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: Seetharaman Hariharan[Show abstract] [Hide abstract]
ABSTRACT: To determine if there is a beneficial effect of bariatric surgery in the management of Diabetes Mellitus in obese patients in a Caribbean setting. A retrospective review of charts of all obese patients with Type-2 Diabetes Mellitus (DM) who had undergone Laparoscopic Roux en Y gastric bypass (LRYGBP) over a 4 year period was undertaken and clinical data recorded. A questionnaire was prospectively administered via telephone to determine the quality of life. Of 146 patients who underwent LRYGBP, 40 were found to have clinically significant DM. Patients of age < 50 years and females had a higher preponderance of DM. Patient body weight decreased significantly from a pre-operative131.2 ± 21.6 [Mean ± Standard Deviation (SD)] to 99.4 ± 16.6 after surgery (p < 0.0001). There was also a significant reduction of BMI from 47.0 ± 7.9 to 34.7 ± 5.8 (p < 0.0001). There was complete resolution of clinically significant DM in 85% of patients, while in 15% there was a significant reduction in the dosage of anti-diabetic medications. Perioperative complications were minimal and there was no mortality. 96% of the patients reported a drastic improvement in their quality of life. Bariatric surgery for obese diabetic patients resulted in complete resolution, improved diabetes control and overall improvement in the quality of life. Due to better outcomes, the surgery can safely be recommended in the Caribbean multiethnic setting where there is a high prevalence of obesity and Diabetes Mellitus.International Journal of Surgery (London, England) 03/2011; 9(5):386-91. · 1.44 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: This study evaluates the epidemiology of diabetic foot infections in an Eastern Caribbean nation in order to direct public health preventive measures. We prospectively identified all patients with diabetic foot infections who were admitted to tertiary care hospitals across Trinidad and Tobago from July 2011 to June 2012. A questionnaire was used to collect data on demographics, patient knowledge, avoidance of risk factors for chronic diseases (a proxy to unhealthy lifestyles), and glycosylated hemoglobin measurements on admission as an index of blood glucose control. The data were analyzed with statistical software. There were 446 patients with diabetic foot infections (mean age = 56.9 years, standard deviation = 12.4 years). Most patients had Type 2 diabetes (93.3%) and were of Indo-Trinidadian (49.1%) or Afro-Trinidadian (41.7%) descent. There were preexisting complications of diabetes in 82.9% of patients with Type 2 diabetes: foot infections requiring hospitalization (70.2%), ischemic heart disease (32.5%), renal impairment (13.7%), and retinopathy (22.1%). Despite most patients claiming compliance with treatment, 75% had glycosylated hemoglobin levels above 7.1% at presentation, and 49.3% continued unhealthy lifestyles. Despite the high prevalence of diabetic complications at admission, and despite 70% having had previous hospitalization for treatment of foot infections, only 57.4% of patients reported ever being counseled or taught about foot care by medical personnel. There is room for improvement in public health strategies to prevent diabetic foot complications in this setting. Such strategies should focus on patient education with emphasis on lifestyle modification and compliance with medical therapy.The Permanente journal 01/2013; 17(2):37-40.
- Diabetology and Metabolic Syndrome 07/2014; 6(77). · 1.92 Impact Factor