RESUMEN
CONTEXT: The views of type 2 diabetes (T2DM) patients have not been considered in the debate on the role of self-monitoring of blood glucose (SMBG) in the management of T2DM. OBJECTIVE: To assess the views of T2DM patients on SMBG. METHODS: Two previously trained research assistants used a structured pre-tested questionnaire to interview 416 T2DM patients practising SMBG in out-patient clinics in the privacy of the patients after they have consented to be interviewed. RESULTS: 79% of patients were unemployed with mean duration of diabetes of 11.8 ± 0.5 year. 94% of patients did not have health insurance policies while 86% did not belong to any diabetes support group. Although 70% of the patients identified SMBG as expensive, 94% believed it assists glycaemic control, while 89% thought it was worth the expense. CONCLUSION: Caribbean T2DM patients believe SMBG was beneficial for the management of their diabetes and empowering them may reduce diabetes complications.
Asunto(s)
Automonitorización de la Glucosa Sanguínea/psicología , Glucemia/análisis , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/psicología , Automonitorización de la Glucosa Sanguínea/economía , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 2/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Autoevaluación (Psicología) , Encuestas y Cuestionarios , Trinidad y TobagoRESUMEN
BACKGROUND AND AIM: The risk of death from coronary heart disease (CHD) in women with diabetes is more than three times that of non-diabetic women. We assessed the difference in CHD risk levels of Afro-Caribbean diabetic women provided with facilities for self-monitoring of blood glucose and their counterparts without such facilities MATERIALS AND METHODS: Forty-nine patients who never used gluco-meters were studied as intervention (23) and control (26) groups. The intervention group was trained on self-monitoring of blood glucose. At baseline, BP, anthropometric indices, and fasting blood glucose of all patients were measured. Subsequently, the intervention patients were provided with gluco-meters, testing strips, and advised to self-monitor fasting and postprandial blood glucose every other day for 6 months. CHD risk was determined with the United Kingdom Prospective Diabetes Study risk engine calculator. RESULTS: The age, duration of diagnosis of diabetes, BP, and anthropometric indices were similar in the two groups (all, P > 0.05). The majority of the patients were unemployed or retired with only primary education. After 3 months, the HbA 1c levels of the control patients did not change (8.3 ± 0.4% vs. 7.8 ± 0.4%, P > 0.05) whereas the HbA 1c levels of the intervention patients reduced significantly from the baseline at 3 (9.2 ± 0.4% vs. 7.4 ± 0.3%, P <0.001) and 6 (9.2 ± 0.4% vs. 7.3 ± 0.3%, P <0.001) months. The 10-year CHD risk level of the intervention group was remarkably reduced from the baseline level after 6 months (7.4 ± 1.3% vs. 4.5 ± 0.9%) of the study. CONCLUSION: Provision of facilities for self-monitoring of blood glucose in Afro-Caribbean women with type 2 diabetes improves both their glycemic control and CHD risk profile.
Asunto(s)
Glucemia/metabolismo , Enfermedad Coronaria/etnología , Diabetes Mellitus Tipo 2/etnología , Hemoglobina Glucada/análisis , Población Negra , Automonitorización de la Glucosa Sanguínea , Presión Sanguínea/fisiología , Estudios de Casos y Controles , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/fisiopatología , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Metabolismo de los Lípidos , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Factores Socioeconómicos , Factores de Tiempo , Trinidad y Tobago/epidemiologíaRESUMEN
BACKGROUND and AIM: The risk of death from coronary heart disease (CHD) in women with diabetes is more than three times that of non-diabetic women. We assessed the difference in CHD risk levels of Afro-Caribbean diabetic women provided with facilities for self-monitoring of blood glucose and their counterparts without such facilities. MATERIALS and METHODS: Forty-nine patients who never used gluco-meters were studied as intervention (23) and control (26) groups. The intervention group was trained on self-monitoring of blood glucose. At baseline, BP, anthropometric indices, and fasting blood glucose of all patients were measured. Subsequently, the intervention patients were provided with gluco-meters, testing strips, and advised to self-monitor fasting and postprandial blood glucose every other day for 6 months. CHD risk was determined with the United Kingdom Prospective Diabetes Study risk engine calculator. RESULTS: The age, duration of diagnosis of diabetes, BP, and anthropometric indices were similar in the two groups (all, P > 0.05). The majority of the patients were unemployed or retired with only primary education. After 3 months, the HbA 1c levels of the control patients did not change (8.3 ñ 0.4% vs. 7.8 ñ 0.4%, P > 0.05) whereas the HbA 1c levels of the intervention patients reduced significantly from the baseline at 3 (9.2 ñ 0.4% vs. 7.4 ñ 0.3%, P <0.001) and 6 (9.2 ñ 0.4% vs. 7.3 ñ 0.3%, P <0.001) months. The 10-year CHD risk level of the intervention group was remarkably reduced from the baseline level after 6 months (7.4 ñ 1.3% vs. 4.5 ñ 0.9%) of the study. CONCLUSION: Provision of facilities for self-monitoring of blood glucose in Afro-Caribbean women with type 2 diabetes improves both their glycemic control and CHD risk profile.
