WIMJ Supplement COVER_March 2012:Layout 1
26/03/2012
09:31 AM
Page 1
Supplement Vol. 61 (Suppl 1) 1 – 38
March 29 – April 1, 2012
ISSN: 0043-3144 WIMJAD
The University Diabetes Outreach Programme (UDOP) The University of the West Indies (UWI) and
University of Technology, Jamaica (UTech) present
The 18th Annual International Conference
THEME: New Frontiers in Diabetes Management March 29 – April 1, 2012
Sunset Jamaica Grande Resort Ocho Rios, Jamaica
WIMJ Supplement COVER_March 2012:Layout 1
26/03/2012
09:31 AM
EDITORIAL BOARD
Page 2
MO Owolabi A Pearson DT Simeon (CHRC) MF Smikle, Y Zhao
Chairman S Ramsewak
Editor-in-Chief EN Barton
Associate Editors D Cohall DT Gilbert A Hennis G Hutchinson T Seemungal
Assistant Editors W Abel MO Castillo-Rangel T Clarke T Ferguson J Plummer PJ Ramphal AK Soyibo H Trotman
Deans JM Branday AH McDonald S Ramsewak R Roberts (Director, UWI Clinical Training Programme)
Treasurer E Robinson T Alleyne F Bennett C Christie-Samuels IW Crandon N Duncan Y Fugita F Henry (CFNI) J Hospedales (PAHO) T Jones GC Lalor (ICENS) W McLaughlin
Editorial Advisory Board B Bain, B Barnett, J Bennett, V Boodhoo, M Boyne FC Brosius III G Burkett W De La Haye H Daisley D Eldemire-Shearer C Escoffery LF Ferder JP Figueroa J Frederick B Hanchard N Kissoon M Lee A McCaw-Binns C Ogunsalu OO Oguntibeju A Ojo H Reid GR Serjeant WH Swanston AAE Verhagen M Voutchkov RJ Wilks R Young Past Editors JL Stafford 1951–1955 JA Tulloch 1956–1960 D Gore 1961 CP Douglas 1962 D Gore 1963–1966 P Curzen 1967 RA Irvine 1967–1969 TVN Persaud 1970–1972 GAO Alleyne 1973–1975 V Persaud 1975–1995 D Raje 1995–1996 WN Gibbs 1996–1999
BUSINESS INFORMATION
Copyright: Material printed in the Journal is covered by copyright and may not be reproduced in whole or in part without the written permission of the Editor. Single photocopies may be made by individuals without obtaining prior permission. Microform: The Journal is available in microform from Bell and Howell Information and Learning.
Abstracting and Indexing: The Journal is currently included in major abstracting and indexing services.
Correspondence should be addressed to: THE EDITOR-IN-CHIEF, West Indian Medical Journal, Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica e-mail: wimj@uwimona.edu.jm, webpage: http://www.mona.uwi.edu/fms/wimj/, www.scielo.org, www.bireme.br Telephone (876) 927-1214 Fax (876) 927-1846
ANNUAL SUBSCRIPTION: Overseas US$150.00
Local J$8900.00 West Indian Medical Journal Published by the Faculty of Medical Sciences, The University of the West Indies, Mona, Jamaica, St Augustine, Trinidad and Tobago and School of Clinical Medicine and Research, Cave Hill, Barbados
The University Diabetes Outreach Programme (UDOP) The University of the West Indies (UWI) and
The University of Technology (UTech) present The 18th Annual International Conference
Theme: New Frontiers in Diabetes Management March 29 – April 1, 2012 Sunset Jamaica Grande Resort Ocho Rios, Jamaica Editor-in-Chief Professor EN Barton Scientific Editors Professor The Hon EY St A Morrison Professor E Albert Reece
The University Diabetes Outreach Programme (UDOP) The University of the West Indies (UWI) and
The University of Technology, Jamaica (UTech) present The 18th Annual International Conference
THEME: New Frontiers in Diabetes Management March 29 – April 1, 2012 Sunset Jamaica Grande Resort Ocho Rios, Jamaica
2
CONTENTS Days-at-a-Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Message from the Editor-in-Chief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Acknowledgements/Exhibitors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
Speakers and Faculty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Abbreviations used in text . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Programme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
1st Scientific Session Sir Alister McIntyre Distinguished Lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
2nd Scientific Session Indicators for Susceptibility to Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20 3rd Scientific Session The Natural Path and Chronic Disease: The Rise of the Ancient Healing Arts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
4th Scientific Session Opening of Satellite Conference on Wellness at the Workplace and The Sir Philip Sherlock Distinguished Lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
5th Scientific Session Integrated Management of Chronic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 6th Scientific Session Nutraceuticals in the Management of Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 Caribbean Endocrine Society Concurrent Satellite Symposium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24 7th Scientific Session Cornerstones in Diabetes Management and Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
8th Scientific Session New Trends in the Treatment of Metabolic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
9th Scientific Session New and Upcoming Trends in the Treatment of Type 2 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30 10th Scientific Session The Most Hon Hugh Lawson Shearer Memorial Lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
