{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzn05p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzn05p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;11\\\/9\\\/26\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;11\\\/9\\\/26\u0022}],\u0022ac\u0022:{\u0022spmdc;11\\\/9\\\/26\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;11\\\/9\\\/26\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EDiabetes is the fourth or fifth leading cause of death in most high-income countries, and evidence indicates that it is an epidemic in many economically developing and newly industrialized nations [\u003Cem\u003EIDF Diabetes Atlas, 4th ed\u003C\/em\u003E. International Diabetes Federation 2011]. This article discusses the disease and its epidemiology, health impact, and intervention measures from a Caribbean perspective.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EDiabetes is the fourth or fifth leading cause of death in most high-income countries, and evidence indicates that it is an epidemic in many economically developing and newly industrialized nations [\u003Cem\u003EIDF Diabetes Atlas, 4th ed.\u003C\/em\u003E International Diabetes Federation 2011]. Hafeezul Mohammed, MD, FRCP, FACP, FACC, University of the West Indies, discussed the disease and its epidemiology, health impact, and intervention measures from a Caribbean perspective.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDiabetes\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EType 1 diabetes is caused by an autoimmune reaction that destroys insulin-producing cells. The reason this occurs is not fully understood. While the disease can affect individuals of any age, it usually occurs in children or young adults. Type I diabetics require daily insulin injections, or they can suffer serious complications, including death [\u003Cem\u003EIDF Diabetes Atlas, 4th ed.\u003C\/em\u003E International Diabetes Federation, 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EType 2 diabetes is characterized by insulin resistance and relative insulin deficiency and accounts for at least 90% of all cases of the disease. It is usually diagnosed after the age of 40 years but can be identified earlier, especially in populations with high prevalence. Type 2 diabetes can remain undetected for many years, and the diagnosis is often made from associated complications or incidentally through abnormal blood or urine glucose tests [\u003Cem\u003EIDF Diabetes Atlas, 4th ed.\u003C\/em\u003E International Diabetes Federation, 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EOften, type 2 diabetes is associated with obesity, which can cause insulin resistance and lead to elevated blood glucose levels. Other factors that drive the increasing rates of diabetes include rapid cultural and social changes, aging populations, increasing urbanization, dietary changes, reduced physical activity, and other unhealthy behavioral patterns [World Health Organization. \u003Cem\u003EPrevention of diabetes mellitus. Report of a WHO Study Group.\u003C\/em\u003E Geneva: World Health Organization; 1994. No. 844].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPrevalence\u003C\/h2\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EApproximately 285 million people worldwide, or 6.6% of those aged 20 to 79 years, had diabetes in 2010; some 70% lived in low- and middle-income countries. Without preventive programs, this number is expected to increase by more than 50% in the next 20 years. By 2030, it is estimated that approximately 438 million people, or 7.8% of the adult population, will have diabetes, with the largest increases in regions that are dominated by developing economies [\u003Cem\u003EIDF Diabetes Atlas 4th ed.\u003C\/em\u003E International Diabetes Federation, 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EThe Caribbean has the highest prevalence of chronic noncommunicable diseases in the region of the Americas [Alafia Samuels T, Fraser H. \u003Cem\u003ERev Panam Salud Publica\u003C\/em\u003E 2010]. Diabetes mortality in Trinidad and Tobago and in Saint Vincent and the Grenadines is 6-fold higher than in North America (United States and Canada), and cardiovascular disease (CVD) mortality rates in Trinidad and Tobago, Guyana, and Suriname are 84%, 62%, and 56% higher, respectively, than in North America [Alafia Samuels T, Fraser H. \u003Cem\u003ERev Panam Salud Publica\u003C\/em\u003E 2010]. In Barbados, the prevalence and mortality rate of diabetes-related lower extremity amputations are among the highest in the world [Hennis AJ et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2004; Hambleton IR et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2009].\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EAccording to Dr. Mohammad, the overall prevalence of diabetes in the Caribbean is 9% versus a global rate of 6.4%. The figure for Trinidad and Tobago is 11.4%; for Jamaica, it is 10.2%; and for Barbados, 9.2% [\u003Cem\u003EIDF Diabetes Atlas, 4th ed.\u003C\/em\u003E International Diabetes Federation, 2011].