Asunto(s)
Humanos , Femenino , Enfermedad Coronaria , Índice Glucémico , Diabetes Mellitus Tipo 2 , Trinidad y TobagoRESUMEN
Glycated haemoglobin A1c (HbA1c) gives an integrated plasma glycaemia for the previous 2-3 months and its measurement is central in the management of diabetic patients. However in many developing countries because kits/regents or expertise for HbA1c measurement are not always available and the test must be conducted on fresh whole blood samples, HbA1c tests are not routinely performed Thus, this study aimed to determine if the degradation products from whole blood sample storage are significant enough to compromise the diagnostic value of HbA1c measurements. Two hundred and thirty-one fresh whole blood samples with pre-determined HbA1c values were stored at between 2-8 degrees C and using boronate affinity immunoassay technique, HbA1c values were then measured in the same whole blood samples after 20 days of storage. The results showed that there were no significant differences in the mean values of the initial HbA1c measurement and the values obtained after storage (7.5 +/- 2.0 vs. 7.5 +/- 2.1, p > 0.05) and this was irrespective of gender. Furthermore, irrespective of gender there were significant correlations between the HbA1c values measured in fresh whole blood samples and values obtained after storage (r = 0.83, p < 0.01). Therefore, based on these findings and other previous reports, the effect of storage degradation product was not significant enough to compromise the clinical or research use of HbA1c test results from stored whole blood samples. However, we recommend that diagnostic laboratories should evaluate their HbA1c measurement techniques for HbA1c determination in stored whole blood samples. Any persistent upward or downward bias in stored whole blood samples should be reported to guide the physician in interpreting HbA1c results from stored whole blood samples from that laboratory and/or technique.
Asunto(s)
Diabetes Mellitus/sangre , Hemoglobina Glucada/análisis , Análisis Químico de la Sangre , Femenino , Humanos , Inmunoensayo , Masculino , Valor Predictivo de las Pruebas , Reproducibilidad de los ResultadosRESUMEN
AIM: To determine how the levels of leptin and monocyte chemotactic protein-1 (MCP-1) are associated with insulin resistance (IR) in obese, non-obese, diabetic and non-diabetic subjects. METHODS: 112 type 2 diabetics and 43 non-diabetics were studied fasting. Anthropometric indices were measured and glucose, insulin, leptin and MCP-1 were measured in blood. IR was calculated. RESULTS: MCP-1 level was significantly higher in diabetics than non-diabetics irrespective of gender (p < 0.05). Irrespective of diabetes status, the serum leptin concentration was significantly higher (p < 0.05) in obese and females subjects than in non-obese and male subjects respectively. There were no significant correlations between IR and MCP-1 or leptin in all subgroups of subjects studied. General linear modelling analysis showed that only diabetes state significantly predicted MCP-1 levels (p < 0.05) whereas non of the factors predicted leptin levels (p > 0.05). CONCLUSION: Routine measurement of leptin and MCP-1 would be potentially useful in assessment of patients for the metabolic syndrome or coronary heart disease especially in black population.
