Wright-Pascoe R

The burden of gestational diabetes mellitus in Jamaican women with a family history of autosomal dominant type 2 diabetes

OBJECTIVES To determine if Jamaican women of African descent with a family history of early onset autosomal dominant type 2 diabetes have greater odds of developing gestational diabetes mellitus (GDM) than those without a family history of the disease. METHODS A comparative study was conducted of two groups of pregnant Jamaican women: the first with a family history of early onset autosomal dominant type 2 diabetes; the second with no history of the disease. Incidence, odds for developing GDM, and metabolic profiles in first and second trimesters were assessed using SPSS 11.5 (SPSS Inc., Chicago, Illinois, United States). RESULTS The incidence of GDM was 12.0% in women with a family history of early onset autosomal dominant type 2 diabetes and 1.5% in women without a family history of the disease (P<0.05). Women with a family history were nine times more likely to develop GDM than those without a family history of diabetes (95% confidence interval: 5.00-16.38, P<0.0001). CONCLUSION Family history of early onset autosomal dominant type 2 diabetes appears to increase susceptibility to GDM in Jamaican women. Pregnant women of any age with family history of early onset autosomal type 2 diabetes should be screened for GDM.

Multigenerational inheritance and clinical characteristics of three large pedigrees with early-onset type 2 diabetes in Jamaica

OBJECTIVE To document the existence and clinical characteristics of three large families with multigenerational inheritance of early-onset type 2 diabetes in Jamaica. METHODS Three probands from large families with multigenerational inheritance of early-onset type 2 diabetes in at least three generations were detected at the University Hospital of the West Indies in Jamaica. Each proband at the time of diagnosis was < 25 years of age, was lean, and did not require insulin therapy. Clinical, metabolic, and genetic assessments were undertaken to profile the diabetes in the three families. RESULTS Three pedigrees--BK, SU, and CA--consisting of 38, 48, and 113 members, respectively, with multigenerational inheritance of early-onset type 2 diabetes in at least three generations, were investigated. The mean age at diagnosis of the three pedigrees was 31.5 +/- 2.9 years, with 10 persons detected below 25 years of age. Findings suggestive of overweight, insulin resistance, low insulin secretion, dyslipidemia, and mild intra-abdominal obesity were present. Islet cell antibodies and sequence variants in MODY1 to -6 genes were absent. CONCLUSIONS Large families demonstrating multigenerational inheritance of diabetes and other characteristics consistent with early-onset type 2 diabetes are present in the Jamaican population.

Cardiovascular disease among diabetic in-patients at a tertiary hospital in Jamaica

age: 18.2% among those <30 years, 48.9% among those 30–59 years and 68.6% among those aged 60 years or older; p < 0.001. In age-adjusted multivariable models, men remained less likely to have any CVD, ACS or CHF. Odds ratios are shown in Table 2. This study shows that CVD is present in almost 60% of persons admitted with DM at UHWI and is more frequent among women compared with men. The greater frequency among women may reflect the higher prevalence of obesity and other CVD risk factors among women, but factors related to health seeking behaviour and hospital admission patterns should also be considered. Further studies are required to document the impact of diabetes on CVD morbidity and mortality in Jamaica.

Prevalence of Chronic Kidney Disease among Patients Attending a Specialist Diabetes Clinic in Jamaica.

