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Diabetes in the Caribbean

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Diabetes Mellitus in Developing Countries and Underserved Communities

Abstract

The Caribbean is undergoing a dramatic epidemiologic transition mostly due to ageing and Westernisation. As such, type 2 diabetes has become a major public health burden, and its prevalence and incidence in the region is higher than many developed countries. Several risk factors have been identified, and most are nutritional, e.g. maternal obesity, intrauterine growth retardation, large-for-gestational-age babies, growth faltering in infancy, faster growth in childhood and cafeteria-like diets among adults. Physical inactivity is common. These act independently and in combination to increase adiposity and alter glucose metabolism. Microvascular and macrovascular complications are common, resulting in significant loss of human capital and unsustainable healthcare costs. Consequently, lifestyle modification, diabetes screening and surveillance need to be on the forefront of public health measures. Caribbean women carry a disproportionate burden of obesity and diabetes, so gender-specific measures are needed as part of a life-course approach. These intervention strategies may be best directed towards women of child-bearing age, as well as children. In general, diabetic patients in the Caribbean need better metabolic control of glycaemia, blood pressure and lipids, especially if a coordinated macroeconomic approach is used. More research is needed to identify factors driving the excess risk of obesity and diabetes in the Caribbean, the role of nutrition, ethnomedicine and interventions.

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References

  1. Benn-Torres J, Bonilla C, Robbins CM, Waterman L, Moses TY, Hernandez W, et al. Admixture and population stratification in African Caribbean populations. Ann Hum Genet. 2008;72:90–8.

    CAS  PubMed  Google Scholar 

  2. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 385:117–71.

    Google Scholar 

  3. Wilks R, Bennett F, Forrester T, McFarlane-Anderson N. Chronic diseases: the new epidemic. West Indian Med J. 1998;47 Suppl 4:40–4.

    PubMed  Google Scholar 

  4. Sargeant LA, Wilks RJ, Forrester TE. Chronic diseases – facing a public health challenge. West Indian Med J. 2001;50 Suppl 4:27–31.

    PubMed  Google Scholar 

  5. Sarmiento L, Cubas-Duenas I, Cabrera-Rode E. Evidence of association between type 1 diabetes and exposure to enterovirus in Cuban children and adolescents. MEDICC Rev. 2013;15:29–32.

    Article  PubMed  Google Scholar 

  6. Sarmiento L, Cabrera-Rode E, Lekuleni L, Cuba I, Molina G, Fonseca M, et al. Occurrence of enterovirus RNA in serum of children with newly diagnosed type 1 diabetes and islet cell autoantibody-positive subjects in a population with a low incidence of type 1 diabetes. Autoimmunity. 2007;40:540–5.

    Article  CAS  PubMed  Google Scholar 

  7. Bartholomew C, Cleghorn F. Retroviruses in the Caribbean. Bull Pan Am Health Organ. 1989;23:76–80.

    CAS  PubMed  Google Scholar 

  8. Smikle MF, Wright-Pascoe R, Barton EN, Dowe G, Gilbert DT, Choo-Kang E, et al. Autoantibodies, human T lymphotropic virus type 1 and type 1 diabetes mellitus in Jamaicans. West Indian Med J. 2002;51:153–6.

    CAS  PubMed  Google Scholar 

  9. Costa GC, Azevedo R, Gadelha SR, Kashima SH, Muricy G, Olavarria VN, et al. Polymorphisms at GLUT1 gene are not associated with the development of TSP/HAM in Brazilian HTLV-1 infected individuals and the discovery of a new polymorphism at GLUT1 gene. J Med Virol. 2009;81:552–7.

    Article  CAS  PubMed  Google Scholar 

  10. Wilks R, Rotimi C, Bennett F, McFarlane-Anderson N, Kaufman JS, Anderson SG, et al. Diabetes in the Caribbean: results of a population survey from Spanish Town, Jamaica. Diabet Med. 1999;16:875–83.

    Article  CAS  PubMed  Google Scholar 

  11. Luke A, Cooper RS, Prewitt TE, Adeyemo AA, Forrester TE. Nutritional consequences of the African diaspora. Annu Rev Nutr. 2001;21:47–71.

    Article  CAS  PubMed  Google Scholar 

  12. Luke A, Durazo-Arvizu R, Rotimi C, Prewitt TE, Forrester T, Wilks R, et al. Relation between body mass index and body fat in black population samples from Nigeria, Jamaica, and the United States. Am J Epidemiol. 1997;145:620–8.

    Article  CAS  PubMed  Google Scholar 

  13. Cooper R, Rotimi C, Ataman S, McGee D, Osotimehin B, Kadiri S, et al. The prevalence of hypertension in seven populations of west African origin. Am J Public Health. 1997;87:160–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Durazo-Arvizu RA, Luke A, Cooper RS, Cao G, Dugas L, Adeyemo A, et al. Rapid increases in obesity in Jamaica, compared to Nigeria and the United States. BMC Public Health. 2008;8:133.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cooper RS, Rotimi CN, Kaufman JS, Owoaje EE, Fraser H, Forrester T, et al. Prevalence of NIDDM among populations of the African diaspora. Diabetes Care. 1997;20:343–8.

    Article  CAS  PubMed  Google Scholar 

  16. Franco M, Bilal U, Ordunez P, Benet M, Morejon A, Caballero B, et al. Population-wide weight loss and regain in relation to diabetes burden and cardiovascular mortality in Cuba 1980–2010: repeated cross sectional surveys and ecological comparison of secular trends. BMJ. 2013;346:f1515.