Asunto(s)
Quimiocina CCL2/sangre , Diabetes Mellitus Tipo 2 , Resistencia a la Insulina , Leptina/sangre , África , Anciano , Animales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupos Raciales , Trinidad y TobagoRESUMEN
OBJECTIVE: Primary prevention of Coronary Heart Disease (CHD) in diabetic patients should be based on absolute CHD risk calculation. This study was aimed to determine the levels of 10-year CHD risk in Caribbean type 2 diabetic patients using the diabetes specific United Kingdom Prospective Diabetes Study (UKPDS) risk engine calculator. SUBJECTS AND METHODS: Three hundred and twenty-five (106 males, 219 females) type 2 diabetic patients resident in two Caribbean Islands of Tobago and Trinidad met the UKPDS risk engine inclusion criteria. Records of their sex, age, ethnicity, smoking habit, diabetes duration, systolic blood pressure, total cholesterol, HDL-cholesterol and glycated haemoglobin were entered into the UKPDS risk engine calculator programme and the absolute 10-year CHD and stroke risk levels were computed. The 10-year CHD and stroke risks were statistically stratified into <15%, 15-30% and >30% CHD risk levels and differences between patients of African and Asian-Indian origin were compared. RESULTS: In comparison with patients in Tobago, type 2 diabetic patients in Trinidad, irrespective of gender, had higher proportion of 10-year CHD risk (10.4 vs. 23.6%, P<0.001) whereas the overall 10-year stroke risk prediction was higher in patients resident in Tobago (16.9 vs. 11.4%, P<0.001). Ethnicity-based analysis revealed that irrespective of gender, higher proportion of patients of Indian origin scored >30% of absolute 10-year CHD risk compared with patients of African descent (3.2 vs. 28.2%, P<0.001). CONCLUSIONS: The results of the study identified diabetic patients resident in Trinidad and patients of Indian origin as the most vulnerable groups for CHD. These groups of diabetic patients should have priority in primary or secondary prevention of coronary heart disease.
Asunto(s)
Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Femenino , Enfermedad Coronaria , Diabetes Mellitus Tipo 2 , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Atención Primaria de Salud , Accidente Cerebrovascular , Trinidad y TobagoRESUMEN
AIM: To determine how the levels of leptin and monocyte chemotactic protein-1 (MCP-1) are associated with insulin resistance (IR) in obese, non-obese, diabetic and non-diabetic subjects. METHODS: 112 type 2 diabetics and 43 non-diabetics were studied fasting. Anthropometric indices were measured and glucose, insulin, leptin and MCP-1 were measured in blood. IR was calculated. RESULTS: MCP-1 level was significantly higher in diabetics than non-diabetics irrespective of gender (p < 0.05). Irrespective of diabetes status, the serum leptin concentration was significantly higher (p < 0.05) in obese and females subjects than in non-obese and male subjects respectively. There were no significant correlations between IR and MCP-1 or leptin in all subgroups of subjects studied. General linear modelling analysis showed that only diabetes state significantly predicted MCP-1 levels (p < 0.05) whereas non of the factors predicted leptin levels (p > 0.05). CONCLUSION: Routine measurement of leptin and MCP-1 would be potentially useful in assessment of patients for the metabolic syndrome or coronary heart disease especially in black population.
