Diabetes self-management education in a high-income developing country: survey of the opinion of nurses and dietitians

To assess the views of nurses and dietitians on diabetes self-management education and the preparedness of their work places for implementing diabetes self-care. 1,057 (71 %) of the estimated 1,498 qualified nurses and dietitians employed in the services of the Regional Health Authorities between November 2011 and April 2012 completed the self-administered research questionnaire previously pre-tested on a cohort of student nurses. The questionnaires did not contain any personal identifiers but were serially numbered to avoid receiving duplicate copies from a participant. The questionnaires were distributed to all public hospitals and health centres within the regional health authorities. The head nurse in each facility assisted in the distribution and collection of completed questionnaires from the volunteers. One thousand thirty-two nurses and 25 dietitians participated in the study. While the majorities of the nurses and dietitians agreed that diabetes self-management education will assist to reduce diabetes complications, 68 % and 58 % of them respectively did not think that there was adequate diabetes health education for the patients in their places of work. Furthermore, 73 % of the nurses and dietitians think that the health care system was not prepared for diabetes self-management education given that there were not enough qualified health personnel, educational facilities and economic resources. Although the nurses and dietitians agreed that diabetes self-management education will assist to reduce diabetes complications, inadequate healthcare personnel, economic resources and educational facilities constitute significant barriers. We recommend that governments in the developing countries should invest human and material resources into healthcare education.     

Caribbean female patients with type 2 diabetes mellitus have lower serum levels of adiponectin than nondiabetic subjects

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.     

Glycaemic responses after ingestion of 3 local carbohydrate-based foods in West Indian patients with type-2 diabetes mellitus

BACKGROUND & AIM: Previous studies suggest that inadequate glycaemic control in diabetic patients might be related to the type of carbohydrates the patients consume regularly. Thus, we aimed to assess glucose and insulin responses after diabetic and non-diabetic subjects ingested 3 commonly consumed carbohydrate-based foods. METHODS: Thirty-eight type-2 diabetic and 27 non-diabetic subjects were studied in 3 different occasions of 7 days apart. On each day of the study, anthropometric indices were measured and after collecting fasting blood samples, subjects randomly consumed bread, roti or rice within 10 min. Subsequently 7 ml of venous blood samples were collected at 60, 90, 120 and 150 min for determination of glucose and insulin responses. RESULTS: Although the diabetic patients were older than the healthy subjects (P < 0.05), both subjects had similar weight, body mass index and waist and hip circumferences (P > 0.05). The mean fasting and post meal plasma glucose concentrations for the 3 test foods were higher in diabetic patients than the corresponding values for the healthy subjects (all; P < 0.001). Generally, roti elicited the highest total incremental glucose responses in the diabetic patients irrespective of ethnic group (P < 0.05). CONCLUSION: There were variations in glucose and insulin responses to the 3 test foods. However, roti elicited the highest postprandial hyperglycaemia and should therefore be discouraged in regular dietary plan of diabetic patients.     

Serum adiponectin levels and enzyme markers of liver dysfunction in diabetic and non-diabetic Caribbean subjects

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.     

Abdominal obesity in type 2 diabetic patients visiting primary healthcare clinics in Trinidad,West Indies

OBJECTIVE: To compare the blood pressure and metabolic parameters of type 2 diabetic patients with high waist circumference (WC) with those of type 2 diabetic patients with normal WC. DESIGN: After 10-14 h overnight fasting, weight, height, waist and hip circumferences and blood pressure were measured, and blood samples taken for glucose, glycated haemoglobin, total cholesteroL triglyceride, HDL-cholesterol, LDL-cholesterol and insulin determinations. Insulin resistance was calculated using the homeostatic model assessment (HOMA) method, while high WC was considered as WC > 102 cm and 89 cm for males and females, respectively. SETTING: Two primary care clinics in Trinidad, West Indies. PATIENTS: 190 confirmed type 2 diabetic patients with mean duration of 9.2 years were studied. RESULTS: About 75% and 17% of female and male patients, respectively, had high WC. Although blood pressure and lipid levels did not differ (p > 0.05) between patients with high and normal WC, the former group of patients had significantly higher mean levels of basal insulin and insulin resistance in each gender group (p < 0.001). However, female patients had an overall higher prevalence rate of hypercholesterolaemia (75% vs 52%) and higher LDL-cholesterol (84% vs 68%) than male patients (p < 0.001). CONCLUSIONS: Although there was similarity in the control of blood pressure and metabolic parameters irrespective of WC, patients with high WC might be at a comparatively higher risk of cardiovascular disease owing to greater basal insulin resistance. Early detection and treatment of abdominal obesity should therefore be encouraged in the primary healthcare setting.     

A preliminary study of the indices of obesity among a select group of apparently healthy Caribbean subjects

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.     

Studies on plasma lipids in industrial workers in central Trinidad and Tobago

We assessed the plasma lipid profiles and other cardiovascular disease (CVD) risk factors in 187 (147 men, 47 women) apparently healthy employees of the Caribbean ISPAT industry in Trinidad and Tobago. Anthropometric indices and fasting plasma levels of total cholesterol (T-chol), triglyceride (TG), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were measured. The results indicate that: there was increased body mass and relative hyperlipidemia in the population studied, these CVD risk factors (increased body mass, increased blood T-chol, TG, and LDL) were more prevalent in men than women (p < 0.05), and these parameters did not differ significantly (p < 0.05) when compared among the three ethnic groups (African and Indian descendants and mixed descents). These features suggest a greater risk of CVD in men than in women. It is likely that this observation in the industrial workers might reflect the situation in the general population especially in men. Although further confirmatory studies are necessary across societal socioeconomic strata within Trinidad, we suggest that efforts should be directed at reducing excess body weight among the workers, and providing advice on increased complex carbohydrate diet in place of saturated fat.     

Determination of the differences in 2-h plasma glucose values after ingestion of carbohydrate foods and oral glucose in Caribbean non-diabetic subjects

It has been reported that mixed meals are used in clinics in developing and developed countries in screening and diagnosis of diabetes. Thus, we aimed to determine the differences in 2-h plasma glucose values after non-diabetic subjects ingested 75 g pure glucose and its equivalent content in frequently consumed carbohydrate foods in Caribbean subjects. Twenty-seven apparently healthy non-diabetic subjects (nine males, 18 females) consumed 75 g pure glucose and its carbohydrate equivalent in three ethnic test foods (bread, rice and roti) at 7 days apart. Plasma glucose and insulin levels were determined in blood samples collected before and after 60, 90, 120 and 150 min of ingestion of these foods. In comparison with each of the test foods, the postprandial 1-h and 2-h plasma glucose values and the 60, 90, 120 and 150 min incremental glucose concentrations after oral glucose load were significantly higher than the corresponding values for each of the test foods (all P<0.01). In spite of these higher postprandial glucose concentrations, the postprandial insulin responses following the oral glucose load and the test foods did not significantly differ at any time point (all P>0.05). However, the test food, roti, tended to stimulate higher absolute and incremental insulin secretions than pure glucose or any other test food (all P>0.05). Generally, the correlation between 2-h plasma glucose value after the ingestion of the pure glucose and each of the test foods was significant (all correlation coefficients were greater than 0.70, P<0.01). In conclusion, different ethnic mixed meals could serve as an alternative to glucose in routine screening and diagnosis of diabetes if its available carbohydrate content is known and quantified.