Diabetes in the Caribbean: Trouble in paradise |
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| Authors: | Michael S Boyne |
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| Institution: | 1. Department of Surgery, San Fernando General Hospital, Trinidad and Tobago;2. Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago;1. Veterinary and Agrochemical Research Centre, National Reference Laboratory (CODA-CERVA), Unit for Coordination of Veterinary Diagnostics, Epidemiology and Risk Analysis (CVD-ERA), Groeselenberg 99, B-1180 Brussels, Belgium;2. Veterinary and Agrochemical Research Centre, National Reference Laboratory (CODA-CERVA), Operational Directorate Viral Diseases, Groeselenberg 99, B-1180 Brussels, Belgium;3. Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium;4. Federal Agency for the Safety of the Food Chain (FASFC), Boulevard du Jardin Botanique 55, 1000 Brussels, Belgium;5. Avia-GIS BVBA, Risschotlei, 33, 2980 Zoersel, Belgium;6. Ghent University of Veterinary Medicine, Laboratory of Veterinary Immunology, Salisburylaan 133, 9820 Merelbeke, Belgium;1. Pan American Health Organization, Washington, DC 20037, USA;1. Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL;2. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL;3. Infection Control, Mayo Clinic, Jacksonville, FL;4. Information Technology Department, Mayo Clinic, Rochester, MN;1. Faculty of Health Sciences, Aarhus University, Denmark;2. Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark;3. Centre for Nutrition and Bowel Diseases, Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark;4. Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark;1. Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA;2. International Diabetes Federation, Brussels, Belgium;3. Department of Biostatistics, Chronic Disease Research Centre, The University of the West Indies, Barbados;4. Ruth and O.C. Hubert Professor of Global Health and Epidemiology, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA |
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| Abstract: | Background: Many developing countries, including countries of the English-speaking Caribbean, are undergoing an epidemiologic transition and experiencing rapid increases in the prevalence of diabetes.Objectives: This article examines the epidemiology of diabetes, the types of diabetes, the etiologic factors and complications of diabetes, and the public health burden associated with diabetes in the Caribbean.Methods: An extensive PubMed literature search was conducted for the period 1951 to 2008 using the search terms diabetes, glucose intolerance, Caribbean, Jamaica, Barbados, Trinidad, Bahamas, Guyana, and the names of all the other English-speaking Caribbean countries.Results: Four hundred articles were identified in the literature search. Of these, 131 original articles were selected for inclusion in this review. Prevalence rates for diabetes ranged from 11% to 18% of the population in several countries. The prevalence of atypical diabetes (ketosis-prone diabetes) may be declining because of increases in the proportions of the population with type 2 diabetes mellitus. Ecologic studies show an east-to-west gradient from West Africa to the Caribbean for obesity and obesity-related diseases. The steep increase in the prevalence of obesity and the increase in sedentarism in Caribbean societies are the main risk factors driving the diabetes epidemic. The roles of early-life origins (specifically, in infants with low birth weight and rapid catch-up growth and/or macrosomic infants) and genetic factors await further clarification in this population. Diabetic foot, nephropathy, and stroke are common complications.Conclusions: In the English-speaking Caribbean, diabetes is a major public health burden that threatens the gross domestic product of these developing island nations. Macroeconomic initiatives are needed to start the combat against diabetes. |
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