Trouble in “Paradise”?Diabetes in the Caribbean

Kathleen, Laura and Fawn

Incidence and Occurrence, Cultural ImpactAverage annual in diabetes surpasses other

chronic conditions: increase of 185% over HTN

in years 2002-2007 compared to hypertensionLower Extremity Amputations (LEA) due to

Diabetes rates are among highest in the world in the Caribbean

75% of Caribbean LEA are due to DM. (Bourne, et al 2010; Hennis et al, 2004)

There are patient factors that cause people to have poorer outcomes: denial, lack of understanding, inability to afford prescribed treatment, and monitoring, forgetfulness, medication side effects, religious beliefs, beliefs in alternative medicine, lack of time, and fear of needles.

Adams, O. P. and Carter, A.O., 2010

In 2003 study in Trinidad, only 44% of clinicians had read recent guidelines on diabetes care.

1 in every 6- 9 people in the Caribbean nations has Diabetes. (likely an underrepresentation of the real figures)

Women are much more likely to be overweight/ obese than men in certain Caribbean nations.

Morren, Baboolal, Davis, and Mc Ray. (2010).

Cultural Beliefs and Practices that Impact the occurrence of Diabetes in the Caribbean

Sugar cane is a main crop in many Caribbean nations. Terrain may vary from ocean side to steep mountains with poor roads. It may take many hours to travel to a clinic; care is limited in many areas.

Partner with care providers in the culture

Name: Village:

Date of Assessment: Providers:

Diabetes Screening Tool Diabetes Education RecordCriteria Values Score

Ethnicity White=0Asian or mixed=2African or Caribbean=3

Healthy Eating:Make Better Food ChoicesReduce Portion SizeMake a meal plan:

AgeM F

11-4445-5455+

123

BMI Height Weight

Adults:25-30=130+ =3

Being Active:Exercise longerExercise more oftenMake an exercise plan:

(ages 18+)Adult WaistMeasurement

Men 94 to <102 =3Women 80 to <88 =3Men >102 =4Women >88 =4

Reduce your Risks:Stop smokingSee your doctor

(Ages 11-17 only)Child BMIPercentile

Height Weight >85th percentile=0

85-94 =395+ =4

Blood Glucose Level: >2 hours post eating Y NB/P: Hg: Cholesterol:

Has a physician or other health care provider ever told you that you have high blood glucose?No= 0 Yes=5 Optical Examination

History of NIDDM in familyNo= 0 Yes=2

Poor Near Vision:

Poor Distance:

Red Eye w/discharge:

Itchy:

Dry:

Other:

Lens Type:

Diopter

Cataract: Do you exercise or exert yourself in your spare time or at work at least 30 minutes on most days?No= 2 Yes=0

How often do you eat vegetables and fruits or berries?Everyday=0 Not everyday=1

Total Risk Score 0-10= Low Risk11-18= Moderate Risk (diet & activity)19+= refer to primary care doctor

Ultra sound Results:Follow up: Yes / No

For care providers and patients now

For the future generations

Incomplete Reference ListAdams, O.P., and Carter, A.O. (2010). Diabetes and hypertension guidelines

and the primary health care practitioner in Barbados: Knowledge, attitudes , practices and barriers- a focus group study. BMC Family Practice. 112 (3): 158-165

 Bourne PA, McDaniel S, Williams MS, Francis C, Kerr-Campbell MD, Beckford OW. The changing faces of diabetes, hypertension and arthritis in a caribbean population. North Am J Med Sci 2010; 2: 221-229.    Doi: 10.4297/najms.2010.221

Hennis, Fuller, Fraser, Chaturvedi, and Jonnalagadda. Explanations for the high-risk of diabetes related amputation in a caribbean population of black african descent and potential for prevention. Diabetes Care (27):2636–2641.

Morren, Baboolal, Davis, and Mc Ray. (2010). Assessment and treatment goals obtained by patients according to guidelines for diabetes management in primary care centres in North Trinidad. Quality in Primary Care 18:335-43.