Counting the cost of diabetic hospital admissions from a multi-ethnic population in Trinidad.
ABSTRACT Many middle-income countries are experiencing an increase in diabetes mellitus but patterns of morbidity and resource use from diabetes in developing countries have not been well described. We evaluated hospital admission with diabetes among different ethnic groups in Trinidad. We compiled a register of all patients with diabetes admitted to adult medical, general surgical, and ophthalmology wards at Port of Spain Hospital, Trinidad. During 26 weeks, 1447 patients with diabetes had 1722 admissions. Annual admission rates, standardized to the World Population, for the catchment population aged 30-64 years were 1031 (95% CI 928 to 1134) per 100,000 in men and 1354 (1240 to 1468) per 100,000 in women. Compared with the total population, admission rates were 33% higher in the Indian origin population and 47% lower in those of mixed ethnicity. The age-standardized rate of amputation with diabetes in the general population aged 30-64 years was 54 (37 to 71) per 100,000. The hospital admission fatality rate was 8.9% (95%CI 7.6% to 10.2%). Mortality was associated with increasing age, admission with hyperglycaemia, elevated serum creatinine, cardiac failure or stroke and with lower-limb amputation during admission. Diabetes accounted for 13.6% of hospital admissions and 23% of hospital bed occupancy. Admissions associated with disorders of blood glucose control or foot problems accounted for 52% of diabetic hospital bed occupancy. The annual cost of admissions with diabetes was conservatively estimated at TT+ 10.66 million (UK 1.24 million pounds). In this community diabetes admission rates were high and varied according to the prevalence of diabetes. Admissions, fatalities and resource use were associated with acute and chronic complications of diabetes. Investing in better quality preventive clinical care for diabetes might provide an economically advantageous policy for countries like Trinidad and Tobago.
- SourceAvailable from: Chidum E Ezenwaka[Show abstract] [Hide abstract]
ABSTRACT: To compare the blood pressure and metabolic parameters of type 2 diabetic patients with high waist circumference (WC) with those of type 2 diabetic patients with normal WC. After 10-14 h overnight fasting, weight, height, waist and hip circumferences and blood pressure were measured, and blood samples taken for glucose, glycated haemoglobin, total cholesteroL triglyceride, HDL-cholesterol, LDL-cholesterol and insulin determinations. Insulin resistance was calculated using the homeostatic model assessment (HOMA) method, while high WC was considered as WC > 102 cm and 89 cm for males and females, respectively. Two primary care clinics in Trinidad, West Indies. 190 confirmed type 2 diabetic patients with mean duration of 9.2 years were studied. About 75% and 17% of female and male patients, respectively, had high WC. Although blood pressure and lipid levels did not differ (p > 0.05) between patients with high and normal WC, the former group of patients had significantly higher mean levels of basal insulin and insulin resistance in each gender group (p < 0.001). However, female patients had an overall higher prevalence rate of hypercholesterolaemia (75% vs 52%) and higher LDL-cholesterol (84% vs 68%) than male patients (p < 0.001). Although there was similarity in the control of blood pressure and metabolic parameters irrespective of WC, patients with high WC might be at a comparatively higher risk of cardiovascular disease owing to greater basal insulin resistance. Early detection and treatment of abdominal obesity should therefore be encouraged in the primary healthcare setting.Scandinavian Journal of Primary Health Care 09/2002; 20(3):177-82. · 1.91 Impact Factor
- BMJ Clinical Research 02/1997; 314(7076):305. · 14.09 Impact Factor
- BMJ Clinical Research 02/1997; 314(7076):301-2. · 14.09 Impact Factor