OBJECTIVE To estimate the prevalence of chronic kidney disease (CKD) among patients attending the University Hospital of the West Indies (UHWI) Diabetes Clinic and to determine the proportion of patients at high risk for adverse outcomes. METHODS We conducted a cross-sectional study among patients attending the UHWI Diabetes Clinic between 2009 and 2010. Trained nurses administered a questionnaire, reviewed dockets, and performed urinalyses. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Albuminuria was assessed using urine test strips for protein and microalbumin. Chronic kidney disease was defined as an eGFR < 60 ml/min/1.73m2 or albuminuria ≥ 30 mg/g creatinine. Risk of adverse outcome (all-cause mortality, cardiovascular disease and kidney failure) was determined using the Kidney Disease: Improving Global Outcome (KDIGO) 2012 prognosis grid. RESULTS Participants included 100 women and 32 men (mean age, 55.4 ± 12.9 years, mean duration of diabetes, 16.7 ± 11.7 years). Twenty-two per cent of participants had eGFR < 60 ml/min/1.73m2. Moderate albuminuria (30-300 mg/g) was present in 20.5% of participants and severe albuminuria (> 300 mg/g) in 62.1%. Overall prevalence of CKD was 86.3% (95%CI 80.4%, 92.2%). Based on KDIGO risk categories, 50.8% were at high risk and 17.4% at very high risk of adverse outcomes. CONCLUSION Most patients at the UHWI Diabetes Clinic had CKD and were at high or very high risk of adverse outcomes. Further studies to determine the burden of CKD in other clinical settings and to identify the best strategies for preventing adverse outcomes in developing countries need to be conducted.

Cardiovascular disease among patients attending a specialist diabetes clinic in Jamaica

Correspondence: Trevor Ferguson epidemiology Research Unit, Tropical Medicine Research institute, The University of the West indies, Mona, Kingston, Jamaica Tel +1 876 927 2471 Fax +1 876 927 2984 email trevor.ferguson02@uwimona.edu.jm Background: This study aimed to estimate the prevalence of cardiovascular disease (CVD) among patients attending The University Hospital of the West Indies diabetes clinic and to examine the relationship between prevalent CVD and its risk factors. Methods: We analyzed data from 174 patients selected from the University Hospital of the West Indies diabetes clinic using gender-stratified random sampling. An intervieweradministered questionnaire was used to obtain data on self-reported CVD (coronary heart disease [CHD], cerebrovascular disease, and peripheral vascular disease [PVD]), physical activity, alcohol consumption, and smoking. Trained nurses performed blood pressure and anthropometric measurements. A capillary blood sample was collected to measure glycosylated hemoglobin, and urine was tested for protein and microalbumin. Means and proportions for patient characteristics, CVD outcomes, and risk factors were calculated. Logistic regression was used to identify factors independently associated with CVD. Results: Data from 129 women and 45 men (mean age 55.7 ± 14.7 years) were analyzed. The prevalence of any self-reported CVD (CHD, cerebrovascular disease, or PVD) was 34.5% (95% confidence interval [CI] 27.4–41.6). PVD had the highest prevalence (25.9%), compared with CHD (6.9%) and cerebrovascular disease (16.1%). There were no gender differences in the prevalence of CVD. Prevalence of CVD was higher among people

Diabetes and psychological co‐morbidity in children with a family history of early‐onset type 2 diabetes

50 years, and those with high blood pressure, central obesity, high total cholesterol, and duration of diabetes

Prospective Evaluation and Characteristics of Patients with Suspected Primary Hyperaldosteronism

20 years. In multivariable models, duration of diabetes was the most consistent factor associated with CVD, odds ratio 1.41 (95% CI 1.15–1.73, P = 0.001) per five-year increment. Having blood pressure at the goal of ,130/80 mmHg and at least three physical activity sessions/ week were associated with lower odds of CVD, odds ratios 0.42 (95% CI 0.20–0.87, P = 0.020) and 0.37 (95% CI 0.16–0.82, P = 0.014), respectively. Conclusion: In this Jamaican setting, 35% of patients with diabetes have at least one CVD. Odds of CVD increased with diabetes duration, while good blood pressure control and increased physical activity were ameliorating factors.