Asunto(s)
Humanos , Masculino , Femenino , Enfermedad Coronaria , Resistencia a la Insulina , Síndrome Metabólico , Quimiocina CCL2 , Obesidad , Diabetes Mellitus Tipo 2 , Población Negra , Región del CaribeRESUMEN
OBJECTIVE: Primary prevention of Coronary Heart Disease (CHD) in diabetic patients should be based on absolute CHD risk calculation. This study was aimed to determine the levels of 10-year CHD risk in Caribbean type 2 diabetic patients using the diabetes specific United Kingdom Prospective Diabetes Study (UKPDS) risk engine calculator. SUBJECTS AND METHODS: Three hundred and twenty-five (106 males, 219 females) type 2 diabetic patients resident in two Caribbean Islands of Tobago and Trinidad met the UKPDS risk engine inclusion criteria. Records of their sex, age, ethnicity, smoking habit, diabetes duration, systolic blood pressure, total cholesterol, HDL-cholesterol and glycated haemoglobin were entered into the UKPDS risk engine calculator programme and the absolute 10-year CHD and stroke risk levels were computed. The 10-year CHD and stroke risks were statistically stratified into <15%, 15-30% and >30% CHD risk levels and differences between patients of African and Asian-Indian origin were compared. RESULTS: In comparison with patients in Tobago, type 2 diabetic patients in Trinidad, irrespective of gender, had higher proportion of 10-year CHD risk (10.4 vs. 23.6%, P<0.001) whereas the overall 10-year stroke risk prediction was higher in patients resident in Tobago (16.9 vs. 11.4%, P<0.001). Ethnicity-based analysis revealed that irrespective of gender, higher proportion of patients of Indian origin scored >30% of absolute 10-year CHD risk compared with patients of African descent (3.2 vs. 28.2%, P<0.001). CONCLUSIONS: The results of the study identified diabetic patients resident in Trinidad and patients of Indian origin as the most vulnerable groups for CHD. These groups of diabetic patients should have priority in primary or secondary prevention of coronary heart disease.
Asunto(s)
Enfermedad Coronaria/etnología , Diabetes Mellitus Tipo 2/etnología , Angiopatías Diabéticas/etnología , Anciano , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/prevención & control , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Prevención Primaria , Medición de Riesgo , Prevención Secundaria , Accidente Cerebrovascular/etnología , Trinidad y Tobago/epidemiologíaRESUMEN
BACKGROUND AND AIM: Tobago and Trinidad are two Caribbean islands with distinct genetic background and lifestyles; while Tobago is serene and a tourist centre, Trinidad is characterized by a hustling and bustling lifestyle. The study was aimed at determining and comparing the prevalence of the metabolic syndrome (MetS) and its critical components in type 2 diabetic patients using the new International Diabetes Federation (IDF) definition. METHODS: Four hundred and thirteen (166 Tobago, 247 Trinidad) type 2 diabetic patients visiting 10 lifestyle disease clinics were studied. Blood pressure, anthropometric parameters (height, weight, body mass index and waist circumference) and overnight fasting blood samples were taken. Plasma glucose and serum triglycerides, total cholesterol, LDL- and HDL-cholesterol, insulin, and adiponectin were determined. Insulin resistance (IR) was determined using the HOMA method. RESULTS: The patients in Tobago were significantly older than patients in Trinidad (p < 0.001) but the duration of diabetes (9.4 +/- 0.5 vs. 11.1 +/- 0.7 yr), medications, generalized (31.7 vs. 38.8%) and central (78.5 vs. 83.7%) obesity were similar (p > 0.05). In comparison with patients in Tobago, diabetic patients in Trinidad, irrespective of gender, had significantly higher prevalence of IDF critical components such as raised BP, raised triglycerides and reduced HDL-cholesterol (all, p < 0.001). Thus, while more patients in Trinidad were diagnosed with MetS based on three or four components, more patients in Tobago were diagnosed based on two components (p < 0.001). CONCLUSIONS: There were high prevalence rates of the components of the MetS in both the islands of Tobago and Trinidad. Quantitatively, the aggregation of the components is higher in patients in Trinidad, which constitute greater risk for adverse cardiovascular outcome. Controlling central obesity should be the target in preventing MetS in the two islands.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Agencias Internacionales , Síndrome Metabólico/complicaciones , Síndrome Metabólico/epidemiología , Distribución por Edad , Presión Sanguínea , Demografía , Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Geografía , Hemoglobina Glucada/metabolismo , Humanos , Estilo de Vida , Metabolismo de los Lípidos , Masculino , Síndrome Metabólico/etnología , Síndrome Metabólico/fisiopatología , Persona de Mediana Edad , Obesidad/complicaciones , Prevalencia , Factores de Riesgo , Caracteres Sexuales , Trinidad y Tobago/epidemiologíaRESUMEN
Low adiponectin levels are associated with elevated plasma alanine aminotransferase, a marker of reduced hepatic insulin sensitivity and a risk factor for type 2 diabetes. This study aims to determine the relationship between serum adiponectin level and alanine aminotransferase in diabetic and non-diabetic subjects. Fifty-six type 2 diabetic patients and 33 non-diabetic subjects participate in the study. Baseline plasma concentrations of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and glucose are measured on a chemistry analyser. Insulin and adiponectin are measured using enzyme-linked immunoassay techniques and insulin resistance is determined using the homeostatic model assessment method. Diabetic patients showed significantly lower levels of serum adiponectin than did the non-diabetic subjects, whereas levels of alanine aminotransferase and alkaline phosphatase were similar in both groups. While female non-diabetic subjects showed higher serum adiponectin levels than did female diabetic patients, alanine aminotransferase level did not differ (P>0.05). No significant relationship was seen between adiponectin and alanine aminotransferase in diabetic and non-diabetic subjects (P>0.05). Serum adiponectin levels were higher in non-diabetic subjects but there was no significant correlation between adiponectin and alanine aminotransferase in both groups of subjects. The data suggest that low serum adiponectin level may not be a suitable marker for impaired liver function in diabetic patients.