West Indian Med J 2011; 60 (Suppl. 1):
11th Scientific Session Treating Diabetic Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32 12th Scientific Session Landmark in Diabetes Understanding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Poster Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
4
West Indian Med J 2012; 61 (Suppl. 1): 5
Eleventh Scientific Session Treating Diabetic Complications VIEWING OF EXHIBITS
11:30 am
12:30 pm 2:00 pm
Fifth Scientific Session Integrated Management of Chronic Diseases Sixth Scientific Session Nutraceuticals in the Management of Diabetes LUNCH
11:00 am
12:00 noon
1:00 pm
LUNCH
Second Scientific Session Indicators for Susceptibility to Diabetes Mellitus
COFFEE AND VIEWING OF BOOTH EXHIBITS AND POSTERS
Third Scientific Session The Natural Path and Chronic Disease: The Rise of the Ancient Healing Arts
12:45 pm
2:00 pm
3:00 pm
3:30 pm
4:00 pm
VIEWING OF EXHIBITS
4:00 pm
The Hon Errol Morrison Distinguished Lecture Twelfth Scientific Session Landmark in Diabetes Understanding
COCKTAILS
6:30 am
10K/5K/2K Fun-Run-Walk
Sunday, April 1
6:00 pm
REPORT ON JUDGING OF POSTERS
3:00 pm
Seventh Scientific Session Cornerstones in Diabetes Management and Diagnosis
2:30 pm
LUNCH
Tenth Scientific Session The Most Hon Hugh Lawson Shearer Memorial lecture
Ninth Scientific Session New and Upcoming Trends in the Treatment of Type 2 Diabetes
10:00 am
First Scientific Session The Sir Alister McIntyre Distinguished Award and Lecture
Eighth Scientific Session New Trends in the Treatment of Metabolic Syndrome
9:00 am
11:45 am
Fourth Scientific Session Opening of Satellite Conference on Wellness at the Workplace and The Sir Philip Sherlock Distinguished Award and Lecture
9:00 am
Event
Opening Ceremony
Time
10:45 am
Event
Time
Saturday, March 31
Event
Friday, March 30
Time
Thursday, March 29
Days-at-a-Glance
General Information Registration/Information/General Assistance Registration/Information/General Assistance
Registration Desk (The Conference Reception Area) Thursday, March 29 – Saturday, March 31 7:30 am – 4:30 pm Exhibits (The Grande Hall) Thursday, March 29 – Saturday, March 31 9:00 am – 4:00 pm Poster Viewing (The Grande Hall) Thursday, March 29 – Saturday, March 31 9:00 am – 4:00 pm Judging of Posters (The Grande Hall) Saturday, March 31, 5:00 pm
Audience The information presented is directed mainly at the members of the healthcare team but is also designed to facilitate understanding amongst the general public.
Duality of Interest The participant (denoted by an asterisk (*) next to his/her name in the programme) has indicated that he/she has a relationship which, in the context of his/her participation in this professional education programme, could be perceived to represent a relevant duality of interest. The relationship is between the participant and a pharmaceutical company, biomedical manufacturer, or other corporation whose products or services are directly related to the subject matter of this professional education programme. Relevant dualities include employment by an individual concerned, ownership of stock, membership on a committee or the board of directors, receiving honoraria or consulting fees, or receiving grants or funds from such corporation. Continuing Medical Education Credits The Caribbean College of Family Practitioners recognizes this programme for 14.25 credit hours.
West Indian Med J 2012; 61 (Suppl. 1): 6
FOREWORD My dear Conferencistas,
The time is here again when we assemble to review what’s new, hear what’s being used by the advanced crew and bid old practices adieu. The University Diabetes Outreach Programme (UDOP) 2012 promises to take a comprehensive and holistic approach to the understanding and management of this condition. We expect to hear of the latest research findings in new drugs, neutraceuticals, technological applications and complementary alternative methods in the management of diabetes. This year we celebrate 18 years of staging this conference and this is within the context of our island’s 50th anniversary of independence. We are proud that we have been able to keep the ‘show’ on the road and to maintain relatively high standards, earning us the title of the largest and the best medical conference in the Caribbean. We continue to evolve and the programme also takes on new approaches from year to year. In addition to the Sir Alister McIntyre and the Sir Philip Sherlock distinguished awardees and lectures, the Most Hon Hugh Lawson Shearer Memorial lecture is now embodied within the sessions and for the first time we are introducing the Landmark lecture, which yours truly will deliver. For the first time too, we are able to acknowledge a gold sponsor in Merck Sharp and Dohme pharmaceutical company. It is more liaisons like these that are needed to really put the conference on a more sustainable path. We have listened to your comments and do endeavour to reduce the sessions so as to allow for greater networking and an earlier closure each day.