    Article  PubMed  Google Scholar 

  17. Miller GJ, Maude GH, Beckles GL. Incidence of hypertension and non-insulin dependent diabetes mellitus and associated risk factors in a rapidly developing Caribbean community: the St James survey, Trinidad. J Epidemiol Community Health. 1996;50:497–504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Sobers-Grannum N, Murphy MM, Nielsen A, Guell C, Samuels TA, Bishop L, et al. Female gender is a social determinant of diabetes in the Caribbean: a systematic review and meta-analysis. PLoS One. 2015;10:e0126799.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  19. Sargeant LA, Boyne MS, Bennett FI, Forrester TE, Cooper RS, Wilks RJ. Impaired glucose regulation in adults in Jamaica: who should have the oral glucose tolerance test? Rev Panam Salud Publica. 2004;16:35–42.

    Article  PubMed  Google Scholar 

  20. El Mabchour A, Delisle H, Vilgrain C, Larco P, Sodjinou R, Batal M. Specific cut-off points for waist circumference and waist-to-height ratio as predictors of cardiometabolic risk in Black subjects: a cross-sectional study in Benin and Haiti. Diabetes Metab Syndr Obes Targets Ther. 2015;8:513–23.

    Article  Google Scholar 

  21. Sargeant LA, Bennett FI, Forrester TE, Cooper RS, Wilks RJ. Predicting incident diabetes in Jamaica: the role of anthropometry. Obes Res. 2002;10:792–8.

    Article  PubMed  Google Scholar 

  22. Boyne MS, Bennett NR, Cooper RS, Royal-Thomas TY, Bennett FI, Luke A, et al. Sex-differences in adiponectin levels and body fat distribution: longitudinal observations in Afro-Jamaicans. Diabetes Res Clin Pract. 2010;90:e33–6.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Albu JB, Kovera AJ, Allen L, Wainwright M, Berk E, Raja-Khan N, et al. Independent association of insulin resistance with larger amounts of intermuscular adipose tissue and a greater acute insulin response to glucose in African American than in white nondiabetic women. Am J Clin Nutr. 2005;82:1210–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Miljkovic-Gacic I, Wang X, Kammerer CM, Gordon CL, Bunker CH, Kuller LH, et al. Fat infiltration in muscle: new evidence for familial clustering and associations with diabetes. Obesity (Silver Spring). 2008;16:1854–60.

    Article  Google Scholar 

  25. Miljkovic-Gacic I, Gordon CL, Goodpaster BH, Bunker CH, Patrick AL, Kuller LH, et al. Adipose tissue infiltration in skeletal muscle: age patterns and association with diabetes among men of African ancestry. Am J Clin Nutr. 2008;87:1590–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Bower JF, Davis JM, Hao E, Barakat HA. Differences in transport of fatty acids and expression of fatty acid transporting proteins in adipose tissue of obese black and white women. Am J Physiol Endocrinol Metab. 2006;290:E87–91.

    Article  CAS  PubMed  Google Scholar 

  27. Prochaska JJ, Sallis JF, Griffith B, Douglas J. Physical activity levels of Barbadian youth and comparison to a U.S. sample. Int J Behav Med. 2002;9:360–72.

    Article  PubMed  Google Scholar 

  28. Boyne MS, Gaskin P, Luke A, Wilks RJ, Bennett FI, Younger N, et al. Energetic determinants of glucose tolerance status in Jamaican adults. Eur J Clin Nutr. 2004;58:1666–8.

    Article  CAS  PubMed  Google Scholar 

  29. Luke A, Bovet P, Plange-Rhule J, Forrester TE, Lambert EV, Schoeller DA, et al. A mixed ecologic-cohort comparison of physical activity & weight among young adults from five populations of African origin. BMC Public Health. 2014;14:397.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Dugas LR, Bovet P, Forrester TE, Lambert EV, Plange-Rhule J, Durazo-Arvizu RA, et al. Comparisons of intensity-duration patterns of physical activity in the US, Jamaica and 3 African countries. BMC Public Health. 2014;14:882.

    Article  PubMed  PubMed Central  Google Scholar 

  31. McKeigue PM, Lithell HO, Leon DA. Glucose tolerance and resistance to insulin-stimulated glucose uptake in men aged 70 years in relation to size at birth. Diabetologia. 1998;41:1133–8.

    Article  CAS  PubMed  Google Scholar 

  32. McCance DR, Pettitt DJ, Hanson RL, Jacobsson LT, Knowler WC, Bennett PH. Birth weight and non-insulin dependent diabetes: thrifty genotype, thrifty phenotype, or surviving small baby genotype? BMJ. 1994;308:942–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Gluckman PD, Hanson MA, Cooper C, Thornburg KL. Effect of in utero and early-life conditions on adult health and disease. N Engl J Med. 2008;359:61–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Li C, Johnson MS, Goran MI. Effects of low birth weight on insulin resistance syndrome in caucasian and African-American children. Diabetes Care. 2001;24:2035–42.

    Article  CAS  PubMed  Google Scholar 

  35. Soto N, Bazaes RA, Pena V, Salazar T, Avila A, Iniguez G, et al. Insulin sensitivity and secretion are related to catch-up growth in small-for-gestational-age infants at age 1 year: results from a prospective cohort. J Clin Endocrinol Metab. 2003;88:3645–50.

    Article  CAS  PubMed  Google Scholar 

  36. Crowther NJ, Trusler J, Cameron N, Toman M, Gray IP. Relation between weight gain and beta-cell secretory activity and non-esterified fatty acid production in 7-year-old African children: results from the Birth to Ten study. Diabetologia. 2000;43:978–85.

    Article  CAS  PubMed  Google Scholar 

  37. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.

    Article  PubMed  Google Scholar 

  38. Boyne MS, Osmond C, Fraser RA, Reid M, Taylor-Bryan C, Soares-Wynter S, et al. Developmental origins of cardiovascular risk in Jamaican children: the Vulnerable Windows Cohort study. Br J Nutr. 2010;104:1026–33.

