Screening for diabetes in schoolchildren in Trinidad, West Indies

Batson, Yvonne Ann; Teelucksingh, Surujpal; Maharaj, Rohan G; Singh, Virendra; Balkaran, Sasha; Cockburn, Brian N.

doi:10.1179/2046905512y.0000000032

Cited by 8 publications

(5 citation statements)

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“…Studies have found that approximately 60% to 92% of Black and Hispanic children with T2DM have AN [19] making it a highly sensitive marker in this age group. Indeed, in a recent survey among asymptomatic school-aged children screened for and confirmed with T2DM in Trinidad, all had AN [24]. The current study provides additional evidence of the value of AN as a valuable marker of T2DM risk in younger age groups.…”

Section: Discussionsupporting

confidence: 56%

Acanthosis nigricans in type 2 diabetes: prevalence, correlates and potential as a simple clinical screening tool - a cross-sectional study in the Caribbean

Bahadursingh

Mungalsingh

Seemungal

et al. 2014

Diabetol Metab Syndr

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BackgroundThis study aimed to evaluate the role of acanthosis nigricans (AN) as a marker of Type 2 Diabetes Mellitus (T2DM) by studying its prevalence and relationship with age, ethnicity, anthropometry and other risk factors for T2DM in the Trinidadian population.Methods311 successive adult patients with T2DM were recruited at diabetic clinics and inpatient wards across Trinidad. The presence, severity and texture of AN at the neck were assessed. Demographic, clinical and anthropometric characteristics were also measured, and logistic regression was used to model their relationship with presence of AN.ResultsThe mean (SD) age was 58.1 years (12.6). 55.6% were female. 61.1% were East Indian, 24.4% African and 14.5% mixed ethnicity. The mean (SD) BMI was 27.3 kg/m2 (6.0) and the mean (SD) waist circumference was 96.7 cm (14.2). Prevalence of AN was 52.7% (95% CI 47.2, 58.3).There was a greater odds of AN among diabetic patients who were: younger (p < 0.001); female (OR 1.67; 95% CI 1.06, 2.62); or East Indian rather than African (0.45; 0.26, 0.77) or mixed (0.43; 0.22, 0.84) descendents. There was a greater age-, sex- and ethnicity-adjusted odds of AN among those: overweight (3.98; 2.10, 7.55) or obese (8.31; 3.84, 18.00) versus normal BMI; centrally obese (4.72; 2.65, 8.43); with history of hypertension (2.19; 1.27, 3.79) or history of hypercholesterolemia (1.72; 1.02, 2.90), but there was no evidence of this demographic-adjusted association (p > 0.4) between AN and history of previous MI or CVA, family history of T2DM, T2DM treatment regimen, duration of T2DM or random blood glucose.On further multivariable analysis, only age, sex, ethnicity, BMI and waist circumference were independently associated with AN (p < 0.05) and the effect of BMI varied with ethnicity.ConclusionsThere was a high prevalence of AN both overall and across age, sex and ethnic groups of diabetic patients. AN exhibited much potential as a valuable addition to T2DM risk assessment in the Trinidadian and similar settings.

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Section: Discussionsupporting

confidence: 56%

Acanthosis nigricans in type 2 diabetes: prevalence, correlates and potential as a simple clinical screening tool - a cross-sectional study in the Caribbean

Bahadursingh

Mungalsingh

Seemungal

et al. 2014

Diabetol Metab Syndr

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“…We had reported the prevalence of diabetes (36.4%, n = 40/110) in renal glycosuria in our province [ 18 ]. Moreover, of 21 students with glycosuria, 8 were diagnosed with diabetes [ 19 ], and in a Japanese study [ 20 ], of 298 glycosuric children, 133 (44.6%) students developed diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, three subjects with positive results for the diabetes-related autoantibodies test such as glutamic acid decarboxylase, islet cell, and insulin antibodies and one subject with the fasting serum C-peptide level under 0.6 ng/ mL were also excluded. Finally, 187 children and adolescents (aged 10.08-17.60 years) were enrolled; of these, 130 visited the hospital to undergo glucosuria examination based on school urinary glucose screening [18][19][20][21], while the other 57 were referred for obesity checkup. A large-scale school urine screening program was implemented in the Jeonbuk Province area.…”

Section: Methodsmentioning

confidence: 99%

Relationship of Serum Total Insulin-Like Growth Factor Binding Protein-3 with Insulin-Like Growth Factor-I and Glucose Tolerance in Korean Children and Adolescents

