Impaired glucose regulation in adults in Jamaica: who should have the oral glucose tolerance test?
ABSTRACT To compare the 1999 World Health Organization (WHO) fasting plasma glucose (FPG) criteria and the WHO 2-hour post-challenge glucose (2hPG) criteria during an oral glucose tolerance test (OGTT) in identifying adults in Jamaica with hyperglycemia. As the OGTT is not commonly used in clinical practice, factors associated with the failure of the FPG criteria to detect persons with impaired 2hPG were investigated.
A random sample of 2 096 adults, 25-74 years old, living in the town of Spanish Town, Jamaica, was evaluated for diabetes. After excluding 215 individuals for reasons such as missing data, the remaining 1 881 persons were composed of 187 who were previously known to have diabetes and 1 694 who were screened for diabetes with both FPG and 2hPG.
The FPG criteria detected 83 cases of diabetes, compared to 72 by the 2hPG criteria. The kappa statistic comparing the two criteria was 0.31 (95% confidence interval: 0.28-0.34), indicating fair agreement. There were 261 cases of impaired glucose tolerance (IGT) and 92 cases of impaired fasting glucose (IFG). In those 92 with IFG, an OGTT would identify 34 cases of IGT and 14 cases of diabetes. Of those classified as normoglycemic by FPG criteria, 14% of them had IGT or diabetes by 2hPG criteria. The factors predicting the likelihood of non-detection of impaired glucose tolerance or diabetes by FPG were age, body mass index, central obesity, systolic blood pressure, and female sex. By receiver operating characteristic curve analysis, an FPG of 5.1 mmol/L would predict a 2hPG >/= 7.8 mmol/L.
A few individuals classified as normal on FPG will have IGT or diabetes, and an OGTT will be needed to identify them. The yield of IGT detected by screening in Jamaica can be improved by lowering the threshold for IFG or by using clinical information to identify high-risk individuals.
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ABSTRACT: Hypertension and obesity are common problems among diabetic patients accelerating progression of vascular diabetic complications. A two-stage stratified random sampling design was used, and individuals aged 15 years and over were interviewed. This cross-sectional study evaluated lipid abnormalities of 117 obese type 2 diabetic patients (28 males and 89 females), and 56 hypertensive obese type 2 diabetic patients (22 males and 34 females). Total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein cholesterol (VLDL-C) and high-density lipoprotein cholesterol (HDL-C) concentrations were assayed using standard biochemical methods. Hypertensive obese type 2 diabetic females had significantly higher mean serum concentrations of TC (p = 0.043), TG (p = 0.046), LDL-C (p= 0.040), TC/HDL-C ratio (p = 0.001) and LDL-C/HDL-C ratio (p = 0.003) compared with hypertensive obese non-diabetic females. Similar results were found in hypertensive obese type 2 diabetic males compared with hypertensive obese non-diabetic males. Hypertensive obese type 2 diabetic females had significantly higher serum TC, TG and TC/HDL-C ratio (p < 0.05) than hypertensive obese type 2 diabetic males. Hypertensive obese type 2 diabetic females had significantly higher mean serum concentrations of TG (p = 0.03) and TC (p = 0.01) than obese type 2 diabetic females. There was a significant association between blood glucose and LDL-C concentrations in type 2 diabetic subjects (r = 0.36; p< 0.05). Obese hypertensive type 2 diabetic females are exposed more profoundly to risk factors including atherogenic dyslipidaemia compared with males.Archives of medical science : AMS. 10/2010; 6(5):701-8.
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ABSTRACT: Developing countries such as Jamaica suffer increasingly from high levels of public health problems related to chronic diseases. To examine the physical health status and use a model to determine the significant predictors of poor health status of Jamaicans who reported being diagnosed with a chronic non-communicable disease. The current study extracted a sub-sample of 714 people from a larger nationally representative cross-sectional survey of 6,783 Jamaicans. A self-administered questionnaire was used to collect the data from the sample. Statistical analysis was performed using chi-square to investigate non-metric variables, and logistic regression to determine predictors of poor health status. Approximately one-quarter 25.3%) of the sample reported that they had poor health status. Thirty-three percent of the sample indicated unspecified chronic diseases: 7.8% arthritis, 28.9% hypertension, 17.2% diabetes mellitus and 13.3% asthma. Asthma affected 47.2% of children and 23.2% of young adults. S ignificant predictors of poor health status of Jamaicans who reported being diagnosed with chronic diseases were: age of respondents, area of residence and inability to work. Majority of the respondents in the sample had good health, and adults with poor health status were more likely to report having hypertension followed by diabetes mellitus and arthritis, while asthma was the most prevalent among children. Improvement in chronic disease control and health status can be achieved with improved patient education on the importance of compliance, access to more effective medication and development of support groups among chronic disease patients.North American journal of medical sciences. 12/2009; 1(7):356-64.
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ABSTRACT: Objectives: The aim of the current study is to examine the health status of elderly in rural, peri-urban and urban areas of residence in Ja-maica, and to propose a model to predict the social determinants of poor health status of elderly Jamaicans with at least one chronic disease. Methods: A sub-sample of 287 re-spondents 60 years and older was extracted from a larger nationally cross-sectional survey of 6783 respondents. The stratified multistage probability sampling technique was used to draw the survey respondents. A self-adminis-tered questionnaire was used to collect the data from the sample. Descriptive statistics were used to examine the demographic characteris-tics of the sample; chi-square was used to in-vestigate non-metric variables, and logistic re-gression was the multivariate technique chosen to determine predictors of poor health status. Results: Almost thirty six percent of the sam-ples had poor health status. Majority (43.2%) of the sample reported hypertension, 25.4% dia-betes mellitus and 13.2% rheumatoid arthritis. Only 35.4% of those who indicated that they had at least one chronic illness reported poor health status and there was a statistical relation be-tween health status and area of residence [χ 2 (df = 4) = 11.569, P = 0.021, n = 287]. Rural residents reported the highest poor health status (44.2%) compared to other town (27.3%) and urban area residents (23.7%). Conclusions: Majority of the respondents in the sample had good health, and those with poor health status were more likely to report having hypertension followed by dia-betes mellitus and rheumatoid arthritis. Poor health status was more prevalent among those of lower economic status in rural areas who re-ported greater medical health care expenditure. The prevalence of chronic diseases and levels of disability in older people can be reduced with appropriate health promotion and strategies to prevent non-communicable diseases.01/2010; 2:101-111.