West Indian Med J 2012; 61 (Suppl. 1): 7
The objectives of this conference, under the theme ‘New Frontiers in Diabetes Management’ are: C To update the healthcare team on the new drugs entering the marketplace. C To review a number of alternative approaches which have been scientifically appraised. C To assess the full spectrum of the pathology that underlies the diabetes process. C To review the latest in technology support in the management of diabetes. As such there is something for everyone … from the members of the healthcare team (inclusive of persons with diabetes) to the family, friends and support groups in the wider community. For the young at heart, there is the social programme which never fails to excite and involve much participation, culminating in the ‘Saturday nite fling’. That is followed by the early Sunday morning walk/run, and this year we intend to expand it with the participation of some of our high profile athletes and ensure we make the statement of the role in exercise in managing the condition. And so we look forward to another few days of good camaraderie, learning and networking. See you March 29 – April 1.
One “luv” and WALK GOOD! Professor the Hon Errol Morrison, OJ Director, University Diabetes Outreach Programme (UDOP)
MESSAGE FROM THE EDITOR-IN-CHIEF The Editorial Board of the West Indian Medical Journal wishes to congratulate the University Diabetes Outreach Programme on its 18th Annual International Conference. The theme this year is New Frontiers in Diabetes Management and the conference deals appropriately with ethnomedicine and some of the ancient healing arts as well as more modern treatment modalities. The elderly represent a significant proportion of the Caribbean population and it is salutary to see diabetes care in the elderly being addressed in the Hugh Lawson Shearer Distinguished Lecture.
West Indian Med J 2012; 61 (Suppl. 1): 8
The Journal wishes the conference organizers and collaborators success in this endeavour to further educate patients and healthcare practitioners on this very common chronic disease – diabetes. Professor Everard N Barton Editor-in-Chief West Indian Medical Journal Faculty of Medical Sciences The University of the West Indies, Kingston 7 Jamaica, West Indies
WELCOMES YOU
Acknowledgements and Exhibitors The Conference Organizers wish to thank the following for their support Exhibitors
Abbott Diabetes Care Abbott Laboratories
Baptist Health South Florida Bio-Tech R&D Institute Boehringer Ingelheim CARIGEN
College of Health Sciences, UTech Denk Pharma
Diabetes Association of Jamaica Dr Reddy’s Laboratories
Environmental Health Foundation
Facey Commodity Company Limited Glenmark INTAS
Jamaica National Building Society Medical Products Limited
Medi-Herb Distributors Limited Merck Sharpe and Dohme Merck Serono
National Health Fund Novartis
Novo Nordisk
Pharmtech Caribbean Limited Qualcare Limited
T Geddes Grant (Distributors) Limited University of Technology, Jamaica Wisynco
West Indian Med J 2012; 61 (Suppl. 1): 9
Speakers and Faculty Alverston Bailey, MB, BS, MRO Associate Professor Occupational Health School of Public Health and Health Technology University of Technology, Jamaica
Sonia Davidson, MB, BS, DPH Wellness Institute for Allied Health and Wellness College of Health Sciences University of Technology, Jamaica
Michael Banbury, MB, BS Physician Medical Associates Hospital and Medical Centre Jamaica
Jennifer Ellis Human Resource Manager University of Technology, Jamaica
Perceval Bahadosingh, PhD Technical Director Bio-Tech R&D Institute Jamaica
Alberto Barcel贸, MD, MSc Advisor on Non-communicable Diseases Pan American Health Organization Washington, DC, USA
Brian Berman, MD Professor, Family and Community Medicine Director, Centre for Integrative Medicine University of Maryland School of Medicine USA Owen Bernard MSSCh, MBChA, Dip Crys, MHPC (UK) Executive Director Diabetes Association of Jamaica Jamaica Michael Boyne, MD, FRCP (C) Endocrinologist Tropical Metabolism Research Unit The University of the West Indies Mona, Kingston 7, Jamaica
Lenore T Coleman, Pharm D, CDE President and Founder Healing Our Village Inc, USA
West Indian Med J 2012; 61 (Suppl. 1): 10
Winston Davidson, MD, DTM&H (Liverpool) Head, School of Public Health and Health Technology University of Technology, Jamaica
The Most Hon Denise Eldemire-Shearer MB, BS, PhD WHO/PAHO Collaborating Centre on Ageing and Health c/o Department of Community Health and Psychiatry The University of the West Indies Mona, Kingston 7, Jamaica The Hon Fenton Ferguson Minister of Health Ministry of Health Jamaica
