Counting the Cost of Diabetic Hospital Admissions from a Multi‐ethnic Population in Trinidad

Commonwealth Caribbean Medical Research Council, Ministry of Health, Trinidad and Tobago, UK.
Diabetic Medicine (Impact Factor: 3.12). 01/1996; 12(12):1077-85. DOI: 10.1111/j.1464-5491.1995.tb00424.x
Source: PubMed


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.

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    • "Approximately 15% of the general adult population in Trinidad and Tobago has diabetes mellitus.1 These persons have 0.75% annual risk to develop lower limb infections.1 When they do, they have a high age-standardized amputation rate, approximately 54 per 100,000 between the ages of 30 and 60 years.12 "
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    ABSTRACT: Aim There has been little focus on self-directed treatment for lower limb wounds, although it a common practice among persons with diabetes across the Caribbean. We sought to document this practice in a Caribbean nation. Methods We prospectively interviewed all consecutive patients with diabetes who were admitted with lower limb wounds at the San Fernando General Hospital in Trinidad and Tobago over a period of 18 months. A questionnaire was used to collect data on patient demographics, use of self-directed treatment, and details of these treatments. Results Of 839 persons with diabetes who were admitted with infected lower limb wounds, 344 (41%) admitted to self-directed treatment before seeking medical attention. These patients were predominantly male (59.9%) at a mean age of 56.4±12.4 years. The practice was most common in persons of Afro-Caribbean descent (45.9%) and those with type 2 diabetes (93.9%). In this group, 255 (74.4%) patients were previously admitted to hospital for lower limb infections. And of those, 32 (12.6%) had a prior amputation and 108 (42.4%) had at least one operative debridement specifically for foot infections. Conclusion Caribbean cultural practices may be an important contributor to negative outcomes when treating lower limb wounds in persons with diabetes. Despite being acutely aware of the potentially devastating consequences of inadequate treatment, 41% of our patients with diabetes still opted to use self-directed treatment for lower limb wounds. This deserves further study in order to give a more tailored approach in care delivery.
    Patient Preference and Adherence 09/2014; 8:1173-7. DOI:10.2147/PPA.S68680 · 1.68 Impact Factor
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    • "More recently data from the Trinidad and Tobago Chronic Non-Communicable Disease Risk Factor (Pan American STEPS) Survey showed a prevalence of T2DM of 20% among individuals between 15–64 years of age [4]. Against this background, it is therefore not surprising that T2DM and its complications account for considerable use of resources, bed space and clinical load [5]. "
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    ABSTRACT: Background: This study aimed to evaluate the role of acanthosis nigricans (AN) as a marker of Type 2 Diabetes Mellitus (T2DM) by studying its prevalence and relationship with age, ethnicity, anthropometry and other risk factors for T2DM in the Trinidadian population. Methods: 311 successive adult patients with T2DM were recruited at diabetic clinics and inpatient wards across Trinidad. The presence, severity and texture of AN at the neck were assessed. Demographic, clinical and anthropometric characteristics were also measured, and logistic regression was used to model their relationship with presence of AN. Results: The mean (SD) age was 58.1 years (12.6). 55.6% were female. 