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.
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ABSTRACT: Integrating information about the glycaemic index (GI) of foods into the Caribbean diet is limited by the lack of data. Therefore, we determined the GI of eight staple foods eaten in the Caribbean and the effect on GI of crushing selected tubers. Groups of eight to ten healthy volunteers participated in three studies at two sites. GI was determined using a standard method with white bread and adjusted relative to glucose. The mean area under the glucose response curve elicited by white bread was similar for the different groups of subjects. In study 1, the GI of cassava (Manihot esculenta; 94 (sem 11)) was significantly higher than those of breadfruit (Artocarpus altilis; 60 (sem 9)), cooking 'green' banana (Musa spp.; 65 (sem 11)) and sadha roti (65 (sem 9)) (P=0.018). There was no significant difference in the GI of the foods in study 2: dasheen (Colocasia esculenta var. esculenta; 77 (sem 10)), eddoes (Colocasia esculenta var. antiquorum; 61 (sem 10)), Irish potato (Solanum tuberosum; 71 (sem 8)), tannia (Xanthosoma sagittifolium; 60 (sem 5)) and white yam (Dioscorea alata; 62 (sem 6)), and, in study 3, crushing did not significantly affect the GI of dasheen, tannia or Irish potato. However, when the results from studies 2 and 3 were pooled, the GI of dasheen (76 (sem 7)) was significantly greater than that of tannia (55 (sem 5); P=0.015) with potato being intermediate (69 (sem 6)). We conclude that dasheen and cassava are high-GI foods, whereas the other tubers studied and sadha roti are intermediate-GI foods. Given the regular usage of cassava and dasheen in Caribbean diets we speculate that these diets would tend to be high GI, although this could be reduced by foods such as sadha roti and white yam. The range of GI between the staples is sufficiently large that health benefits may be accrued by replacing high-GI staples with intermediate-GI staples in the Caribbean diet.British Journal Of Nutrition 07/2004; 91(6):971-7. DOI:10.1079/BJN20041125 · 3.34 Impact Factor
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ABSTRACT: Diabetes is reaching epidemic proportions in Caribbean territories, and steadily increasing rates have been reported in the English-speaking Caribbean. The prevalence of type 2 diabetes is growing in children and adolescents. Studies from Jamaica, Trinidad, and Barbados indicate that glycemic control in patients evaluated in various clinical settings is suboptimal, giving rise to concerns about mortality, morbidity, and quality of care. Acute diabetes-related illnesses inflict a heavy disease burden particularly in ocular complications, renal failure, and amputations, resulting in notable bed occupancy in hospitals. To address the continued poor quality-of-life and disease complications, guidelines for the management of diabetes in primary care in the Caribbean were published in 1996 and a revised version became available in 2006. Following the first edition, studies suggested that disease outcomes were not favorably influenced, and even after the second edition, a report from Trinidad indicated that current standards of care do not meet the recommendations in the guidelines. This paper looks at the quality of care in a Caribbean nation in relation to that advocated in the guidelines and uses examples from a specialty center in Trinidad and a primary care practice in the United Kingdom (UK) to illustrate that guideline-based care can be achieved.