James R Gavin III, MD, PhD CEO and Chief Medical Officer Healing Our Village, Inc Clinical Professor of Medicine Emory University School of Medicine National Programme Director Harold Amos Medical Faculty Development Programme Chairman of the Board Partnership for a Healthier America, Inc, USA Patrick Hylton Group Managing Director National Commercial Bank Jamaica
Beverley King, RN, MSc Acting Head School of Nursing College of Health Sciences University of Technology, Jamaica
E Albert Reece, MD, PhD, MBA Vice President for Medical Affairs University of Maryland John Z and Akiko K Bowers Distinguished Professor and Dean, University of Maryland School of Medicine, Maryland, USA
Glen Lalljie, MD Consultant Cardiologist Coastal Internal Medicine and Cardiology Montego Bay, Jamaica
Cliff Riley, PhD Associate Dean College of Health Sciences University of Technology, Jamaica
Lurline Less, BSc, MPhil Chairman North American and Caribbean Region International Diabetes Federation, Brussels Executive Chair The Diabetes Association of Jamaica Jamaica
Daniel Sarpong, PhD Jackson State University Jackson, Mississippi, USA
Alan Shuldiner, MD Associate Dean and Director Programme in Personalized and Genomic Medicine Director of the Division of Endocrinology, Diabetes and Metabolism University of Maryland School of Medicine Maryland, USA
Henry Lowe, CD, JP, PhD, FRSH Executive Chairman Environmental Health Foundation Founder/Executive Chairman Bio-Tech R&D Institute Jamaica
Cecil White, JP, BSc, MBA, PMP Vice Pesident – Operations National Health Fund (NHF) Jamaica
The Hon Dr Wykeham McNeil Minister of Tourism and Entertainment Ministry of Tourism and Entertainment Jamaica
Janice Wissart, BSc, MPhil, MAT College of Health Sciences University of Technology, Jamaica
Luis Mejia, MD, PhD Clinical Pharmacologist Biochemistry and Pharmacology San Juan Bautista School of Medicine Puerto Rico
Rosemarie Wright-Pascoe, MB, BS, DM, FACP, FRCP (UK) Senior Lecturer Department of Medicine The University of the West Indies Mona, Kingston 7, Jamaica
The Hon Errol Morrison, OJ MD, PhD, FACP, FRCP, FRSM (UK), FRSH, FJIM Director University Diabetes Outreach Programme President, University of Technology, Jamaica
Donna-Marie Wynter-Adams, BSc, MPhil PhD candidate College of Health Sciences University of Technology, Jamaica
Sebastian Peter, MB, BS, DM Endocrinologist Bahamas
Dalip Ragoobirsingh, PhD, FRSPH Professor of Medical Biochemistry and Diabetology Director, UWI (Mona) Diabetes Education Programme Head, Biochemistry Section Department of Basic Medical Sciences The University of the West Indies Mona, Kingston 7, Jamaica
11
Abbreviations Used in Text
CARES
–
Caribbean Endocrine Society
EHF
–
Environmental Health Foundation
DM
NHF
UDOP WIMJ
West Indian Med J 2012; 61 (Suppl. 1): 12
–
– –
–
Diabetes Mellitus
National Health Fund
University Diabetes Outreach Programme West Indian Medical Journal
Programme Thursday, March 29, 2012 7:30 am – 11:00 am
REGISTRATION
10:45 am – 11:00 am
Welcome
Professor the Hon Errol Morrison, OJ
11:00 am – 11:15 am
Opening Remarks
Patrick Hylton
OPENING CEREMONY
11:15 am – 11:45 am
Keynote Address
The Hon Dr Wykeham McNeil
1st SCIENTIFIC SESSION Sponsor: University of Technology, Jamaica (UTech)
11:45 am – 12:00 noon
12:00 noon – 12:45 pm
12:45 pm – 2:00 pm 2nd SCIENTIFIC SESSION Sponsor: National Health Fund (NHF)
2:00 pm – 2:20 pm
The Sir Alister McIntyre Distinguished Award Citation
E Albert Reese
Presentation of Plaque
Sir Alister McIntyre
Sir Alister McIntyre Distinguished Lecture “Integrative practices for diabetes management”
Brian Berman
LUNCH AND VIEWING OF EXHIBITS
Indicators for Susceptibility to Diabetes Mellitus
NHF performance review
West Indian Med J 2012; 61 (Suppl. 1): 13
Chair: Cecil White
Cecil White
2:20 pm – 3:00 pm
The new genomic science and implications for diabetes care
3:00 pm – 3:30 pm
COFFEE AND VIEWING OF EXHIBITS (coffee break sponsored by Organo Gold)
3rd SCIENTIFIC SESSION Sponsor: Wellness Institute School of Allied Health and Wellness, College of Health Sciences, UTech
3:30 pm – 4:30 pm
5:00 pm – 7:00 pm
Alan Shuldiner
Roundtable – The Natural Path and Chronic Disease: The Rise of the Ancient Healing Arts Naturopathy, Oriental, energy and herbal medicine
Chair: Sonia Davidson
Panel: Derek Senior, Rupika Delgoda, Cherri Taylor, Tracy Ann Brown WELCOME COCKTAIL
Friday, March 30, 2012 4th SCIENTIFIC SESSION 9:00 am – 9:30 am
Opening of Satellite Conference on Wellness at the Workplace Keynote Address
Sponsor: Environmental Health Foundation (EHF)
