Management of diabetes mellitus in three settings in Jamaica (original) (raw)

Glycaemic Control among Patients with Diabetes in Primary Care Clinics in Jamaica, 1995 and 2012

WIMJ Open, 2014

Objective: To compare the quality of care received by patients with diabetes in public primary care clinics in 2012 with that reported in 1995. Methods: Patient records were audited at six randomly selected Type III health centres in the South East Health Region of Jamaica. The 2012 audit data were compared with published data from a similar audit conducted in 1995. Quality of care measures included timely screening tests and counselling of the patients. Fasting and postprandial glucose tests were used to assess glycaemic control. Results: Two hundred and forty-two patient records were analysed in 2012, and 185 in 1995. In 2012, 88% of patients were weighed within the last year compared with 43% in 1995. Advice on physical activity increased from 1% to 60% and on dietary practices from 6% to 79%. No patient had done the HBA 1C in 1995 compared to 38% in 2012. In 1995, 66% had blood glucose measured at a laboratory during the last year while in 2012, 60% had a laboratory test and 90% were tested at the clinic by glucometer. Blood pressure control increased from 19% in 1995 to 41% in 2012 (p < 0.001). Poor glucose control was recorded among 61% of patients in 1995 compared with 68% in 2012. Conclusions: There was no improvement in glycaemic control. Health providers and patients must work together to improve patient outcomes. This will involve closer patient monitoring, treatment intensification where indicated, and the adoption of lifestyle practices that can lead to better control.

The dilemma of diabetes: health care crisis in the Caribbean

Revista Panamericana de Salud Pública, 2001

The epidemiologic transition in the Caribbean over the last 40 years has produced an epidemic of lifestyle-related chronic noncommunicable diseases. Among these are obesity, diabetes, and hypertension, along with such complications as stroke, heart disease, and amputations. The World Health Organization projects that the number of adults with diabetes in the Americas will double by 2025, and that most of the increase will occur in Latin America and the Caribbean (1). Both obesity and diabetes have been increasing in Barbados (2-4), in Trinidad (5, 6), and in Jamaica (7-9). Obesity (body mass index (BMI) > 30 kg/m 2) already occurs in 30% of Barbadian women 25-75 years old, and overweight (BMI > 25 kg/m 2) in 57.8% of them (10). Diabetes occurs in 17% of Barbadians over age 40 (2). In Jamaica diabetes occurs in 17% of persons over age 25, according to one study (7), and in 13.4%, according to another study (8). The combination of a rapid increase in calorie intake and a decrease in physical activity, against a background of cultural traditions that favor female obesity (11), imposes an unmanageable burden on the limited health care resources of these small countries of the Caribbean. Enormous research effort has been dedicated to evaluating diabetes care and outcome. There is clear evidence that good glycemic control reduces complications of type 1 diabetes (12), but the benefits of improving glycemic control in type 2 diabetes are modest, affecting mainly microvascular outcomes (retinopathy, nephropathy and neuropathy) (13). The United Kingdom Prospective Diabetes Study (UKPDS) has shown that control of hypertension is even more important than glycemic control in determining microvascular outcomes (14). On the other hand, macrovascular (cardiovascular and cerebrovascular) outcomes appear poorly related to glycemic control, and are more likely to be related to the multiple risk factors of obesity, hypertension, hyperlipidemia, and physical activity. Although there are many studies on glycemic control, there are few adequate studies of the benefits of multiple risk factor control, and guidelines for diabetes management are usually based on "expert" consensus rather than hard evidence. A Pan American Health Organization (PAHO) workshop in St. Lucia in 1986 produced a review of the growing problem of diabetes in the Caribbean and guidelines for diabetes management (15). There was, however, no evaluation of the quality of care or control. In 1992 the Commonwealth Caribbean Medical Research Council (now the Caribbean Health Research Council) implemented a project to evaluate quality of care across the Caribbean and to develop updated, regional guidelines. The first report from that study (16) described the findings in Barbados, Trinidad, and Tortola (British Virgin Islands). In this issue of this journal Wilks et al. report the data from three clinics in Jamaica, the largest English-speaking Caribbean island, with a population of 2.6 million-and a struggling economy. Neither of these two studies from the Caribbean is reassuring. Their findings are a major cause for concern, particularly with respect to the public clinics in Jamaica and Trinidad. Only two-thirds of the patients at the public clinic in Jamaica and a mere one-third of the patients in the Trinidadian public clinics had had blood glucose measured at least once in the preceding 12 months. Glycated hemoglobin measurements were not available in those