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ENatural History of Diabetes and Complications\u003C\/h2\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EType 2 diabetes is a progressive disease that is characterized by two fundamental defects: insulin resistance and \u03b2-cell dysfunction. It starts with normal glucose tolerance, insulin resistance, and compensatory hyperinsulinemia, with progression to impaired glucose tolerance (IGT) and overt diabetes (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [deFronzo RA. \u003Cem\u003EMed Clin N Am\u003C\/em\u003E 2004]. Chronic elevation of blood glucose, even when no symptoms are present, will eventually lead to tissue damage, with consequent, and often serious, disease. Evidence of micro- and macrovascular damage can be found in many organ systems, especially the kidneys, eyes, peripheral nerves, and vascular tree. Complications from diabetes are significant and sometimes fatal [deFronzo RA. \u003Cem\u003EMed Clin N Am\u003C\/em\u003E 2004].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/9\/26\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Natural History of Disease Progression.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1285135865\u0022 data-figure-caption=\u0022Natural History of Disease Progression.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/9\/26\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/9\/26\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/9\/26\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12573\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-10\u0022 class=\u0022first-child\u0022\u003ENatural History of Disease Progression.\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from H. Mohammed, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECardiovascular Disease\u003C\/h2\u003E\n         \u003Cp id=\u0022p-11\u0022\u003ECVD is the major cause of death in diabetes, accounting in most populations for 50% or more of all fatalities and much disability. The kinds of CVD that accompany diabetes include angina, myocardial infarction, stroke, peripheral artery disease, and congestive heart failure.\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EOver 4 years of follow-up, Hennis et al. found that among 4709 individuals aged 40 to 84 years and born in Barbados, the cumulative mortality among diabetics was 10.2%, with a 9% increase in 4-year mortality for each 1% increase in HbA1C. Overall, diabetics had a 42% higher risk of death compared with those who did not have the disease [Hennis A et al. \u003Cem\u003EInt J Epidemiol\u003C\/em\u003E 2002].\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EAccording to Dr. Mohammad, the Jamaican Ministry of Health reported that diabetes accounted for 60 of every 100,000 deaths in 1999 and was the third leading cause of mortality. In 2004, it accounted for 70 of every 100,000 deaths and was the second leading cause of mortality. McDougal et al. found that diabetes-related mortality in 17 Caribbean countries increased 50% from 1981\u20131985 (40\/100,000 to 60\/100,000) [McDougal L. \u003Cem\u003ECAREC Surveillance Report\u003C\/em\u003E 2006].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EComplications\u003C\/h2\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EDiabetes is linked to diabetic retinopathy, the leading cause of blindness in working age adults [Fong DS et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2003]. Other diabetes-related complications include diabetic nephropathy, the leading cause of end-stage renal disease [Molitch ME et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2003]; stroke (a 2- to 4-fold increase in cardiovascular mortality and stroke) [Kannel WB et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E 1990]; and diabetic neuropathy, the leading cause of nontraumatic lower extremity amputations [Mayfield JA et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2003].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-6\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EIntervention\u003C\/h2\u003E\n         \u003Cp id=\u0022p-15\u0022\u003ETreatments include lifestyle changes (diet and exercise) and medications. Current American Diabetes Association treatment targets call for HbA1C \u0026lt;7%; blood pressure \u0026lt;130\/80 mm Hg; low-density lipoprotein cholesterol \u0026lt;100 mg\/dL; high-density lipoprotein cholesterol in men \u0026gt;40 mg\/dL and in women \u0026gt;50 mg\/dL; and triglycerides \u0026lt;150 mg\/dL [American Diabetes Association. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-16\u0022\u003EThe increasing prevalence of diabetes in the Caribbean represents a significant disease burden that is associated with serious microvascular and macrovascular complications. Early detection and risk factor interventions are crucial for successful prevention and management of the disease.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/9\/26.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn05p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn05p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}