Asunto(s)
Humanos , Adiponectina/biosíntesis , Adiponectina/química , Diabetes Mellitus/etiología , Diabetes Mellitus/patología , Región del CaribeRESUMEN
BACKGROUND: Previous studies in other populations suggest that low levels of serum adiponectin may be a cardiovascular risk factor. We aimed to determine the baseline concentration of serum adiponectin and its relationship with selected biochemical risk factors for coronary artery disease (CAD) in a cross-section of Caribbean patients with type 2 diabetes. METHODS: Anthropometric indices and fasting plasma concentrations of glucose, insulin, adiponectin, triglyceride, and total and HDL cholesterol were measured in 56 type 2 diabetic patients and 33 nondiabetic subjects. Insulin resistance (IR) was determined using the homeostatic model assessment (HOMA) method. RESULTS: Consistent with previous reports, Caribbean type 2 diabetic patients had significantly lower fasting serum adiponectin levels and higher mean levels of glucose, triglyceride and IR than the nondiabetic subjects (all, p < 0.01). The nondiabetic female subjects had significantly higher serum adiponectin levels than did the female diabetics or nondiabetic males (p < 0.01). Serum adiponectin level was negatively correlated with triglyceride or LDL cholesterol and positively related with HDL cholesterol among nondiabetic subjects, and the latter relationship persisted after adjusting for the effects of age, sex and BMI (r = 0.70, p < 0.01). CONCLUSION: Similar to reports from other populations, Caribbean patients with type 2 diabetes, particularly the females, have lower levels of serum adiponectin than their nondiabetic counterparts and this is an additional CVD risk factor for the patients.
Asunto(s)
Humanos , Adiponectina/análisis , Adiponectina , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/patología , Región del Caribe/epidemiologíaRESUMEN
The aim of this study was to determine the differences in postprandial glucose levels between Type 2 diabetic patients visiting two different primary care clinics after ingestion of three carbohydrate test foods. Thirty-eight Type 2 diabetic patients visiting the Chaguanas and Arima Lifestyle Disease Clinics and 27 healthy non-diabetic subjects were studied on three different occasions, seven days apart, after an overnight fast. On each day of the study, anthropometric indices were measured and after collecting fasting blood samples, subjects randomly consumed three pre-selected carbohydrate test foods: bread, roti or rice within 10 minutes and water taken as wished. Subsequently, seven millimetres of venous blood samples were collected at 60, 90, 120 and 150 minutes for insulin, glucose and lipid determinations. Age, body weight, body mass index, waist and hip circumferences did not differ between the healthy subjects and diabetic patients or between patients of the two clinics (p > 0.05). The mean fasting and 2.5-hour postprandial glucose values for the patients visiting the Chaguanas clinic were higher, after consuming at least one test food, than those of patients visiting the Arima clinic (p < 0.05). The mean HbA1c, and 2.5-hour glucose levels for the diabetic patients visiting either of the two clinics exceeded the internationally recommended cut-off values; this is worst in patients visiting the Chaguanas clinic. It is suggested that primary care physicians should start by targeting glycaemic control based on international standards while a more aggressive diabetes dietary education should be reinforced at the clinics, especially Chaguanas
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Diabetes Mellitus Tipo 2 , Carbohidratos de la Dieta/metabolismo , Atención Primaria de Salud , Glucemia/metabolismo , Instituciones de Atención Ambulatoria , Periodo Posprandial , Diabetes Mellitus Tipo 2 , Carbohidratos de la Dieta/administración & dosificación , Estudios de Casos y Controles , Hiperglucemia/complicaciones , Hiperglucemia/metabolismo , Prueba de Tolerancia a la Glucosa , Trinidad y TobagoRESUMEN
