mortality in adults and infants during the pre-independence period 1953-1962 with the post-independence period 1962-2006 thus providing evidence for the burden of disease and the impact of independence on the state of health of the nation. METHODS: The study examined data from 1953-2006, collected under statutory regulations by the Central Statistical Office. RESULTS: While the population doubled during the study period, the standardized death rate improved from 16.4 to 4.5, infant mortality also declined from 70 per 1000 live births to 10.5 per 1000 live births. Mortality from selected infectious diseases also declined, however, mortality from chronic diseases continued to increase. Deaths associated with HIV increased during the 1990s, reaching a peak of 42 per 100 000 population in 2001 before declining. CONCLUSION: Like the developed world, some developing countries have experienced similar transitions in the patterns of disease occurrence and thus will need to develop strategies to effectively cope with these new challenges.

Knowledge, attitudes, practice on human papilloma virus and cervical cancer among Trinidadian women.

Cervical cancer remains a major reproductive health problem among women especially in developing countries where about 190,000 women die from this disease annually. Despite efforts to reduce the burden of this disease, most attempts in low-resourced countries have not been successful partly from lack of awareness by women of this common cancer, as well as the role the human papilloma virus (HPV) plays in its aetiology and pathogenesis. To determine knowledge, attitudes and practice of women in Trinidad (a developing country) on HPV, cervical cancer and the HPV vaccine, we conducted a cross-sectional survey among 426 women in the reproductive age. A majority (58.4%) of participants had attained secondary level education. Whereas 326 (76.5%) women knew of cervical cancer, only 108 (25.4%) were aware of HPV and 68 (15.9%) knew of the association between HPV and cervical cancer. This study highlights the limited awareness of Trinidadian women with respect to HPV and its implication in cervical cancer aetiology. If the scourge of cervical cancer is to be adequately addressed, especially in low-resourced countries, then mass educational programmes on HPV, cervical cancer prevention, including screening and early detection and treatment of pre-cancerous lesions of the cervix, must be given high priority.

The changing face of death in Trinidad and Tobago, before and after independence / La faz cambiante de la muerte en Trinidad y Tobago, antes y después de la independencia

OBJECTIVES: The aim of this study is to compare the changing patterns of mortality in adults and infants during the pre-independence period 1953 - 1962 with the post-independence period 1962 - 2006 thus providing evidence for the burden of disease and the impact of independence on the state of health of the nation. METHODS: The study examined data from 1953 - 2006, collected under statutory regulations by the Central Statistical Office. RESULTS: While the population doubled during the study period, the standardized death rate improved from 16.4 to 4.5, infant mortality also declined from 70 per 1000 live births to 10.5 per 1000 live births. Mortality from selected infectious diseases also declined, however, mortality from chronic diseases continued to increase. Deaths associated with HIV increased during the 1990s, reaching a peak of 42 per 100 000 population in 2001 before declining. CONCLUSION: Like the developed world, some developing countries have experienced similar transitions in the patterns of disease occurrence and thus will need to develop strategies to effectively cope with these new challenges.

OBJETIVOS: El objetivo de este estudio es comparar los patrones cambiantes de mortalidad en adultos y niños durante el periodo de pre-independencia de 1953 - 1962 y el periodo de la post-independencia de 1962 - 2006, y brindar así evidencia en relación con la carga de enfermedades y el impacto de la independencia sobre el estado de salud de la nación. MÉTODOS: El estudio examinó los datos de 1953 - 2006, recogidos bajo regulaciones obligatorias por la Oficina Central de Estadísticas. RESULTADOS: Aunque la población se duplicó durante el periodo de estudio, la tasa de mortalidad estandarizada mejoró de 16.4 a 4.5, la mortalidad infantil también disminuyó de 70 por 1000 nacidos vivos a 10.5 por 1000 nacidos vivos. La mortalidad por enfermedades infecciosas seleccionadas también disminuyó. Sin embargo, la mortalidad de las enfermedades crónicas continuó aumentando. Las muertes asociadas con el VIH aumentaron durante los años 90, alcanzando un pico de 42 por 100 000 de población en 2001 antes de disminuir. CONCLUSIÓN: Al igual que el mundo desarrollado, algunos países en desarrollo han experimentado transiciones similares en los patrones de manifestación de las enfermedades, y por ende necesitarán desarrollar estrategias para hacer frente a estos nuevos desafíos de manera efectiva.

