Year: 2001
Type: editorial
Abstract: The epidemiologic transition in the Caribbean over the last 40 years has p roduced an epidemic of lifestyle-related chronic noncommunicable diseases.Among these are obesity, diabetes, and hypertension, along with such complications as stroke, heart disease, and amputations.The World Health O rganization projects that the number of adults with diabetes in the Americas will double by 2025, and that most of the increase will occur in Latin America and the Caribbean (1).Both obesity and diabetes have been i n c reasing in Barbados (2-4), in Trinidad (5, 6), and in Jamaica (7-9).Obesity (body mass index (BMI) > 30 kg/m 2 ) already occurs in 30% of Barbadian women 25-75 years old, and overweight (BMI > 25 kg/m 2 ) in 57.8% of them (10).Diabetes occurs in 17% of Barbadians over age 40 (2).In Jamaica diabetes occurs in 17% of persons over age 25, according to one study (7), and in 13.4%, according to another study (8).The combination of a rapid i n c rease in calorie intake and a decrease in physical activity, against a backg round of cultural traditions that favor female obesity (11), imposes an unmanageable burden on the limited health care re s o u rces of these small countries of the Caribbean.Enormous research effort has been dedicated to evaluating diabetes care and outcome.There is clear evidence that good glycemic control reduces complications of type 1 diabetes ( 12), but the benefits of improving glycemic control in type 2 diabetes are modest, affecting mainly microvascular outcomes (retinopathy, nephropathy and neuropathy) (13).The United Kingdom Prospective Diabetes Study (UKPDS) has shown that control of hypertension is even more important than glycemic control in determining microvascular outcomes (14).On the other hand, macrovascular (cardiovascular and cerebrovascular) outcomes appear poorly related to glycemic control, and are more likely to be related to the multiple risk factors of obesity, hypertension, hyperlipidemia, and physical activity.Although there are many studies on glycemic control, there are few adequate studies of the benefits of multiple risk factor control, and guidelines for diabetes management are usually based on "expert" consensus rather than hard evidence.A Pan American Health Organization (PAHO) workshop in St. Lucia in 1986 produced a review of the growing problem of diabetes in the Caribbean and guidelines for diabetes management (15).There was, however, no evaluation of the quality of care or control.In 1992 the Commonwealth Caribbean Medical Research Council (now the Caribbean Health Research Council) implemented a project to evaluate quality of care across the Caribbean and to develop updated, regional guidelines.The first report from that study (16) described the findings in Barbados, Trinidad, and Tortola (British Virgin Islands).In this issue of this journal Wilks et al. report the data from three clinics in Jamaica, the largest English-speaking Caribbean island, with a population of 2.6 million-and a struggling economy.Neither of these two studies from the Caribbean is reassuring.Their findings are a major cause for concern, particularly with respect to the public clinics in Jamaica and Trinidad.Only two-thirds of the patients at the public clinic in Jamaica and a mere one-third of the patients in the Trinidadian public clinics had had blood glucose measured at least once in the preceding 12 months.Glycated hemoglobin measurements were not available in those EditorialThe dilemma of diabetes: health care crisis in the Caribbean
Author: Henry S. Fraser
Institution: University of the West Indies
Language: Catalan
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2015801432