    Article  CAS  PubMed  Google Scholar 

  39. Murphy MJ, Metcalf BS, Voss LD, Jeffery AN, Kirkby J, Mallam KM, et al. Girls at five are intrinsically more insulin resistant than boys: the Programming Hypotheses Revisited – The EarlyBird Study (EarlyBird 6). Pediatrics. 2004;113:82–6.

    Article  PubMed  Google Scholar 

  40. Boyne MS, Thame M, Osmond C, Fraser RA, Gabay L, Taylor-Bryan C, et al. The effect of earlier puberty on cardiometabolic risk factors in Afro-Caribbean children. J Pediatr Endocrinol Metab. 2014;27:453–60.

    Article  CAS  PubMed  Google Scholar 

  41. Bennett F, Watson-Brown C, Thame M, Wilks R, Osmond C, Hales N, et al. Shortness at birth is associated with insulin resistance in pre-pubertal Jamaican children. Eur J Clin Nutr. 2002;56:506–11.

    Article  CAS  PubMed  Google Scholar 

  42. Forrester TE, Wilks RJ, Bennett FI, Simeon D, Osmond C, Allen M, et al. Fetal growth and cardiovascular risk factors in Jamaican schoolchildren. BMJ. 1996;312:156–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Chin-Harty LA, Royal-Thomas T, Thompson DS, Osmond C, Forrester TE, Boyne MS. Role of prenatal factors and postnatal growth on insulin sensitivity and beta-cell function in Afro-Caribbean youth: vulnerable Windows Cohort Study. J Dev Orig Health Dis. 2015;6:S12. (abstract).

    Google Scholar 

  44. Francis-Emmanuel PM, Thompson DS, Barnett AT, Osmond C, Byrne CD, Hanson MA, et al. Glucose metabolism in adult survivors of severe acute malnutrition. J Clin Endocrinol Metab. 2014;99:2233–40.

    Article  CAS  PubMed  Google Scholar 

  45. Boyne MS, Sargeant LA, Bennett FI, Wilks RJ, Cooper RS, Forrester TE. Isoprostanes, a marker of lipid peroxidation, may not be involved in the development of glucose intolerance. Diabetes Res Clin Pract. 2007;76:149–51.

    Article  CAS  PubMed  Google Scholar 

  46. Thompson DS, Ferguson TS, Wilks RJ, Phillips DI, Osmond C, Samms-Vaughan M, et al. Early-life factors are associated with nocturnal cortisol and glucose effectiveness in Afro-Caribbean young adults. Clin Endocrinol (Oxf). 2015;82:352–8.

    Google Scholar 

  47. Boyne MS, Thompson DS, Osmond C, Fraser RA, Thame MM, Taylor-Bryan C, et al. The effect of antenatal factors and postnatal growth on serum adiponectin levels in children. J Dev Orig Health Dis. 2013;4:317–23.

    Article  CAS  PubMed  Google Scholar 

  48. Ferguson TS, Younger-Coleman NO, Tulloch-Reid MK, Knight-Madden JM, Bennett NR, Samms-Vaughan M, et al. Birth weight and maternal socioeconomic circumstances were inversely related to systolic blood pressure among Afro-Caribbean young adults. J Clin Epidemiol. 2015;68:1002–9.

    Article  PubMed  Google Scholar 

  49. Ezenwaka CE, Kalloo R. Caribbean female patients with type 2 diabetes mellitus have lower serum levels of adiponectin than nondiabetic subjects. Neth J Med. 2005;63:64–9.

    CAS  PubMed  Google Scholar 

  50. Bennett NR, Boyne MS, Cooper RS, Royal-Thomas TY, Bennett FI, Luke A, et al. Impact of adiponectin and ghrelin on incident glucose intolerance and on weight change. Clin Endocrinol (Oxf). 2009;70:408–14.

    Article  CAS  Google Scholar 

  51. Miljkovic-Gacic I, Wang X, Kammerer CM, Bunker CH, Wheeler VW, Patrick AL, et al. Genetic determination of adiponectin and its relationship with body fat topography in multigenerational families of African heritage. Metabolism. 2007;56:234–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Mehrotra S, Ling KL, Bekele Y, Gerbino E, Earle KA. Lipid hydroperoxide and markers of renal disease susceptibility in African-Caribbean and Caucasian patients with Type 2 diabetes mellitus. Diabet Med. 2001;18:109–15.

    Article  CAS  PubMed  Google Scholar 

  53. Nayak BS, Roberts L. Relationship between inflammatory markers, metabolic and anthropometric variables in the Caribbean type 2 diabetic patients with and without microvascular complications. J Inflamm (Lond). 2006;3:17.

    Google Scholar 

  54. Lutchmansingh FK, Bennett FI, Badaloo AV, McFarlane-Anderson N, Gordon-Strachan GM, Wright-Pascoe R, et al. Glutathione metabolism in persons with type 2 diabetes. West Indian Med J. 2012;61:24. (abstract).

    Google Scholar 

  55. Cumberbatch CG, Younger NO, Ferguson TS, McFarlane SR, Francis DK, Wilks RJ, et al. Reported hours of sleep, diabetes prevalence and glucose control in Jamaican adults: analysis from the Jamaica lifestyle survey 2007–2008. Int J Endocrinol. 2011;716214.

    Google Scholar 

  56. Hugh-Jones P. Diabetes in Jamaica. Lancet. 1955;269:891–7.

    Article  CAS  PubMed  Google Scholar 

  57. Balasubramanyam A, Nalini R, Hampe CS, Maldonado M. Syndromes of ketosis-prone diabetes mellitus. Endocr Rev. 2008;29:292–302.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Morrison EY, Ragoobirsingh D. J type diabetes revisited. J Natl Med Assoc. 1992;84:603–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  59. Boyne MS. Diabetes in the Caribbean: trouble in paradise. Insulin. 2009;4:94–105.