The epidemiology of end stage renal disease at a centre in Trinidad / Epidemiología de la fase terminal de la enfermedad renal en un centro de Trinidad

OBJECTIVE: The aim of this study is to estimate the trends in prevalence of end stage renal disease (ESRD) during the period 1999-2007 at one site in Trinidad, the Eric Williams Medical Sciences Complex (EWMSC), and to describe the epidemiological features, age, gender, ethnicity and co-morbidities associated with ESRD. DESIGN AND METHODS: A retrospective cohort study design was used. There was a count of patients on haemodialysis at the EWMSC centre from 1999 - 2007 in order to demonstrate trends in prevalence but more detailed data were collected and analysed for patients with ESRD attending the nephrology clinic between January 2002 and December 2007. The data that were collected from the patients' records included: demographic data (age, gender and ethnicity), medical history (diabetes mellitus, hypertension, end stage renal disease and autoimmune disorders), history of dialysis (type of vascular access, frequency of dialysis), mortality and its cause. RESULTS: Records of 81 patients were retrieved. Their age range was 10-79 years. The survey showed that patients most affected in the study population were: males, aged 50-59 years, who were hypertensive and/or diabetic and of African descent. CONCLUSIONS: In conclusion, we provide epidemiological evidence of ESRD and the associated contributing factors at one hospital in Trinidad.

OBJETIVO: El objetivo de este estudio es estimar las tendencias de la prevalencia de la enfermedad renal en fase terminal (ERFT) durante el periodo 1999-2007 en el Complejo de Ciencias Médicas Eric Williams, en Trinidad, y describir los rasgos epidemiológicos - edad, género, etnicidad - y co-morbilidades asociadas con la ERFT. DISEÑO Y MÉTODOS: Se usó un diseño de estudio de cohorte retrospectivo. Se llevó a cabo un análisis de todos los pacientes que asistieron a las clínicas de nefrología de EWMSC, de enero de 2002 a diciembre de 2007. Los datos recogidos de las historias clínicas de los pacientes al final del período de estudio incluyeron: datos demográficos (edad, género y etnicidad), historia médica (diabetes mellitus, hipertensión, enfermedad renal en fase terminal, trastornos autoinmunes), historia de diálisis (tipo de acceso vascular, frecuencia de diálisis), mortalidad y causa. RESULTADOS: Se obtuvieron las historias clínicas de 81 pacientes, cuya edad fluctuaba de 10 a 79 años. La encuesta mostró que los pacientes más afectados en la población del estudio fueron varones, de 50-59 años de edad, que eran hipertensos y/o diabéticos, de ascendencia africana. CONCLUSIONES: En conclusión, se ofrece evidencia epidemiológica de la ERFT en un hospital en Trinidad y se señalan los factores asociados que contribuyen a la enfermedad.

Epidemiology of multiple myeloma and the role of M-band detection on serum electrophoresis in a small developing country. A retrospective study.

OBJECTIVE: The objective of the study was to determine the role of M-band component on serum protein electrophoresis and bone marrow biopsy in the diagnosis. METHODS: Data was collected on 34 patients with MM diagnosed and/or treated. RESULTS: There were equal numbers of men 17 (50%) and women 17 (50%). All patients were first screened for the presence of M-Band using serum protein electrophoresis (SPE) followed by bone marrow biopsy as the confirmatory test. Only two patients screened negative by SPE. On the other hand six patients who tested positive by SPE were negative on biopsy. Thus the sensitivity of the SPE was 96% and specificity 71%. This means that 29 patients had an established diagnosis of MM. There was a slight male predominance when compared to females. CONCLUSION: The data showed that the SPE and bone biopsy are the important tools in the diagnosis of multiple myeloma in a small developing country.

The epidemiology of end stage renal disease at a centre in Trinidad.

OBJECTIVE: The aim of this study is to estimate the trends in prevalence of end stage renal disease (ESRD) during the period 1999-2007 at one site in Trinidad, the Eric Williams Medical Sciences Complex (EWMSC), and to describe the epidemiological features, age, gender, ethnicity and comorbidities associated with ESRD. DESIGN AND METHODS: A retrospective cohort study design was used. There was a count of patients on haemodialysis at the EWMSC centre from 1999-2007 in order to demonstrate trends in prevalence but more detailed data were collected and analysed for patients with ESRD attending the nephrology clinic between January 2002 and December 2007. The data that were collected from the patients' records included: demographic data (age, gender and ethnicity), medical history (diabetes mellitus, hypertension, end stage renal disease and autoimmune disorders), history of dialysis (type of vascular access, frequency of dialysis), mortality and its cause. RESULTS: Records of 81 patients were retrieved. Their age range was 10-79 years. The survey showed that patients most affected in the study population were: males, aged 50-59 years, who were hypertensive and/or diabetic and of African descent. CONCLUSIONS: In conclusion, we provide epidemiological evidence of ESRD and the associated contributing factors at one hospital in Trinidad.