Foot care and footwear practices among patients attending a specialist diabetes clinic in Jamaica

The present study was conducted to evaluate for depressive symptoms and undiagnosed diabetes in children with familial history of early-onset type 2 diabetes. Studies have shown that diabetes doubles the risk for depression and that the duration of diabetes is related to the severity of the depression. Individuals with depression are also said to be at greater risk for developing diabetes. In many cases diabetes is detected whilst screening for depression. Fifty-three children aged between 6 and 17 years were screened for diabetes and assessed for depressive symptoms using the Children Depression Rating Scale, revised version (CDRS-R). Thirty-six (68.0 %) of the children with a family history of early-onset type 2 diabetes had CDRS-R scores consistent with likely or very likely major depressive disorders. Depressive symptoms score was predicted best by the number of generations of diabetes in the family, with an associated r = .65 and adjusted R(2) = .41. As the generations of diabetes increased, the more likely it was for a child to have diabetes (r = .38, p = .005). Four (7.5%) of the children were diagnosed with diabetes. The findings suggest that depressive symptoms are common in children with a family history of early onset type 2 diabetes and may co-exist with diabetes. The independent variable that reliably predicted the child depressive symptoms score was the number of generations of diabetes in the family.

Glutathione metabolism in type 2 diabetes and its relationship with microvascular complications and glycemia

Primary hyperaldosteronism (PH), resulting in hypokalaemic hypertension, may be due to an aldosterone-producing adenoma (APA) or bilateral zona glomerulosa hyperplasia. Six patients with suspected PH were identified at the University Hospital of the West Indies and standardized screening was carried out. Plasma renin activity (PRA) and serum aldosterone concentrations (SAC) were measured, followed by confirmatory intravenous saline suppression test. The patients were all women, of median age 48 years (interquartile range, IQR: 41-51.7 years). They tended to be overweight with suboptimal blood pressure control. Median serum potassium was 3.1 mmol/L (IQR 2.7 - 3.3 mmol/l) and kaliuresis was elevated or inappropriately normal. All individuals had suppressed PRA (< 0.6 ng/ml/hr) and elevated SAC (> 30 ng/dl), with SAC/PRA ratios > 50. Five patients had confirmed PH (ie post-saline SAC > 10 ng/dl); PH could not be definitely excluded in the sixth patient (ie post-saline SAC 5 - 10 ng/dl). Imaging studies revealed normal adrenal glands in one patient, unilateral adrenal enlargement in three patients, and unilateral adrenal masses in two patients. Only one of these latter two patients was shown to have an adrenal adenoma on histological examination. In this series, there appears to be fewer cases of the APA subtype of PH than expected. It remains to be seen whether the distribution of PH subtypes in Jamaica is actually different from elsewhere. This, and the cost-effectiveness of different approaches to screening, identification and management of patients suspected of having PH in Jamaica are areas for further study.

Obstetric Outcomes of an Afro-Caribbean Cohort Following Universal Screening and Treatment of Subclinical Hypothyroidism.

This study aimed to estimate the proportion of patients at the University Hospital of the West Indies (UHWI) Diabetes Clinic who engage in recommended foot care and footwear practices. Seventy-two participants from the UHWI Diabetes Clinic completed an interviewer-administered questionnaire on foot care practices and types of footwear worn. Participants were a subset of a sex-stratified random sample of clinic attendees and were interviewed in 2010. Data analysis included frequency estimates of the various foot care practices and types of footwear worn. Participants had a mean age of 57.0±14.3 years and mean duration of diabetes of 17.0±10.3 years. Fifty-three percent of participants reported being taught how to care for their feet, while daily foot inspection was performed by approximately 60% of participants. Most participants (90%) reported daily use of moisturizing lotion on the feet but almost 50% used lotion between the toes. Approximately 85% of participants reported wearing shoes or slippers both indoors and outdoors but over 40% reported walking barefoot at some time. Thirteen percent wore special shoes for diabetes while over 80% wore shoes without socks at some time. Although much larger proportions reported wearing broad round toe shoes (82%) or leather shoes (64%), fairly high proportions reported wearing pointed toe shoes (39%), and 43% of women wore high heel shoes. In conclusion, approximately 60% of patients at the UHWI diabetic clinic engage in daily foot inspection and other recommended practices, but fairly high proportions reported foot care or footwear choices that should be avoided.