    Article  Google Scholar 

  60. Maldonado M, Hampe CS, Gaur LK, D’Amico S, Iyer D, Hammerle LP, et al. Ketosis-prone diabetes: dissection of a heterogeneous syndrome using an immunogenetic and beta-cell functional classification, prospective analysis, and clinical outcomes. J Clin Endocrinol Metab. 2003;88:5090–8.

    Article  CAS  PubMed  Google Scholar 

  61. Tulloch-Reid MK, Boyne MS, Choo-Kang EG, Parkes R, Wright-Pascoe RA, Barton EN, et al. Autoantibodies in Caribbean youth with diabetes mellitus. Hum Antibodies. 2008;17(3–4):57–62.

    CAS  PubMed  Google Scholar 

  62. Mauvais-Jarvis F, Sobngwi E, Porcher R, Riveline JP, Kevorkian JP, Vaisse C, et al. Ketosis-prone type 2 diabetes in patients of sub-Saharan African origin: clinical pathophysiology and natural history of beta-cell dysfunction and insulin resistance. Diabetes. 2004;53:645–53.

    Article  CAS  PubMed  Google Scholar 

  63. Boutin P, Gresh L, Cisse A, Hara M, Bell G, Babu S, et al. Missense mutation Gly574Ser in the transcription factor HNF-1alpha is a marker of atypical diabetes mellitus in African-American children. Diabetologia. 1999;42:380–1.

    Article  CAS  PubMed  Google Scholar 

  64. Mauvais-Jarvis F, Boudou P, Sobngwi E, Riveline JP, Kevorkian JP, Villette JM, et al. The polymorphism Gly574Ser in the transcription factor HNF-1alpha is not a marker of adult-onset ketosis-prone atypical diabetes in Afro-Caribbean patients. Diabetologia. 2003;46:728–9.

    Article  CAS  PubMed  Google Scholar 

  65. Aguilera E, Casamitjana R, Ercilla G, Oriola J, Nicoletti F, Gomis R, et al. Clinical characteristics, beta-cell function, HLA class II and mutations in MODY genes in non-paediatric subjects with Type 1 diabetes without pancreatic autoantibodies. Diabet Med: J Br Diabet Assoc. 2005;22:137–43.

    Article  CAS  Google Scholar 

  66. Stride A, Ellard S, Clark P, Shakespeare L, Salzmann M, Shepherd M, et al. Beta-cell dysfunction, insulin sensitivity, and glycosuria precede diabetes in hepatocyte nuclear factor-1alpha mutation carriers. Diabetes Care. 2005;28:1751–6.

    Article  CAS  PubMed  Google Scholar 

  67. Mills JL, Irving RR, Choo-Kang EG, Wright-Pascoe R, McLaughlin W, Mullings AA, et al. Multigenerational inheritance and clinical characteristics of three large pedigrees with early-onset type 2 diabetes in Jamaica. Rev Panam Salud Publ Pan Am J Publ Health. 2010;27:435–41.

    Google Scholar 

  68. Cockburn BN, Bermano G, Boodram LL, Teelucksingh S, Tsuchiya T, Mahabir D, et al. Insulin promoter factor-1 mutations and diabetes in Trinidad: identification of a novel diabetes-associated mutation (E224K) in an Indo-Trinidadian family. J Clin Endocrinol Metab. 2004;89:971–8.

    Article  CAS  PubMed  Google Scholar 

  69. Pyke DA, Wattley GH. Diabetes in Trinidad. West Indian Med J. 1962;11:22–6.

    CAS  PubMed  Google Scholar 

  70. Poon-King T, Henry MV, Rampersad F. Prevalence and natural history of diabetes in Trinidad. Lancet. 1968;291:155–60.

    Article  Google Scholar 

  71. Tulloch JA, Johnson HM. A pilot survey of the incidence of diabetes in Jamaica. West Indian Med J. 1958;7:134–6.

    CAS  PubMed  Google Scholar 

  72. Wright HB, Taylor B. The incidence of diabetes in a sample of the adult population in South Trinidad. West Indian Med J. 1958;7:123–33.

    CAS  PubMed  Google Scholar 

  73. Litvak J. Diabetes mellitus: a challenge for the countries of the region. Bull Pan Am Health Organ. 1975;9:317–24.

    CAS  PubMed  Google Scholar 

  74. Cunningham-Myrie C, Younger-Coleman N, Tulloch-Reid M, McFarlane S, Francis D, Ferguson T, et al. Diabetes mellitus in Jamaica: sex differences in burden, risk factors, awareness, treatment and control in a developing country. Tropical Med Int Health: TM IH. 2013;18:1365–78.

    Article  PubMed  Google Scholar 

  75. Ferguson TS, Francis DK, Tulloch-Reid MK, Younger NO, McFarlane SR, Wilks RJ. An update on the burden of cardiovascular disease risk factors in Jamaica: findings from the Jamaica Health and Lifestyle Survey 2007–2008. West Indian Med J. 2011;60:422–8.

    CAS  PubMed  Google Scholar 

  76. Washington RE, Orchard TJ, Arena VC, Laporte RE, Tull ES. Incidence of type 1 and type 2 diabetes in youth in the U.S. Virgin Islands, 2001–2010. Pediatr Diabetes. 2013;14:280–7.

    Article  PubMed  Google Scholar 

  77. Batson YA, Teelucksingh S, Maharaj R, Singh V, Balkaran S, Cockburn B. Screening for diabetes in schoolchildren in Trinidad, West Indies. Paediatr Int Child Health. 2013;33:37–41.

    Article  PubMed  Google Scholar 

  78. Tulloch-Reid MK, Boyne MS, Smikle MF, Choo-Kang EG, Parkes RH, Wright-Pascoe RA, et al. Clinical and laboratory features of youth onset type 2 diabetes in Jamaica. West Indian Med J. 2010;59:131–8.

