Differences in glycemic control and cardiovascular risk in primary care patients with type 2 diabetes in West Indies

Abstract

There are limited resources and facilities at primary care clinics in most developing countries. Medical professionals are often faced with the challenges of providing standard health care delivery in the absence of adequate resources. We aimed to evaluate the long-term glycemic control and risk of cardiovascular disease in multi-ethnic groups of diabetic patients attending primary care clinics in Trinidad. One hundred and ninety-one (127 females, 64 males, mean age 56.6 years) patients with type 2 diabetes (mean duration 9.2 years) attending primary care clinics in Trinidad were studied after a 12 to 14-h overnight fast. Weight, height, waist and hip circumferences, and blood pressure were measured, and a blood sample was taken for glucose, glycated hemoglobin, total cholesterol, triglycerides, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol. and creatinine determinations. About 85% of patients had glycated hemoglobin levels >7.0%, 31% had central obesity, 49% had diastolic blood pressure >83 mmHg, while 40% had a total-cholesterol/high-density lipoprotein-cholesterol ratio greater than 6. In comparison with males, female patients had significantly higher levels of total-cholesterol and low-density lipoprotein-cholesterol independent of obesity (P<0.01) while male patients of East Indian descent had the highest risk of cardiovascular disease compared with males of any other ethnic group (P<0.01). In conclusion patients with type 2 diabetes attending primary care clinics in Trinidad had poor glycemic control. Female and male patients of Indian ethnic group were at the highest risk of cardiovascular disease. Efforts at strict glycemic control and protection against microvascular complications should be intensified at primary care levels.

Metabolic control of type 2 diabetic patients commonly treated with sulphonylureas in a developing country

“…Although fasting hyperinsulinaemia and insulin resistance are constant pathogenic mechanism in type 2 diabetes(6,7), insulin resistance is also associated with age and obesity, and with long standing diabetes, continued tissue insulin resistance gives rise to lipid abnormalities such as hypertriglyceridaemia. The disproportionate cluster of cardiovascular risk factors (hypercholesterolaemia, obesity, hypertriglyceridaemia, hyperinsulinaemia, elevated LDL cholestesterol) around the female patients and patients of East Indian origin is consistent with previous reports in this population (27,28). It would appear that the higher CVD risk in females than males might be related to the higher prevalence of obesity in females than males (Tables 2 and 5), a finding previously reported in non-diabetic healthy African subjects (18).…”

“…values and reduced rates of complications than patients whose physicians set higher glycaemic goals (30). In conclusion, it is recognised that there is unequal gender and ethnic representation in the study, which is a reflection of the pattern of diabetes prevalence and general uptake in the primary care setting in this population (27,28). Again, although we assessed insulin sensitivity with a lessrecognised technical method, HOMA, results obtained with this method was comparable with other established techniques (31).…”

Prediction of 10-year coronary heart disease risk in Caribbean type 2 diabetic patients using the UKPDS risk engine

“…Although previous studies in this population have highlighted the greater risk of cardiovascular disease for this ethnic group [3][4][5]17], perhaps, due to their diet and glycaemic responses to foods [26]; this is the first report to indicate the levels of the risk in absolute terms. Our findings suggest that patients of Indian origin, irrespective of gender, were more vulnerable group and should be the first target for primary prevention of CHD.…”

“…While Tobago is comprised mainly of people of African descent, Trinidad has higher proportion of people of Indian origin [1]. Previous reports on cardiovascular disease risk in Trinidad have consistently shown that people of Indian origin had higher CVD risk factors than the other ethnic groups [3][4][5]17]. Similarly, studies in the United Kingdom [20] and North America [21,22] have confirmed higher risk of CHD amongst people of Asian origin than people of African descent.…”

“…Poor glycaemic control, usually assessed with HbA 1c , is linked to macrovascular complications in type 2 diabetes [15] and it is still controversial whether it is poor fasting or postprandial glycaemia that contributes more to the complication [16]. Therefore, the incorporation of HbA 1c factor in UKPDS risk engine would be most valuable in assessing absolute CHD risk in our population with records of poor glycaemic control in type 2 diabetic patients [17]. Although there are some controversies regarding the risk level (10-year risk N 15, or 30%) at which primary prevention of CHD should be initiated [10,14,18], primary prevention of CHD using aspirin and/or statin has not been streamlined especially in the developing countries [19].…”