AIM: To examine the relationship between adiponectin and metabolic variables in the offspring of patients with type 2 diabetes mellitus. METHODS: Fasting blood samples and anthropometric indices were taken from 34 subjects, offspring of patients with type 2 diabetes, and 24 healthy control subjects without any immediate family history of diabetes. Plasma glucose and serum adiponectin, insulin, triglycerides, total cholesterol, HDL and LDL cholesterol levels were measured, and insulin resistance (IR) was calculated based on the homeostasis model assessment (HOMA) method. RESULTS: Offspring and control subjects were sex-matched, but the offspring were older and had higher body mass index and waist circumference than the control subjects (p < 0.05). The offspring had significantly higher mean fasting plasma glucose concentrations; however, their mean serum insulin, adiponectin, triglyceride, total cholesterol, HDL and LDL cholesterol and HOMA-derived IR levels did not significantly differ from those of the control subjects (p > 0.05). While the negative correlation between serum adiponectin and HDL cholesterol levels in the offspring remained statistically significant after adjusting for the effect of age, sex and BMI (r = -0.37, p < 0.05), the negative correlation between adiponectin and serum triglyceride, LDL cholesterol or IR levels became non-significant after controlling for the above variables (p > 0.05 in all cases). CONCLUSION: The correlation between adiponectin and some known biochemical risk factors for developing diabetes and cardiovascular disease in the offspring of patients with diabetes warrants further study to evaluate its potential in assessing the risk of developing these disorders.
Asunto(s)
Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Metabolismo Energético/fisiología , Péptidos y Proteínas de Señalización Intercelular/sangre , Adiponectina , Adulto , Biomarcadores , Glucemia , Enfermedades Cardiovasculares/epidemiología , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Salud de la Familia , Femenino , Humanos , Insulina/sangre , Resistencia a la Insulina , Masculino , Factores de Riesgo , Triglicéridos/sangre , Trinidad y Tobago/epidemiologíaRESUMEN
AIM: To examine the relationship between adiponectin and metabolic variables in the offspring of patients with type 2 diabetes mellitus. METHODS: Fasting blood samples and anthropometric indices were taken from 34 subjects, offspring of patients with type 2 diabetes, and 24 healthy control subjects without any immediate family history of diabetes. Plasma glucose and serum adiponectin, insulin, triglycerides, total cholesterol, HDL and LDL cholesterol levels were measured, and insulin resistance (IR) was calculated based on the homeostasis model assessment (HOMA) method. RESULTS: Offspring and control subjects were sex-matched, but the offspring were older and had higher body mass index and waist circumference than the control subjects (p < 0.05). The offspring had significantly higher mean fasting plasma glucose concentrations; however, their mean serum insulin, adiponectin, triglyceride, total cholesterol, HDL and LDL cholesterol and HOMA-derived IR levels did not significantly differ from those of the control subjects (p > 0.05). While the negative correlation between serum adiponectin and HDL cholesterol levels in the offspring remained statistically significant after adjusting for the effect of age, sex and BMI (r = - 0.37, p < 0.05), the negative correlation between adiponectin and serum triglyceride, LDL cholesterol or IR levels became non-significant after controlling for the above variables (p > 0.05 in all cases). CONCLUSION: The correlation between adiponectin and some known biochemical risk factors for developing diabetes and cardiovascular disease in the offspring of patients with diabetes warrants further study to evaluate its potential in assessing the risk of developing these disorders.