    CAS  PubMed  Google Scholar 

  79. Peter SA, Johnson R, Taylor C, Hanna A, Roberts P, McNeil P, et al. The incidence and prevalence of type-1 diabetes mellitus. J Natl Med Assoc. 2005;97:250–2.

    PubMed  PubMed Central  Google Scholar 

  80. Jordan OW, Lipton RB, Stupnicka E, Cruickshank JK, Fraser HS. Incidence of type I diabetes in people under 30 years of age in Barbados, West Indies, 1982–1991. Diabetes Care. 1994;17:428–31.

    Article  CAS  PubMed  Google Scholar 

  81. Tull ES, Jordan OW, Simon L, Laws M, Smith DO, Vanterpool H, et al. Incidence of childhood-onset IDDM in black African-heritage populations in the Caribbean. The Caribbean African Heritage IDDM Study (CAHIS) Group. Diabetes Care. 1997;20:309–10.

    Article  CAS  PubMed  Google Scholar 

  82. Clapperton M, Jarvis J, Mungrue K. Is gestational diabetes mellitus an important contributor to metabolic disorders in Trinidad and tobago? Obstet Gynecol Int. 2009;2009:289329.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  83. Irving RR, Mills JL, Choo-Kang EG, Morrison EY, Kulkarni S, Wright-Pascoe R, et al. The burden of gestational diabetes mellitus in Jamaican women with a family history of autosomal dominant type 2 diabetes. Rev Panam Salud Publ Pan Am J Publ Health. 2008;23:85–91.

    Google Scholar 

  84. Ali Z, Alexis SD. Occurrence of diabetes mellitus after gestational diabetes mellitus in Trinidad. Diabetes Care. 1990;13:527–9.

    Article  CAS  PubMed  Google Scholar 

  85. Murray T, Beaty TH, Mathias RA, Rafaels N, Grant AV, Faruque MU, et al. African and non-African admixture components in African Americans and an African Caribbean population. Genet Epidemiol. 2010;34:561–8.

    Article  PubMed  Google Scholar 

  86. Miljkovic-Gacic I, Ferrell RE, Patrick AL, Kammerer CM, Bunker CH. Estimates of African, European and Native American ancestry in Afro-Caribbean men on the island of Tobago. Hum Hered. 2005;60:129–33.

    Article  PubMed  Google Scholar 

  87. Moreno-Estrada A, Gravel S, Zakharia F, McCauley JL, Byrnes JK, Gignoux CR, et al. Reconstructing the population genetic history of the Caribbean. PLoS Genet. 2013;9:e1003925.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  88. Diaz-Horta O, Cintado A, Fernandez-De-Cossio ME, Nazabal M, Ferrer A, Roca J, et al. Relationship of type 1 diabetes to ancestral proportions and HLA DR/DQ alleles in a sample of the admixed Cuban population. Ann Hum Biol. 2010;37:778–88.

    Article  PubMed  Google Scholar 

  89. Heward JM, Mijovic CH, Kelly MA, Morrison E, Barnett AH. HLA-DQ and DRB1 polymorphism and susceptibility to type 1 diabetes in Jamaica. Eur J Immunogenet. 2002;29:47–52.

    Article  CAS  PubMed  Google Scholar 

  90. Cruickshank JK, Mbanya JC, Wilks R, Balkau B, McFarlane-Anderson N, Forrester T. Sick genes, sick individuals or sick populations with chronic disease? The emergence of diabetes and high blood pressure in African-origin populations. Int J Epidemiol. 2001;30:111–7.

    Article  CAS  PubMed  Google Scholar 

  91. Hennis A, Wu SY, Nemesure B, Li X, Leske MC. Diabetes in a Caribbean population: epidemiological profile and implications. Int J Epidemiol. 2002;31:234–9.

    Article  PubMed  Google Scholar 

  92. Humphries SE, Gable D, Cooper JA, Ireland H, Stephens JW, Hurel SJ, et al. Common variants in the TCF7L2 gene and predisposition to type 2 diabetes in UK European Whites, Indian Asians and Afro-Caribbean men and women. J Mol Med. 2006;84:1005–14.

    Article  CAS  PubMed  Google Scholar 

  93. Boodram LG, Miyake K, Hayes MG, Bell GI, Cockburn BN. Association of the KCNJ11 variant E23K with type 2 diabetes in Indo-Trinidadians. West Indian Med J. 2011;60:604–7.

    CAS  PubMed  Google Scholar 

  94. McFarlane-Anderson N, Bennett F, Wilks R, Howell S, Newsome C, Cruickshank K, et al. The Trp64Arg mutation of the beta3-adrenergic receptor is associated with hyperglycemia and current body mass index in Jamaican women. Metabolism. 1998;47:617–21.

    Article  CAS  PubMed  Google Scholar 

  95. Miljkovic I, Yerges LM, Li H, Gordon CL, Goodpaster BH, Kuller LH, et al. Association of the CPT1B gene with skeletal muscle fat infiltration in Afro-Caribbean men. Obesity. 2009;17:1396–401.

    CAS  PubMed  PubMed Central  Google Scholar 

  96. Shungin D, Winkler TW, Croteau-Chonka DC, Ferreira T, Locke AE, Magi R, et al. New genetic loci link adipose and insulin biology to body fat distribution. Nature. 2015;518:187–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  97. Locke AE, Kahali B, Berndt SI, Justice AE, Pers TH, Day FR, et al. Genetic studies of body mass index yield new insights for obesity biology. Nature. 2015;518:197–206.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Beckles GL, Miller GJ, Kirkwood BR, Alexis SD, Carson DC, Byam NT. High total and cardiovascular disease mortality in adults of Indian descent in Trinidad, unexplained by major coronary risk factors. Lancet. 1986;1:1298–301.