9:30 am – 9:40 am
Chair: Jennifer Ellis
The Hon Dr Fenton Ferguson
Satellite Symposium resumes in the Portland Ballroom A
The Sir Phillip Sherlock Distinguished Lecture Citation
14
Chair: Alverston Bailey
9:40 am – 10:30 am
10:30 am – 11:00 am 5th SCIENTIFIC SESSION Sponsor: Pan American Health Organization (PAHO)
11:00 am – 11:30 am
11:30 am – 12:00 noon
The Sir Phillip Sherlock Distinguished Lecture
Henry Lowe
“Anti-diabetic Caribbean plants: Natural remedies and their future potential role in diabetes management”
COFFEE AND VIEWING OF EXHIBITS
Integrated Management of Chronic Diseases Improving chronic illness care Chronic disease electronic management system
Chair: Lurline Less Alberto Barceló Cecil Pollard
6th SCIENTIFIC SESSION
Sponsor: Bio-Tech R&D Institute
12:00 noon – 12:30 pm 12:30 pm – 1:00 pm 1:00 pm – 2:30 pm
2:00 pm – 2:10 pm
Nutraceuticals in the Management of Diabetes
Impact of nutraceutical products on global health trends: A public health perspective
Hypoglycaemic properties of Bixa orellana (annatto) extract: Exploitation for its use in diabetes management
Chair: Cliff Riley Winston Davidson Perceval Bahadosingh
LUNCH
Wound Care Workshop hosted by Baptist Health South Florida Grande Hall, 1:00 pm – 2:30 pm
Caribbean Endocrine Society (CARES) Concurrent Satellite Symposium: “Endocrinology and Ageing” Portland Ballroom B, 2:00 pm – 6:00 pm Welcome and Remarks
15
Michael Boyne
SESSION 1
Frailty and Sex Hormone Replacement
2:10 pm – 2:45 pm
Frailty: a new endocrine disorder?
2:55 pm – 3:10 pm
Hormone replacement therapy: Which woman and what regimen?
2:45 pm – 2:55 pm
3:10 pm – 3:25 pm 3:25 pm – 3:35 pm 3:35 pm – 4:00 pm
Question and answer period
Testosterone replacement and late-onset hypogonadism
4:00 pm – 4:20 pm
Vitamin D deficiency: What do the new guidelines say?
Subclinical thyroid disease: A common problem in the elderly
Clinical Corner
5:10 pm – 5:25 pm
Prevention of diabetes Type 2 in Curaçao: When and where do we start?
5:40 pm – 5:50 pm
Marshall Tulloch-Reid
Chair: Michael Banbury Nicole Tilluckdharry Anne Cappola
Question and answer period
SESSION 3
5:25 pm – 5:40 pm
Diane Hislop-Chestnut
COFFEE BREAK
Vitamin D and Thyroid Disease in the Elderly
5:00 pm – 5:10 pm
Anne Cappola
Question and answer period
SESSION 2
4:20 pm – 4:40pm
Chair: Michael Boyne
A child diagnosed with congenital adrenal hyperplasia
Vote of thanks and closure of conference
Chair: Patrice Francis Marilyn C Moses
Stephanie Clato-Day Scarlett Carlisle Goddard
7th SCIENTIFIC SESSION Sponsor: College of Health Sciences, University of Technology, Jamaica
Cornerstones in Diabetes Management and Diagnosis
16
Chair: Beverley King
2:30 pm – 2:50 pm
Current approaches and techniques in the diagnosis and management of diabetes mellitus
Janice Wissart
2:50 pm – 3:20 pm
Sound brain in a sound body: the neuroscience of wellness
Donna-Marie Wynter-Adams
3:20 pm – 3:40 pm
Community empowerment on diabetes through diabetes self-management training programme
Lurline Less
3:40 pm – 4:00 pm
Pharmaco-economic burden of diabetes mellitus: Applications and methods
Daniel Sarpong
4:00 pm – 5:00 pm
VIEWING OF EXHIBITS
Saturday, March 31, 2012 8th SCIENTIFIC SESSION
New Trends in the Treatment of Metabolic Syndrome Chair: Rosemarie Wright-Pascoe
9:00 am – 9:40 am
Challenges in lipid management – Achieving more intensive treatment goals
Glen Lallje
9:40 am – 10:00 am
Biology of incretins: Physiology and pharmacology
Luis Mejia
9th SCIENTIFIC SESSION
New and Upcoming Trends in the Treatment of Type 2 Diabetes Chair: Michael Banbury
10:00 am – 10:40 am
The role of incretin physiology in glucose metabolism
Michael Boyne
10:40 am – 11:00 am
Lipid abnormalities in patients with chronic kidney disease
Luis Mejia
Presentation to Gold Sponsor – Merck Sharpe and Dohme 11:00 am – 11:30 am
COFFEE AND VIEWING OF EXHIBITS
17
10th SCIENTIFIC SESSION Sponsor: The Hugh Lawson Shearer Foundation
11:30 am – 12:30 pm 12:30 pm – 2:00 pm 11th SCIENTIFIC SESSION 2:00 pm – 2:30 pm 2:30 pm – 3:00 pm 3:00 pm – 4:00 pm 12th SCIENTIFIC SESSION
4:00 pm – 5:00 pm
The Most Hon Hugh Lawson Shearer Memorial Lecture Diabetes in older persons LUNCH Treating Diabetic Complications The link between diabetes and heart disease
Strategies to improve medication adherence
Chair: Alverston Bailey
The Most Hon Denise EldemireShearer
Chair: Sebastian Peter Lenore Coleman Lenore Coleman
VIEWING OF EXHIBITS
The Hon Errol Morrison Distinguished Lecture Landmark in Diabetes Understanding
The unitarian hypothesis of the aetiology of diabetes mellitus
Chair: Dalip Ragoobirsingh