Asunto(s)
Humanos , Adiponectina/análisis , Adiponectina , Diabetes Mellitus Tipo 2/diagnóstico , Enfermedades Cardiovasculares/etiología , Región del CaribeRESUMEN
The aim of this study was to determine the differences in postprandial glucose levels between Type 2 diabetic patients visiting two different primary care clinics after ingestion of three carbohydrate test foods. Thirty-eight Type 2 diabetic patients visiting the Chaguanas and Arima Lifestyle Disease Clinics and 27 healthy non-diabetic subjects were studied on three different occasions, seven days apart, after an overnight fast. On each day of the study, anthropometric indices were measured and after collecting fasting blood samples, subjects randomly consumed three pre-selected carbohydrate test foods: bread, roti or rice within 10 minutes and water taken as wished. Subsequently, seven millimetres of venous blood samples were collected at 60, 90, 120 and 150 minutes for insulin, glucose and lipid determinations. Age, body weight, body mass index, waist and hip circumferences did not differ between the healthy subjects and diabetic patients or between patients of the two clinics (p > 0.05). The mean fasting and 2.5-hour postprandial glucose values for the patients visiting the Chaguanas clinic were higher, after consuming at least one test food, than those of patients visiting the Arima clinic (p < 0.05). The mean HbA1c, and 2.5-hour glucose levels for the diabetic patients visiting either of the two clinics exceeded the internationally recommended cut-off values; this is worst in patients visiting the Chaguanas clinic. It is suggested that primary care physicians should start by targeting glycaemic control based on international standards while a more aggressive diabetes dietary education should be reinforced at the clinics, especially Chaguanas.
Asunto(s)
Instituciones de Atención Ambulatoria , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Carbohidratos de la Dieta/metabolismo , Periodo Posprandial , Atención Primaria de Salud , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/complicaciones , Carbohidratos de la Dieta/administración & dosificación , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/metabolismo , Masculino , Persona de Mediana Edad , Trinidad y TobagoRESUMEN
BACKGROUND: Previous reports suggest that currently available drugs used in the treatment of type 2 diabetes do not sustain glycaemic control. OBJECTIVE: To assess metabolic control in type 2 diabetic patients predominantly treated with sulphonylurea drugs at primary care clinics in a developing country. DESIGN: Descriptive. SETTING: Two primary care clinics in Trinidad, West Indies. SUBJECTS: One hundred and seventy nine (117 females and 62 males), randomly selected, type 2 diabetic patients. PROTOCOL: Body weight, height, blood pressure (BP), waist and hip circumferences were measured and fasting blood samples taken for glycated haemoglobin (HbA1c, glucose, insulin and lipids determinations. Fasting insulin and glucose concentrations were used to assess insulin resistance and sensitivity (%S) using Homeostasis model assessment (HOMA) method. RESULTS: Of the 179 patients studied, 87% of male and 92% of female patients were treated with sulphonylurea drugs whereas 13% and 9% of male and female patients respectively were managed on diet and/or exercise. Female patients had significantly higher prevalence of obesity than males, and despite similar fasting glucose and HbA1c, levels, the females and patients of East Indian ethnic group had significantly higher prevalence rates of insulin resistance, hypercholesterolaemia, hypertriglyceridaemia and reduced HDL-cholesterol than the males and patients of African origin respectively. CONCLUSION: Consistent with previous reports, the results showed indications of poor metabolic control among the patients particularly females and patients of East Indian ethnic group.