    Article  CAS  PubMed  Google Scholar 

  99. McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in South Asians. Lancet. 1991;337:382–6.

    Article  CAS  PubMed  Google Scholar 

  100. Chaturvedi N. Ethnic differences in cardiovascular disease. Heart. 2003;89:681–6.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Earle KK, Porter KA, Ostberg J, Yudkin JS. Variation in the progression of diabetic nephropathy according to racial origin. Nephrol Dial Transplant. 2001;16:286–90.

    Article  CAS  PubMed  Google Scholar 

  102. Chaturvedi N, McKeigue PM, Marmot MG. Resting and ambulatory blood pressure differences in Afro-Caribbeans and Europeans. Hypertension. 1993;22:90–6.

    Article  CAS  PubMed  Google Scholar 

  103. Tulloch-Reid MK, Boyne MS, Smikle MF, Choo-Kang EG, Parkes RH, Wright-Pascoe RA, et al. Cardiovascular risk profile in Caribbean youth with diabetes mellitus. West Indian Med J. 2009;58:219–26.

    CAS  PubMed  Google Scholar 

  104. Mortality GBD, Causes of Death C. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–71.

    Article  Google Scholar 

  105. Miller GJ, Kirkwood BR, Beckles GL, Alexis SD, Carson DC, Byam NT. Adult male all-cause, cardiovascular and cerebrovascular mortality in relation to ethnic group, systolic blood pressure and blood glucose concentration in Trinidad. West Indies Int J Epidemiol. 1988;17:62–9.

    Article  CAS  PubMed  Google Scholar 

  106. Ferguson TS, Tulloch-Reid MK, Younger NO, Boyne MS, Wright-Pascoe RA, Elliott VE, et al. Cardiovascular disease among diabetic in-patients at a tertiary hospital in Jamaica. Diab Vasc Dis Res. 2010;7:241–2.

    Article  PubMed  Google Scholar 

  107. Blanchet Deverly A, Amara M, Larifla L, Velayoudom-Cephise FL, Roques F, Kangambega P, et al. Silent myocardial ischaemia and risk factors in a diabetic Afro-Caribbean population. Diabetes Metab. 2011;37:533–9.

    Article  CAS  PubMed  Google Scholar 

  108. Larifla L, Maimaitiming S, Velayoudom-Cephise FL, Ferdinand S, Blanchet-Deverly A, Benabdallah S, et al. Association of 2238T>C polymorphism of the atrial natriuretic peptide gene with coronary artery disease in Afro-Caribbeans with type 2 diabetes. Am J Hypertens. 2012;25:524–7.

    Article  CAS  PubMed  Google Scholar 

  109. Yisahak SF, Beagley J, Hambleton IR, Narayan KM, Atlas IDFD. Diabetes in North America and the Caribbean: an update. Diabetes Res Clin Pract. 2014;103:223–30.

    Article  PubMed  Google Scholar 

  110. Andrade F. Estimating diabetes and diabetes-free life expectancy in Mexico and seven major cities in Latin America and the Caribbean. Rev Panam Salud Publ Pan Am J Publ Health. 2009;26:9–16.

    Article  Google Scholar 

  111. Washington RE, Orchard TJ, Arena VC, LaPorte RE, Secrest AM, Tull ES. All-cause mortality in a population-based type 1 diabetes cohort in the U.S. Virgin Islands. D Diabetes Res Clin Pract. 2014;103:504–9.

    Article  Google Scholar 

  112. Ferguson TS, Tulloch-Reid MK, Younger NO, Wright-Pascoe RA, Boyne MS, McFarlane SR, et al. Diabetic foot complications among patients attending a specialist diabetes clinic in Jamaica: prevalence and associated factors. West Indian Med J. 2013;62:216–23.

    CAS  PubMed  Google Scholar 

  113. Taylor Jr CG, Krimholtz M, Belgrave KC, Hambleton I, George CN, Rayman G. The extensive inpatient burden of diabetes and diabetes-related foot disease in Barbados. Clin Med. 2014;14:367–70.

    Article  Google Scholar 

  114. Cawich SO, Islam S, Hariharan S, Harnarayan P, Budhooram S, Ramsewak S, et al. The economic impact of hospitalization for diabetic foot infections in a Caribbean nation. Permanente J. 2014;18:e101–4.

    Article  Google Scholar 

  115. Hennis AJ, Fraser HS, Jonnalagadda R, Fuller J, Chaturvedi N. Explanations for the high risk of diabetes-related amputation in a Caribbean population of black African descent and potential for prevention. Diabetes Care. 2004;27:2636–41.

    Article  PubMed  Google Scholar 

  116. Hambleton IR, Jonnalagadda R, Davis CR, Fraser HS, Chaturvedi N, Hennis AJ. All-cause mortality after diabetes-related amputation in Barbados: a prospective case-control study. Diabetes Care. 2009;32:306–7.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Landis RC, Evans BJ, Chaturvedi N, Haskard DO. Persistence of TNFalpha in diabetic wounds. Diabetologia. 2010;53:1537–8.

    Article  CAS  PubMed  Google Scholar 

  118. Quimby KR, Greenidge AR, Hennis AJ, Harrison DK, Landis RC. Tumor necrosis factor receptor-associated periodic syndrome P46L and bilateral amputation in diabetes. Rheumatology. 2010;49:2454–5.

    Article  CAS  PubMed  Google Scholar 

  119. Vigilance JE, Reid HL. Glycaemic control influences peripheral blood flow and haemorheological variables in patients with diabetes mellitus. Clin Hemorheol Microcirc. 2005;33:337–46.

    CAS  PubMed  Google Scholar 

  120. Leske MC, Wu SY, Hyman L, Li X, Hennis A, Connell AM, et al. Diabetic retinopathy in a black population: the Barbados Eye Study. Ophthalmology. 1999;106:1893–9.