61.1% were East Indian, 24.4% African and 14.5% mixed ethnicity. The mean (SD) BMI was 27.3 kg/m(2) (6.0) and the mean (SD) waist circumference was 96.7 cm (14.2). Prevalence of AN was 52.7% (95% CI 47.2, 58.3). THERE WAS A GREATER ODDS OF AN AMONG DIABETIC PATIENTS WHO WERE: younger (p < 0.001); female (OR 1.67; 95% CI 1.06, 2.62); or East Indian rather than African (0.45; 0.26, 0.77) or mixed (0.43; 0.22, 0.84) descendents. There was a greater age-, sex- and ethnicity-adjusted odds of AN among those: overweight (3.98; 2.10, 7.55) or obese (8.31; 3.84, 18.00) versus normal BMI; centrally obese (4.72; 2.65, 8.43); with history of hypertension (2.19; 1.27, 3.79) or history of hypercholesterolemia (1.72; 1.02, 2.90), but there was no evidence of this demographic-adjusted association (p > 0.4) between AN and history of previous MI or CVA, family history of T2DM, T2DM treatment regimen, duration of T2DM or random blood glucose. On further multivariable analysis, only age, sex, ethnicity, BMI and waist circumference were independently associated with AN (p < 0.05) and the effect of BMI varied with ethnicity. Conclusions: There was a high prevalence of AN both overall and across age, sex and ethnic groups of diabetic patients. AN exhibited much potential as a valuable addition to T2DM risk assessment in the Trinidadian and similar settings.
    Diabetology and Metabolic Syndrome 07/2014; 6(77). DOI:10.1186/1758-5996-6-77 · 2.17 Impact Factor
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    • "Patients who reported burning or numbness in the feet or feelings of tiredness, weakness, giddiness or dizziness used folk medicines more frequently than those who reported other symptoms [7]. Subsequent studies by the same authors have discarded folk medicine and focussed on the standards of conventional medical care for diabetes [8-10]. In a 2004 study they found that diabetes was associated with low income status and worse health status and more frequent expenditure on medical services [9]. "
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    ABSTRACT: This paper is based on ethnobotanical interviews conducted from 1996-2000 in Trinidad and Tobago with thirty male and female respondents. A non-experimental validation was conducted on the plants used for urinary problems and diabetes mellitus: This is a preliminary step to establish that the plants used are safe or effective, to help direct clinical trials, and to inform Caribbean physicians of the plants' known properties to avoid counter-prescribing. The following plants are used to treat diabetes: Antigonon leptopus, Bidens alba, Bidens pilosa, Bixa orellana, Bontia daphnoides, Carica papaya, Catharanthus roseus, Cocos nucifera, Gomphrena globosa, Laportea aestuans, Momordica charantia, Morus alba, Phyllanthus urinaria and Spiranthes acaulis. Apium graviolens is used as a heart tonic and for low blood pressure. Bixa orellana, Bontia daphnoides, Cuscuta americana and Gomphrena globosa are used for jaundice. The following plants are used for hypertension: Aloe vera, Annona muricata, Artocarpus altilis, Bixa orellana, Bidens alba, Bidens pilosa, Bonta daphnoides, Carica papaya, Cecropia peltata, Citrus paradisi, Cola nitida, Crescentia cujete, Gomphrena globosa, Hibiscus sabdariffa, Kalanchoe pinnata, Morus alba, Nopalea cochinellifera, Ocimum campechianum, Passiflora quadrangularis, Persea americana and Tamarindus indicus. The plants used for kidney problems are Theobroma cacao, Chamaesyce hirta, Flemingia strobilifera, Peperomia rotundifolia, Petiveria alliacea, Nopalea cochinellifera, Apium graveolens, Cynodon dactylon, Eleusine indica, Gomphrena globosa, Pityrogramma calomelanos and Vetiveria zizanioides. Plants are also used for gall stones and for cooling. Chamaesyce hirta, Cissus verticillata, Kalanchoe pinnata, Peperomia spp., Portulaca oleraceae, Scoparia dulcis, and Zea mays have sufficient evidence to support their traditional use for urinary problems, "cooling" and high cholesterol. Eggplant extract as a hypocholesterolemic agent has some support but needs more study. The plants used for hypertension, jaundice and diabetes that may be safe and justify more formal evaluation are Annona squamosa, Aloe vera, Apium graveolens, Bidens alba, Carica papaya, Catharanthus roseus, Cecropia peltata, Citrus paradisi, Hibsicus sabdariffa, Momordica charantia, Morus alba, Persea americana, Phyllanthus urinaria, Tamarindus indicus and Tournefortia hirsutissima. Several of the plants are used for more than one condition and further trials should take this into account.
    Journal of Ethnobiology and Ethnomedicine 02/2006; 2(1):45. DOI:10.1186/1746-4269-2-45 · 2.00 Impact Factor
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