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: Background: Many developing countries, including countries of the English-speaking Caribbean, are undergoing an epidemiologic transition and experiencing rapid increases in the prevalence of diabetes. Objectives: This article examines the epidemiology of diabetes, the types of diabetes, the etiologic factors and complications of diabetes, and the public health burden associated with diabetes in the Caribbean. Methods: An extensive PubMed literature search was conducted for the period 1951 to 2008 using the search terms diabetes, glucose intolerance, Caribbean, Jamaica, Barbados, Trinidad, Bahamas, Guyana, and the names of all the other English-speaking Caribbean countries. Results: Four hundred articles were identified in the literature search. Of these, 131 original articles were selected for inclusion in this review. Prevalence rates for diabetes ranged from 11% to 18% of the population in several countries. The prevalence of atypical diabetes (ketosis-prone diabetes) may be declining because of increases in the proportions of the population with type 2 diabetes mellitus. Ecologic studies show an east-to-west gradient from West Africa to the Caribbean for obesity and obesity-related diseases. The steep increase in the prevalence of obesity and the increase in sedentarism in Caribbean societies are the main risk factors driving the diabetes epidemic. The roles of early-life origins (specifically, in infants with low birth weight and rapid catch-up growth and/or macrosomic infants) and genetic factors await further clarification in this population. Diabetic foot, nephropathy, and stroke are common complications. Conclusions: In the English-speaking Caribbean, diabetes is a major public health burden that threatens the gross domestic product of these developing island nations. Macroeconomic initiatives are needed to start the combat against diabetes.Insulin 01/2009; 4(2):12.
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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.Health 01/2010; 2:101-111. · 2.10 Impact Factor
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ABSTRACT: Population ageing in Jamaica follows a global trend where the number of persons aged 60 and over is increasing. This study investigated age-specific death rates, mortality sex ratio and health status of the elderly in Jamaica aged 55 years and over. The study utilized secondary data published by the Statistical Institute of Jamaica on mortality and secondary cross-sectional probability survey data were used to model poor health status in elderly residents. The findings revealed that there is increased life expectancy. In 2005, the age-specific mortality rate for elderly 75 years and older was 4.4 times more than that of the crude death rate for the population; 9.4 times more than that of age-specific death rate at ages 55 to 59 years and that disparity narrows at the elderly gets older. The mortality sex ratio revealed that between 115 to 120 males die for every 100 females. More men die between the ages of 55 and 75, than men 75 years and older. As Jamaicans become older than 55 years their poor health status significantly increased. Poor health status was accounted for significantly by hypertension, diabetes mellitus, and arthritis. Eight factors determine poor health status of elderly Jamaicans. Some of these factors are retirement income (OR = 1.461, 95%CI:1.001, 2.131); cost of medical care (OR = 1.144, 95%CI = 1.073, 1.220); area of residence (other towns -OR = 0.754, 95%CI = 0.597, 0.953); marital status (separated -OR = 1.901, 95%CI = 1.479, 2.445; married -OR = 1.406, 95%CI = 1.103, 1.792); education (secondary -OR = 1.206, 95%CI = 1.001, 1.451; tertiary level education -OR = 0.492, 95%CI = 0.281, 0.861), and number of men in household (OR = 0.987, 95%CI = 0.806, 0.998). This study provides valuable information about the mortality rates and health status of elderly residents in Jamaica. High mortality rates for avoidable and preventable diseases and potential years of life lost are major public health concerns, especially for regional healthcare providers.The Open Geriatric Medicine Journal 01/2009; 2:34-43.