Asunto(s)
Países en Desarrollo , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/metabolismo , Hipoglucemiantes/uso terapéutico , Compuestos de Sulfonilurea/uso terapéutico , Adulto , África/etnología , Anciano , Diabetes Mellitus Tipo 2/etnología , Femenino , Humanos , India/etnología , Masculino , Persona de Mediana Edad , Trinidad y TobagoRESUMEN
We previously reported poor metabolic control in type 2 diabetic patients attending 2 primary care clinics in Trinidad. In an attempt to explain the poor metabolic control, we assessed primary care patients' theoretical knowledge of diabetes control and risk factors. Two hundred fifty-four diabetic out-patients recruited consecutively were asked by questionnaire: (i) if they were aware that family history of diabetes, obesity, physical inactivity and cigarette smoking were diabetes risk factors; (ii) if they knew the benefits of weight loss, exercise and healthy diet in diabetes management, and (iii) what where their common sources of diabetes health information. Although the majority of the patients (81.1%) were unaware that cigarette smoking is a diabetes risk factor, a majority were aware that obesity (66.3%), physical inactivity (73.5%) and being a relative of a diabetic patient (78.7%) constitute diabetes risk factors. Again, the majority of the patients were aware that healthy diet (94.9%), exercise (94.5%) and weight loss (87.4%) are beneficial in diabetes control. While media (48.6%) was the commonest source of diabetes information, doctors and nurses were consulted by 39.9% and 11.0% of patients, respectively. Type 2 diabetic patients in these clinics were well informed about diabetes risk factors and benefits of healthy lifestyle. Given our recent reports on poor metabolic control, application of this theoretical knowledge in controlling their diabetes remains doubtful.
Asunto(s)
Diabetes Mellitus/rehabilitación , Educación del Paciente como Asunto , Edad de Inicio , Países en Desarrollo , Diabetes Mellitus/genética , Diabetes Mellitus/prevención & control , Dieta/normas , Escolaridad , Empleo , Ejercicio Físico , Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pérdida de Peso , Indias OccidentalesRESUMEN
The purpose of this study was to assess the anthropometric indices of obesity among apparently healthy Caribbean subjects who have the potentials of living an affluent lifestyle. One hundred and eleven (38 males, 73 females) young adults aged between 17 and 38 years participated in the study. Subjects provided information on age, ethnic group, educational attainment, occupation, and previous record of body mass index (BMI) and family history of diabetes mellitus in a self-administered research questionnaire. Waist and hip circumferences (cm), weight (kg) and height (m) were measured. Subsequently, BMI and waist-to-hip ratio (W/H) were calculated. The majority of the subjects (83%) had never measured their BMI. Although the male subjects were significantly taller and heavier than the females (p < 0.01), there was no significant difference in the prevalence rates of obesity between the male and female subjects (p > 0.05). In this preliminary study there was a trend for more females than males to be underweight (BMI < 20 kg/m2). The male subjects had significantly higher waist circumference than the females (p < 0.01), but both genders had a similar percentage of male and female subjects with increased waist circumference (p > 0.05). The limitations of this study are its small size and self selection bias and hence the results obtained must be interpreted with caution. We suggest that assessment of body mass index should be incorporated in the routine clinical measurements of all patients to facilitate early identification, evaluation and treatment of overweight and obesity.
Asunto(s)
Obesidad/epidemiología , Adolescente , Adulto , Antropometría , Constitución Corporal , Índice de Masa Corporal , Región del Caribe/epidemiología , Femenino , Humanos , Masculino , Factores Sexuales , Factores SocioeconómicosRESUMEN
The purpose of this study was to assess the anthropometric indices of obesity among apparently healthy Caribbean subjects who have the potentials of living an affluent lifestyle. One hundred and eleven (38 males, 73 females) young adults aged between 17 and 38 years participated in the study. Subjects provided information on age, ethnic group, educational attainment, occupation, and previous record of body mass index (BMI) and family history of diabetes mellitus in a self-administered research questionnaire. Waist and hip circumferences (cm), weight (kg) and height (m) were measured. Subsequently, BMI and waist-to-hip ratio (W/H) were calculated. The majority of the subjects (83) had never measured their BMI. Although the male subjects were significantly taller and heavier than the females (p < 0.01), there was no significant difference in the prevalence rates of obesity between the male and female subjects (p > 0.05). In this preliminary study there was a trend for more females than males to be underweight (BMI < 20 kg/m2). The male subjects had significantly higher waist circumference than the females (p < 0.01), but both genders had a similar percentage of male and female subjects with increased waist circumference (p > 0.05). The limitations of this study are its small size and self selection bias and hence the results obtained must be interpreted with caution. We suggest that assessment of body mass index should be incorporated in the routine clinical measurements of all patients to facilitate early identification, evaluation and treatment of overweight and obesity.