Prof The Hon Errol Morrison, OJ
Report on Judging of Posters Judges: Professor E Albert Reece, Dr Alverston Bailey and Professor Dalip Ragoobirsingh 6:00 pm
10:00 pm – 2:00 am
COCKTAILS
Reggae-Soca Party Grande Hall, Sunset Jamaica Grande Resort, Ocho Rios
Sunday, April 1, 2012
Sponsor: Splenda/Victoria Mutual Building Society/UTech Road to Olympic Glory 6:30 am
Chair: Owen Bernard
FUN-RUN-WALK
18
1st Scientific Session: The Sir Alister McIntyre Distinguished Lecture
Sir Alister McIntyre Distinguished Awardee for Integrative Medicine Brian Berman
Integrative Practices for Diabetes Management
The rising tide of Type 2 diabetes incurs an unacceptable human and societal toll throughout the world. Research has revealed that healthy lifestyle practices can prevent the development of Type 2 diabetes and that control of blood pressure, blood sugar levels and lipids improves outcomes of the disease. Nevertheless, the worldwide incidence of Type 2 diabetes continues to increase and management of the disease with current medical treatments is suboptimal, particularly among persons of low socio-economic status and minority populations. A more comprehensive treatment approach and creative preventive solutions for this public health crisis are necessary. The practice of integrative medicine appears to be one such solution, as this style of medicine offers an expansive set of evidence-based modalities that are known to aid both the prevention and treatment of Type 2 diabetes. Integrative therapies such as nutraceuticals, therapeutic diets, herbs and spices, and mind-body modalities are successfully being used in both the prevention and treatment of Type 2 diabetes with
West Indian Med J 2012; 61 (Suppl. 1): 19
Chair: Errol Morrison
increasing frequency. This presentation will focus upon recent evidence that demonstrates how the intertwining of personalized medicine, healthy behaviours and integrative treatment modalities can reduce the tremendous burden of Type 2 diabetes. Previous Awardees Prof Jean-Philippe Assal Prof Harry Keen Prof Jasbir Bajaj Prof Phillip James Dr Richard Kahn Dr James Gavin III Dr Alexander Kalache Dr Jean Yan Prof Jean-Marie Ekoe Dr Alberto Barcelo Dr Robert Gallo Dr Prakash Gupta Prof Lloyd Johnston
(Switzerland) (UK) (India) (UK) (USA) (USA) (Brazil) (Switzerland) (Canada) (USA) (USA) (India) (USA)
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
2nd Scientific Session
Indicators for Susceptibility to Diabetes Mellitus Chair: Cecil White NHF Performance Review Cecil White
In 2003, the government of Jamaica established the National Health Fund (NHF) as an additional mechanism to fund healthcare. The NHF provides drug subsidies and other direct forms of assistance to beneficiaries; grant funding to institutions for approved projects, and health information to promote healthy lifestyle behaviours. This paper will examine the NHF’s intervention, and review its intervention in the treatment of chronic diseases over the past eight years. It will outline the framework of the NHF model, provide an overview of the financing mechanism, and review the healthcare spending experience. Special emphasis will be placed on the NHF’s involvement in the treatment of and the support provided for diabetes mellitus. The paper will conclude with the description of a study that was designed to examine the impact of an NHF programme that provides support for diabetics.
West Indian Med J 2012; 61 (Suppl. 1): 20
The New Genomic Science and Implications for Diabetes Care Alan Shuldiner Advances in knowledge of sequence variation across the human genome have provided unprecedented opportunities for the discovery of the genetic underpinnings of diabetes and related disorders. To date, causative variants in genes for more than a dozen monogenic syndromes of diabetes are known. Common susceptibility variants are known for more than 40 loci for Type 2 diabetes and 50 loci for Type 1 diabetes. Some of these loci have unveiled novel targets for the design of new drugs. In addition, decreasing costs of high-throughput genomic technologies have made possible whole genome genotyping and sequencing of DNA from individual patients, which will allow physicians to better predict individual disease risk as well as responses to medications, diet and lifestyle interventions. This presentation will review the rapidly advancing field of genomic and personalized medicine, and how implementation of this new knowledge may be used to individualize patient care to improve treatment and prevention of diabetes and related disorders.