    Article  CAS  PubMed  Google Scholar 

  121. Leske MC, Wu SY, Hennis A, Nemesure B, Hyman L, Schachat A. Incidence of diabetic retinopathy in the Barbados Eye Studies. Ophthalmology. 2003;110:941–7.

    Article  PubMed  Google Scholar 

  122. Leske MC, Wu SY, Hennis A, Nemesure B, Schachat AP, Hyman L, et al. Nine-year incidence of diabetic retinopathy in the Barbados Eye Studies. Arch Ophthalmol. 2006;124:250–5.

    Article  PubMed  Google Scholar 

  123. Leske MC, Wu SY, Hennis A, Hyman L, Nemesure B, Yang L, et al. Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies. Ophthalmology. 2005;112:799–805.

    Article  PubMed  Google Scholar 

  124. Moriarty BJ, Dunn DT, Moriarty AP. Diabetic maculopathy in a Jamaican population. Int Ophthalmol. 1989;13:301–3.

    Article  CAS  PubMed  Google Scholar 

  125. Mowatt L. Diabetic retinopathy and its risk factors at the university hospital in Jamaica. Middle East Afr J Ophthalmol. 2013;20:321–6.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Ferguson TS, Tulloch-Reid MK, Younger-Coleman NO, Wright-Pascoe RA, Boyne MS, Soyibo AK, et al. Prevalence of chronic kidney disease among patients attending a specialist diabetes clinic in Jamaica. West Indian Med J. 2015;64:201.

    CAS  PubMed  Google Scholar 

  127. Soyibo AK, Barton EN. Report from the Caribbean renal registry, 2006. West Indian Med J. 2007;56:355–63.

    CAS  PubMed  Google Scholar 

  128. Ragoobirsingh D, Bennett F, Morrison EY. Kidney function in phasic insulin dependent diabetes mellitus in Jamaica. West Indian Med J. 1997;46:22–4.

    CAS  PubMed  Google Scholar 

  129. Chung ST, Perue GG, Johnson A, Younger N, Hoo CS, Pascoe RW, et al. Predictors of hyperglycaemic crises and their associated mortality in Jamaica. Diabetes Res Clin Pract. 2006;73:184–90.

    Article  PubMed  Google Scholar 

  130. Frederick FT, Maharajh HD. Prevalence of depression in type 2 diabetic patients in Trinidad and Tobago. West Indian Med J. 2013;62:628–31.

    CAS  PubMed  Google Scholar 

  131. Wilks RJ, Sargeant LA, Gulliford MC, Reid ME, Forrester TE. Management of diabetes mellitus in three settings in Jamaica. Rev Panam Salud Publica. 2001;9:65–72.

    Article  CAS  PubMed  Google Scholar 

  132. Mahabir D, Gulliford MC. Changing patterns of primary care for diabetes in Trinidad and Tobago over 10 years. Diabet Med. 2005;22:619–24.

    Article  CAS  PubMed  Google Scholar 

  133. Apparico N, Clerk N, Henry G, Seale J, Sealy R, Ward S, et al. How well controlled are our type 2 diabetic patients in 2002? An observational study in North and Central Trinidad. Diabetes Res Clin Pract. 2007;75:301–5.

    Article  PubMed  Google Scholar 

  134. Forde H, Marshall M, Cohall D, Nielsen AL. Assessing predictors for sustainable management of type 2 diabetes using evidence-based guidelines in public primary care in a predominantly Afro-Caribbean population. Ethn Dis. 2014;24:469–74.

    Google Scholar 

  135. Adams OP, Carter AO. Are primary care practitioners in Barbados following diabetes guidelines? – a chart audit with comparison between public and private care sectors. BMC Res Notes. 2011;4:199.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Adams OP, Carter AO. Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers – a focus group study. BMC Fam Pract. 2010;11:96.

    Article  PubMed  PubMed Central  Google Scholar 

  137. Barcelo A, Aedo C, Rajpathak S, Robles S. The cost of diabetes in Latin America and the Caribbean. Bull World Health Organ. 2003;81:19–27.

    PubMed  PubMed Central  Google Scholar 

  138. Hassell T, Hennis A. The road to the United Nations High Level Meeting on chronic non-communicable diseases. West Indian Med J. 2011;60:384–6.

    CAS  PubMed  Google Scholar 

  139. Batson YA, Teelucksingh S, Maharaj RG, Cockburn BN. A cross-sectional study to determine the prevalence of obesity and other risk factors for type 2 diabetes among school children in Trinidad, West Indies. Paediatr Int Child Health. 2014;34:178–83.

    Article  PubMed  Google Scholar 

  140. Bahado-Singh PS, Riley CK, Wheatley AO, Lowe HI. Relationship between processing method and the glycemic indices of ten sweet potato (Ipomoea batatas) cultivars commonly consumed in Jamaica. J Nutr Metab. 2011;2011:584832.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  141. Riley CK, Bahado-Singh PS, Wheatley AO, Ahmad MH, Asemota HN. Relationship between the physicochemical properties of starches and the glycemic indices of some Jamaican yams (Dioscorea spp.). Mol Nutr Food Res. 2008;52:1372–6.

    Article  CAS  PubMed  Google Scholar 

  142. Bahado-Singh PS, Wheatley AO, Ahmad MH, Morrison EY, Asemota HN. Food processing methods influence the glycaemic indices of some commonly eaten West Indian carbohydrate-rich foods. Br J Nutr. 2006;96:476–81.

    CAS  PubMed  Google Scholar 

  143. Ramdath DD, Isaacs RL, Teelucksingh S, Wolever TM. Glycaemic index of selected staples commonly eaten in the Caribbean and the effects of boiling v. crushing. Br J Nutr. 2004;91:971–7.

    Article  CAS  PubMed  Google Scholar 

  144. Bahado-Singh PS, Wheatley AO, Osagie AU, Boyne MS, Morrison EYS, Ahmad MH, et al. Low to intermediate-glycemic-index Caribbean foods reduce glycemia, cardiovascular and inflammatory markers in overweight persons with type 2 diabetes. Curr Res Nutr Food Sci. 2015;3:36–45.