Trinidadian women's knowledge, perceptions, and preferences regarding cesarean section: How do they make choices?

OBJECTIVES: The objective of this study is to determine the awareness of perception and attitude toward cesarean section (CS) in a high-user setting. DESIGN AND METHODS: A cross-sectional design using multistage sampling methods was used to select participants from antenatal and postnatal clinics in a primary health care setting in north Trinidad. A multi-item structured questionnaire was designed and administered by in-depth interviews. Sociodemographic data and data about history of previous pregnancies and outcomes and about knowledge and perceptions of CSs were collected from women aged 16 years and older. RESULTS: Of the women who were eligible for entry into the study, 368 participated. However, participants chose not to respond to some questions. The majority of women (46.2%) were found to have very little information from which to make informed decisions about selecting CS as the preferred choice of delivery. Their preference was significantly associated with the perception of safety (maternal or fetal death, P = 0.001), difficulty (complications to mother and baby, P = 0.001), and pain (P = 0.001). Notwithstanding, persons who received information from health care professionals (odds ratio [OR], 1.9; confidence interval, 1.50-2.33) were more likely to have high or adequate levels of information about CSs. Data were analyzed using SPSS software, and ORs were calculated using logistic regression. CONCLUSION: The majority of women attending antenatal and postnatal clinics in north Trinidad were not sufficiently knowledgeable about CS to enable them to make informed choices. In addition, the information obtained was from an unreliable source, emphasizing the need for information on CS to form a component of a structured antenatal education program.

Trinidadian women's knowledge, perceptions, and preferences regarding cesarean section: how do they make choices?

OBJECTIVES: The objective of this study is to determine the awareness of perception and attitude toward cesarean section (CS) in a high-user setting. DESIGN AND METHODS: A cross-sectional design using multistage sampling methods was used to select participants from antenatal and postnatal clinics in a primary health care setting in north Trinidad. A multi-item structured questionnaire was designed and administered by in-depth interviews. Sociodemographic data and data about history of previous pregnancies and outcomes and about knowledge and perceptions of CSs were collected from women aged 16 years and older. RESULTS: Of the women who were eligible for entry into the study, 368 participated. However, participants chose not to respond to some questions. The majority of women (46.2%) were found to have very little information from which to make informed decisions about selecting CS as the preferred choice of delivery. Their preference was significantly associated with the perception of safety (maternal or fetal death, P = 0.001), difficulty (complications to mother and baby, P = 0.001), and pain (P = 0.001). Notwithstanding, persons who received information from health care professionals (odds ratio [OR], 1.9; confidence interval, 1.50-2.33) were more likely to have high or adequate levels of information about CSs. Data were analyzed using SPSS software, and ORs were calculated using logistic regression. CONCLUSION: The majority of women attending antenatal and postnatal clinics in north Trinidad were not sufficiently knowledgeable about CS to enable them to make informed choices. In addition, the information obtained was from an unreliable source, emphasizing the need for information on CS to form a component of a structured antenatal education program.

Is gestational diabetes mellitus an important contributor to metabolic disorders in trinidad and tobago?

Objective. To investigate the incidence of Gestational Diabetes Mellitus at the Mt. Hope Women's Hospital and to describe its epidemiological pattern. Design. A retrospective observational study (Jan 2005 to Dec 2007). Setting. A teaching hospital of The University of the West Indies. Population/Sample. Pregnant women who gave birth. Methods. A sample size of 720. The variables analyzed were: age, ethnicity, BMI of mother, family history of diabetes; history of GDM, obstetric history, birth weight and APGAR score of infant. Main Outcome Measures. (1) Incidence of cases of GDM. (2) Impact of the measured variable. Chi-squares, odds ratios and logistic regression were performed. Results. The incidence of GDM was 4.31% (95% C.I. 2.31%, 6.31%). The proportion of GDM patients for the years 2005, 2006, and 2007 were 1.67%, 4.58%, and 6.67%, respectively. Age, Obesity Ethnicity, Family history of diabetes and a history of GDM were determined risk factors. Associations between GDM and (1) Mode of Delivery and (2) APGAR score of the baby were found. Discussion & Conclusion. There was an apparent increase in the incidence of GDM. Additional studies should be conducted to measure the occurrence of GDM in Trinidad and Tobago. Efforts to promote public awareness and a healthy lifestyle should be made to reverse this trend.

