Diabetes in the Caribbean

ABSTRACT

For the past 20 years, diabetes mellitus has been among the leading causes of death in the Caribbean. Its prevalence is set to double within the next two decades. Its potential to cause incapacity and premature death in individuals in the prime of their economic life has serious implications for the Caribbean and for developing countries throughout the world. From an epidemiological viewpoint, type 2 diabetes mellitus contributes the major burden, accounting for up to 90 percent of caseload. Not surprisingly, much more data are available for this form of diabetes. Most of the remaining 10 percent of cases are of type 1 diabetes but also part of the picture is J-type diabetes, which was originally introduced to the world literature from Jamaica in the 1950s. It represents an unusual and interesting form of diabetes that has since been recognised outside the region. Increased awareness, improved diagnosis, screening of high-risk individuals and groups, and strategies aimed at prevention of obesity are all crucial. At the same time, there is a need to address the huge gaps in the availability of care, as well as the quality of the care itself. We must face up to a situation which involves increasing disease burden, scarce resources, inaequate services, and poor attention to the quality of care. Cost-effective systems are required that are specific to Caribbean needs. Recent elucidation of the pivotal influence of the in-utero environment in programming future cardiovascular risk offers a strategic leverage point for intervention. Close attention to maternal health, ensuring a healthy fetal environment, could positively influence the next generation (AU)