    Article  Google Scholar 

  145. Wint YB, Duff EM, McFarlane-Anderson N, O'Connor A, Bailey EY, Wright-Pascoe RA. Knowledge, motivation and barriers to diabetes control in adults in Jamaica. West Indian Med J. 2006;55:330–3.

    Article  CAS  PubMed  Google Scholar 

  146. Babwah F, Baksh S, Blake L, Cupid-Thuesday J, Hosein I, Sookhai A, et al. The role of gender in compliance and attendance at an outpatient clinic for type 2 diabetes mellitus in Trinidad. Rev Panam Salud Publ Pan Am J Publ Health. 2006;19:79–84.

    Google Scholar 

  147. Adams OP, Carter AO. Knowledge, attitudes, practices, and barriers reported by patients receiving diabetes and hypertension primary health care in Barbados: a focus group study. BMC Fam Pract. 2011;12:135.

    Article  PubMed  PubMed Central  Google Scholar 

  148. Morrison E, Haye I, Amarakoon K, Whitbourne F, Kirlew J, Less L, et al. An interim report of an intervention strategy for diabetes care in Jamaica. West Indian Med J. 2001;50 Suppl 1:55–9.

    PubMed  Google Scholar 

  149. Less LA, Ragoorbirsingh D, Morrison EY, Boyne M, Johnson P. Assessment of a community based Intervention for diabetes control in adults with type 2 diabetes mellitus in three parishes in Jamaica: participant were assigned to interventions using random allocations. West Indian Med J. 2008;57 Suppl 1:39.

    Google Scholar 

  150. Less LA, Ragoobirsingh D, Morrison EY, Boyne M, Johnson PA. A preliminary report on an assessment of a community-based intervention for diabetes control in adults with type 2 diabetes. Fam Pract. 2010;27 Suppl 1:i46–52.

    Article  PubMed  Google Scholar 

  151. Gordon LA, Morrison EY, McGrowder DA, Young R, Fraser YT, Zamora EM, et al. Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes. BMC Complement Altern Med. 2008;8:21.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  152. Picking D, Younger N, Mitchell S, Delgoda R. The prevalence of herbal medicine home use and concomitant use with pharmaceutical medicines in Jamaica. J Ethnopharmacol. 2011;137:305–11.

    Article  PubMed  Google Scholar 

  153. Russell KR, Omoruyi FO, Pascoe KO, Morrison EY. Hypoglycaemic activity of Bixa orellana extract in the dog. Methods Find Exp Clin Pharmacol. 2008;30:301–5.

    Article  CAS  PubMed  Google Scholar 

  154. McAnuff MA, Harding WW, Omoruyi FO, Jacobs H, Morrison EY, Asemota HN. Hypoglycemic effects of steroidal sapogenins isolated from Jamaican bitter yam, Dioscorea polygonoides. Food Chem Toxicol: Int J Published Br Ind Biol Res Assoc. 2005;43:1667–72.

    Article  CAS  Google Scholar 

  155. Alexander-Lindo RL, Morrison EY, Nair MG. Hypoglycaemic effect of stigmast-4-en-3-one and its corresponding alcohol from the bark of Anacardium occidentale (cashew). Phytother Res: PTR. 2004;18:403–7.

    Article  CAS  PubMed  Google Scholar 

  156. Tolan I, Ragoobirsingh D, Morrison EY. Isolation and purification of the hypoglycaemic principle present in Capsicum frutescens. Phytother Res: PTR. 2004;18:95–6.

    Article  CAS  PubMed  Google Scholar 

  157. Christie SL, Levy A. Evaluation of the hypoglycaemic activity of Petiveria alliacea (Guinea Hen Weed) extracts in normoglycaemic and diabetic rat models. West Indian Med J. 2013;62:685–91.

    PubMed  Google Scholar 

  158. Dan D, Harnanan D, Singh Y, Hariharan S, Naraynsingh V, Teelucksingh S. Effects of bariatric surgery on type-2 diabetes mellitus in a Caribbean setting. Int J Surg. 2011;9:386–91.

    Article  PubMed  Google Scholar 

  159. Samuels TA, Fraser H. Caribbean Wellness Day: mobilizing a region for chronic noncommunicable disease prevention and control. Rev Panam Salud Publ Pan Am J Publ Health. 2010;28:472–9.

    Article  Google Scholar 

  160. Samuels TA, Guell C, Legetic B, Unwin N. Policy initiatives, culture and the prevention and control of chronic non-communicable diseases (NCDs) in the Caribbean. Ethn Health. 2012;17:631–49.

    Article  PubMed  Google Scholar 

  161. Barrett SC, Huffman FG, Johnson P, Campa A, Magnus M, Ragoobirsingh D. A cross-sectional study of Jamaican adolescents’ risk for type 2 diabetes and cardiovascular diseases. BMJ Open. 2013;3:e002817.

    Article  PubMed  PubMed Central  Google Scholar 

  162. Tulloch-Reid MK, Ferguson TS, Younger NO, Van den Broeck J, Boyne MS, Knight-Madden JM, et al. Appropriate waist circumference cut points for identifying insulin resistance in black youth: a cross sectional analysis of the 1986 Jamaica birth cohort. Diabetol Metab Syndr. 2010;2:68.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Tropical Metabolism Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Mona, Kingston 7, Jamaica

    Michael S. Boyne MD, FRCPC

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    Sam Dagogo-Jack

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Boyne, M.S. (2017). Diabetes in the Caribbean. In: Dagogo-Jack, S. (eds) Diabetes Mellitus in Developing Countries and Underserved Communities. Springer, Cham. https://doi.org/10.1007/978-3-319-41559-8_8

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