Diabetes education—Cornerstone in management of diabetes mellitus in Jamaica

AIMS Medical Science, 2021

Background Diabetes mellitus (DM) is one of the leading causes of morbidity and mortality among Caribbean populations. Ideal glycemic control can be attained when patients adhere to self-management behaviors such as consistent monitoring of blood glucose (BG) levels, staying physically active, taking medications, and eating a healthy diet. Aim The present study has the following aims: (1) to assess knowledge of self-care and the initiative of type 2 diabetic patients in medication compliance, making suitable food choices, regular physical exercise and BG monitoring, (2) to evaluate diabetic patient self-management by adhering to instructions of healthcare provider in attaining outcomes such as medication adherence, appropriate food choices, prescribed physical exercise, and self-monitoring of BG levels and determination of glycated hemoglobin (HbA1c) levels at clinic visits and (3) to determine whether there are associations between BG control (glucose and HbA1 levels) and sociodemo...

Impact of a Program to Improve Quality of Diabetes Care in the Caribbean

The aim of this research was to evaluate if the training on the use of the " Protocol for the Nutritional Management of Obesity, Diabetes and Hypertension in the Caribbean " improves the quality of care delivered to patients with Type 2 Diabetes in Jamaica, Guyana, Belize, St. Vincent and the Grenadines, and Suriname. The main goals of the protocol were to improve the standards of care for diabetics in the Caribbean region by providing tools essential for nutrition management. This study looked at healthcare professionals from the five countries and evaluated practice change following continuing professional development (CPD), in the use of the protocol. The training consisted of a two and a half day workshop led by the Caribbean Food and Nutrition Institute (CFNI). The training overviewed noncommunicable diseases in the region and the role of nutrition management; nutrition assessment and the management processes.The 279 participants for the CPD were chosen by the respective Ministries of Health. Of these, 133 were randomly selected by the national coordinators for a chart audit. For each healthcare professional, up to ten patients, medical charts were randomly selected totaling 1140 (25% male and 75% female) charts selected from the five countries. An evaluation instrument was developed and used for the audit and results were analysed using McNemar test to establish change. A statistical improvement in the quality of care following CPD was found through the chart audit, showing that using a protocol of care improves practice in primary care settings in the Caribbean.

Are current guidelines addressing the diabetes challenge in the Caribbean?

Diabetes is reaching epidemic proportions in Caribbean territories, and steadily increasing rates have been reported in the English-speaking Caribbean. The prevalence of type 2 diabetes is growing in children and adolescents. Studies from Jamaica, Trinidad, and Barbados indicate that glycemic control in patients evaluated in various clinical settings is suboptimal, giving rise to concerns about mortality, morbidity, and quality of care. Acute diabetes-related illnesses inflict a heavy disease burden particularly in ocular complications, renal failure, and amputations, resulting in notable bed occupancy in hospitals. To address the continued poor quality-of-life and disease complications, guidelines for the management of diabetes in primary care in the Caribbean were published in 1996 and a revised version became available in 2006. Following the first edition, studies suggested that disease outcomes were not favorably influenced, and even after the second edition, a report from Trinidad indicated that current standards of care do not meet the recommendations in the guidelines. This paper looks at the quality of care in a Caribbean nation in relation to that advocated in the guidelines and uses examples from a specialty center in Trinidad and a primary care practice in the United Kingdom (UK) to illustrate that guideline-based care can be achieved.

Exploring the management of type 2 diabetes in the Caribbean

Introduction Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder with a prevalence that has been increasing steadily and rapidly across the world, including the Caribbean region. It has negatively impacted individuals health and wellbeing, and in addition, it has increased the economic and social burden on the countries. T2DM management is an integral part of positive health outcomes, however, it has been poor in the Caribbean and is resulting in an alarming number of complications. The best way to reduce the negative outcomes associated with T2DM is to ensure that the disease is managed correctly. To do this, issues associated with poor T2DM management must be identified and disseminated to the public. Aim This thesis aims to highlight and raise awareness of the disparities impacting T2DM management in the Caribbean region to assist with future research, developmental plans and strategies. From the main aim two study objectives were developed. The first objective was to...