3rd Scientific Session
Roundtable – The Natural Path and Chronic Disease: The Rise of the Ancient Healing Arts
Chair: Sonia Davidson
Naturopathy, Oriental, Energy and Herbal Medicine Panellists: Derek Senior, Rupika Delgoda, Cherri Taylor, Tracy Ann Brown
International health policy-makers have proposed 25 parameters of quality of life, with which a country’s health status should be evaluated. The proposal is based on a concern that the fact of more people living longer does not give the whole picture. How people are utilizing the additional years is also important. The ageing populations are experiencing an increase in health conditions usually associated with ageing but which have their genesis through the life cycle. Chronic, non-communicable, lifestyle related diseases such as hypertension, diabetes, heart disease, arthritis and cancer dominate and take a great toll on quality of life. The concept of wellness has emerged as a distinct identity as increasing numbers of research findings provided the evidence for the multi-factorial nature of disease occurrence. Seven to eight influences of wellness called dimensions, were identified as physical, mental (intellectual) emotional, environmental, occupational, financial, social and spiritual. In identifying these dimensions, health professionals are being asked to take into consideration the total person when evaluating health status and managing patients.
West Indian Med J 2012; 61 (Suppl. 1): 21
Wellness philosophy reinforces the need for a team approach to ensuring human well-being. Wellness places self-responsibility and self-care high on the agenda of healthcare. It also emphasizes the proactive approach throughout the continuum of the natural history of any disease and it introduces gender-specific and age-specific interventions. Domains such as the family, domicile, school, workplace, media, places of worship, retirement villages, assisted living, penal and special needs institutions require tailored approaches to wellness interventions. Health institutions worldwide are re-orienting themselves to become wellness facilitators and coaches rather than dispensers of care. In that respect they have been reaching out to cultures that have had a tradition of healthcare which emphasizes self-reliance and addresses the whole person: mind, body and spirit. The general public, by its increased utilization of ancient unconventional healing practices, is indicating to mainstream medicine that it requires more than is currently being offered by it. This panel will examine some of the issues which influence this demand and provide a synopsis of the contribution of disciplines from four major categories.
4th Scientific Session
The Sir Philip Sherlock Distinguished Award Anti-diabetic Caribbean Plants: Natural Remedies and their Future Potential Role in Diabetes Management Henry Lowe
Diabetes mellitus is one of the commonest diseases affecting citizens of both the developed and developing countries. The International Diabetes Federation estimates that 194 million people live with diabetes worldwide, accounting for 5.1% of the adult population and it is projected to affect 333 million persons by 2025. In Jamaica, there are about 400 000 people suffering from diabetes with a resultant high mortality rate. The disease, which is characterized by hyperglycaemia, is also an important factor in accelerating cardiovascular and cerebrovascular associated diseases and other long-term complications including retinopathy, nephropathy and peripheral and autonomic neuropathy. The increasing prevalence of diabetes and associated complications not only present significant socio-economic concerns, but significant challenges for the medical and scientific community to provide effective management of the disease. Additionally, the aetiology and pathophysiology leading to hyperglycaemia is markedly different among patients with diabetes, which therefore dictates different prevention strategies, diagnostic screening and treatment methods, which can ultimately reduce the economic burden caused by this disease. While much scientific research has been done on dietary management of the disease, traditional medicines using herbals have historically been widely used in all cultures and despite the significant growth in modern pharmaceuticals to treat diabetes, these traditional medicines continue to play a significant role in diabetes management. In recent years, there has been a resurgence of interest in phyto-medicines and their synthetic alternatives for the treatment of diabetes not only by academic research scientists, but also by the pharmaceutical industry.