Epidemiological trends of Kawasaki disease among paediatric patients admitted to the Wendy Fitzwilliam Paediatric Hospital, Trinidad, during 2004-2007.

The aim of this study was to determine the epidemiological trends, clinical presentation and outcomes in patients presenting with Kawasaki disease (KD) in Trinidad at the Eric Williams Medical Sciences Complex, a 350-bed teaching hospital, during the years 2004-2007. Using a retrospective study design, data from all established cases during the period 2004-2007 were collected. Overall, 39 confirmed cases of KD occurred in Trinidad and six on the island of Tobago. The majority of patients (40) were 4 years or younger, with a male to female ratio of 2:1. A peak in hospital admissions occurred in 2005, with 15 (33.3%) patients presenting with the disease. A seasonal trend was also observed, with the majority of cases being admitted in the rainy season each year, and a peak of admissions in November. KD is a disease of public health significance in Trinidad and Tobago, affecting predominantly males within the 0- to 4-year age group. Our study emphasises the need for an effective awareness campaign to sensitize both healthcare workers and the general public to KD and its typical presentation. This would raise the level of awareness among physicians and facilitate early diagnosis and treatment.

Is gestational diabetes mellitus an important contributor to metabolic disorders in Trinidad and Tobago?

OBJECTIVE. To investigate the incidence of gestational diabetes mellitus at the Mt. Hope Women's Hospital and to describe its epidemiological pattern. DESIGN. A retrospective observational study (Jan 2005 to Dec 2007). SETTING. A teaching hospital of The University of the West Indies. POPULATION/SAMPLE. Pregnant women who gave birth. METHODS. A sample size of 720. The variables analyzed were: age, ethnicity, BMI of mother, family history of diabetes; history of GDM, obstetric history, birth weight and APGAR score of infant. MAIN OUTCOME MEASURES. (1) Incidence of cases of GDM. (2) Impact of the measured variable. Chi-squares, odds ratios and logistic regression were performed. RESULTS. The incidence of GDM was 4.31 per cent (95 per cent C.I. 2.31 per cent, 6.31 per cent). The proportion of GDM patients for the years 2005, 2006, and 2007 were 1.67 per cent, 4.58 per cent, and 6.67 per cent, respectively. Age, Obesity Ethnicity, Family history of diabetes and a history of GDM were determined risk factors. Associations between GDM and (1) Mode of Delivery and (2) APGAR score of the baby were found. DISCUSSION & CONCLUSIONS. There was an apparent increase in the incidence of GDM. Additional studies should be conducted to measure the occurrence of GDM in Trinidad and Tobago. Efforts to promote public awareness and a healthy lifestyle should be made to reverse this trend.

Taking the next step in 2005, the year of the diabetic foot.

OBJECTIVES: To determine the age-standardized rate of lower limb amputations among Type 2 diabetics admitted to the Port of Spain General Hospital (POSGH), San Fernando General Hospital (SFGH) and Sangre Grande County Hospital (SGCH) for the period 2000-2004. To determine in-hospital mortality following amputation, for the same period. To determine the risk factors that contributed to diabetic foot complications. DESIGN AND METHODS: All patients who had a lower limb amputation at the three major public health institutions in Trinidad during the study period were enrolled. In addition patients attending the surgical out-patient clinic and currently admitted to the ward with a diabetic septic foot was selected for the administration of a questionnaire to determine the major contributing factors. Data on the type of amputation, age, sex, ethnicity, from which an age-standardized mortality rate, was determined for the age group 30-60. RESULTS: Of 822 patient files examined, 515 (80 per cent) of these major amputations were performed on Type 2 diabetics, of which 352 (68 per cent) were AKA and 163 (32 per cent) were BKA. The AKA:BKA ratio for the period 2000-2004 was 2.2:1. There was a significant difference between the mean ages at which females had a major amputation to males (p=0.001). The overall ratio of Africans to South East Asians was 1.5:1 amongst the Type 2 diabetic amputees. For major amputations the average length of stay was found to be 22.5 (0-192) days. The age-standardized rate for the age group 30-60 was 13.85 per 100,000 for 2004. Of 66 deaths, 31 (47 per cent) were septicemia cases and 14 (21 per cent) cardio-respiratory failure cases. Finally, of 97 persons interviewed, the major causative agent for diabetic foot complications and amputations was foot trauma (51 per cent). CONCLUSION: Type 2 diabetic amputation status of Trinidad would seem to have improved as shown by this study.