Kim

et al. 2021

International Journal of Endocrinology

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Insulin is important in glucose metabolism. However, insulin-like growth factor binding protein (IGFBP) also plays an important role in glucose homeostasis, although the IGF-independent role of IGFBP-3 in the glucose intolerance state is poorly understood. We investigated the relationship of serum IGF-I with total IGFBP-3 levels and glucose tolerance in Korean children and adolescents who underwent the oral glucose tolerance test (OGTT). A total of 187 children without known diabetes underwent OGTT, and data related to their clinical and laboratory parameters were collected. Serum IGF-I and total IGFBP-3 levels, fasting plasma glucose levels, lipid profiles, insulin levels, C-peptide levels, homeostasis model assessment of insulin resistance (HOMA-IR) index, and glycated hemoglobin (HbA1c) levels were measured. Serum IGF-I and total IGFBP-3 levels were significantly higher in individuals with impaired glucose tolerance and type 2 diabetes (DM) than in those with normal glucose tolerance (NGT) ( P < 0.05 ). Serum IGF-I and IGFBP-3 levels were correlated with age, HbA1c, C-peptide, insulin, and HOMA-IR in the NGT group. However, these relationships were altered in patients with glucose intolerance, especially in those with DM. In the DM group, serum IGF-I and total IGFBP-3 levels were positively correlated with fasting plasma glucose and HbA1c levels. In addition, total IGFBP-3 levels were positively correlated with total cholesterol and low-density lipoprotein cholesterol and IGF-I levels but not with age or body mass index. The IGF-I-IGFBP-3 axis, especially IGFBP-3, may be involved in the pathogenesis and metabolic control of glucose intolerance, specifically in diabetes patients. Moreover, IGFBP-3 might be a therapeutic marker.

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“…The secular trends also indicate that every successive generation of children of school age is becoming more overweight or obese such that primary school children have a greater prevalence of overweight and obesity than their peers in secondary schools. In the wake of this phenomenon, Batson et al have reported a high rate of silent type 2 diabetes among school children all of whom were overweight/obese and bore the hallmark clinical feature of insulin resistance by exhibiting acanthosis nigricans at the neck (12). Routine screening identified these children with silent T2D which could have gone unnoticed for many years waiting to come to attention when the disease was seriously advanced.…”

Section: Obesitymentioning

confidence: 99%

Need for Policy to Reduce Sugar Consumption in Trinidad and Tobago?

Naidu¹,

Lutchmansingh²,

Sharma³

et al. 2016

West Indian Med J

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In a recent recommendation The World Health Organization (WHO) advises that adults and children reduce free sugars to less than 10% of total daily energy intake. This guidance is based on research evidence for the relationship between sugar and chronic non-communicable diseases, specifically obesity, type 2 diabetes mellitus (T2D), cardiovascular disease as well as dental caries.Overconsumption of free sugars has been attributed largely to the availability and popularity of sugar sweetened beverages (SSBs). Recent data have shown that the Caribbean region as a whole has high consumption of SSBs and Trinidad and Tobago has been singled out for having the highest daily intake in the world. The need to implement the new WHO guidance on sugar consumption is urgent given the high and apparently increasing prevalence of obesity, T2D and dental caries particularly among the nation's children. This paper recommends that national policy for Trinidad and Tobago aimed at reducing sugar consumption, should be developed and implemented and that such policy should be based on strategies that have been shown to be effective internationally and regionally but leave ample room for locally relevant, culturally sensitive and socially acceptable innovative models of intervention.

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Screening for diabetes in schoolchildren in Trinidad, West Indies

Abstract: Despite the low PPV of urine glucose testing, our data support the view that mass screening of schoolchildren in Trinidad for T2DM is both feasible and cost-effective.

Cited by 8 publications

References 23 publications

Acanthosis nigricans in type 2 diabetes: prevalence, correlates and potential as a simple clinical screening tool - a cross-sectional study in the Caribbean

Acanthosis nigricans in type 2 diabetes: prevalence, correlates and potential as a simple clinical screening tool - a cross-sectional study in the Caribbean

Relationship of Serum Total Insulin-Like Growth Factor Binding Protein-3 with Insulin-Like Growth Factor-I and Glucose Tolerance in Korean Children and Adolescents

Need for Policy to Reduce Sugar Consumption in Trinidad and Tobago?

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