West Indian Med J 2012; 61 (Suppl. 1): 22
Chair: Alverston Bailey
Most of these plants have been scientifically validated through research carried out by the leading universities in the Caribbean which has revealed that some plants have significant positive bioactivity for the treatment of hyperglycaemia. Examples include Bixa orellana (annatto), Capsicum frutescent (bird pepper), and Dioscorea polygonoides (bitter yam). However, most of these scientific breakthroughs have never been commercialized as nutraceuticals or pharmaceuticals and remain only in the scientific literature. As a result of this, an extensive literature review has been done and we have compiled all the Caribbean folklore plants with proven efficacy, based on scientific research, used for the treatment of diabetes. We anticipate that this research will serve as a reference to clinicians and scientists to expand the research and development of these plants for commercial drugs and pharmaceuticals for diabetes management. In addition, researchers may utilize this database to scientifically investigate those plants for possible validation as practical medication for the management of this disease. Previous Awardees: Prof Rolf Richards Prof David Picou Prof Sir George Alleyne, OCC Prof Rene Charles Dr Compton Seaforth Ron Raab Dr Knox Hagley Prof Lawson Douglas and Prof George Nicholson Dr Winston Davidson and Jean-Claude Mbanya The Rev Ronald Thwaites Prof Edward Greene
(Jamaica/Trinidad) (Jamaica/Trinidad) (Jamaica/Barbados) (Haiti) (Trinidad) (Australia) (Jamaica) (Jamaica and (Barbados) (Jamaica) (Cameroon) (Jamaica) (USA)
2000 2001 2002 2003 2004 2005 2006
2007 2008 2009 2010 2011
5th Scientific Session
Integrated Management of Chronic Diseases Improving Chronic Illness Care Alberto Barcel贸
The Chronic Care Model (CCM) is a basic, yet comprehensive system for organizing chronic disease care that is patient-centred as well as evidence and population-based. The CCM has been successfully applied in strategies to organize and improve chronic care in developed and developing countries. This presentation outlines updates on the application of the CCM across the Americas as well as the progress of the Caribbean Quality of Diabetes Care Improvement Project. This project is an application of the CCM in 10 Caribbean countries (142 centres providing care for more than 40 000 patients), based on a collaborative methodology throughout learning sessions with health providers. The project is being implemented in Anguilla, Antigua, Barbados, Belize, Guyana, Grenada, Jamaica, St Lucia, Suriname and Trinidad and Tobago. The objective of the Caribbean Quality of Diabetes Care Improvement Project is to strengthen the capacity of health systems and competencies of the workforce for the integrated management of chronic diseases and their risk factors. The project promotes the integrated management of chronic diseases with a preventive focus, based on equity, the participation of the individual, his or her family, and the community to developing resources trained in chronic care and quality improvement programmes. Providing tools to health providers and patients is an important part of this project. One such example is the Chronic Care Passport, a patient-held card containing a care plan, healthy lifestyle advice, a personalized healthy meal plan and preventive measures for cardiovascular disease, among others.
West Indian Med J 2012; 61 (Suppl. 1): 23
Chair: Lurline Less
Chronic Disease Electronic Management System Cecil Pollard
One of the most well-known clinical information systems, the Chronic Disease Electronic Management System (CDEMS), has been successfully used to improve care for chronic conditions such as diabetes, asthma, congestive heart failure, depression and geriatrics in more than 300 healthcare organizations in the United States of America (USA). The CDEMS is an open-source public domain registry that was first released in 2002. The CDEMS is used by community health centres, primary care practices, rural clinics and hospitals. The benefits of CDEMS are: C User-friendly, no cost transition tool for electronically monitoring chronic disease healthcare C consistent, standardized organization of patient/population data C can be easily customized for individual providers or clinics C healthcare planning for individual patients with timely reminders for patients and providers C population-based analysis of care for patients with chronic conditions; improved, proactive patient care C gaps in care identified for action; performance tracked for practice team and care system C simple templates for custom reports creation by medical staff; outcomes documented for measuring quality improvement, quality certifications, pay-for-performance reimbursements, grant utilization C user owns data This presentation will outline the main characteristics and benefits of using CDEMS. The presenter will make a demonstration of how CDEMS can be downloaded from the internet, customized and used to monitor patients with chronic conditions.
6th Scientific Session
Nutraceuticals in the Management of Diabetes Chair: Cliff Riley Impact of Nutraceutical Products on Global Health Trends: A Public Health Perspective Winston Davidson1, Perceval S Bahadosingh2,3,4, Cliff K Riley1, Errol St A Morrison1, Henry IC Lowe1,2,3,4,5 1College of Health Sciences, University of Technology, Kingston, Jamaica, 2Bio-Tech R&D Institute, 3Environmental Health Foundation, 4The University of the West Indies, Kingston, Jamaica and 5University of Maryland, USA
The rising prevalence of chronic non-communicable diseases, globally, has prompted people of all ages to explore and embrace healthier lifestyle options inclusive of complimentary/alternative remedies. This has resulted in a significant increase in the production, development and use of nutraceutical products to treat/prevent diseases and maintain good health. Additionally, it has been reported that over 66% (200 million) of people living in the United States of America (USA) use at least one type of nutraceutical health product on a regular basis. The use of nutraceuticals as a means to deliver nutritional and medicinal benefits has earned tremendous monetary and health successes globally. The value of the nutraceutical market in the US is over $86 billion with the European, Japanese and Chinese markets slightly higher. Furthermore, the global nutraceuticals market is projected to exceed US$243 billion by 2015. This is primarily driven by consumer demands and increasing scientific evidence supporting nutraceutical products. Additionally, rising healthcare costs, ageing population and growing beauty affixations are expected to stimulate continued growth in the nutraceutical market. This implies that there is great dependency on nutraceutical products as persons become more health conscious, out of a desire to improve and extend their lives. However, this growing trend has implications on public health and must be addressed or evaluated urgently. Rigorous scientific evaluations must be done to ensure that the correct dosage is determined to minimize the risk of adverse side effects and at the same time provide optimum efficacy towards the particular health concern.
West Indian Med J 2012; 61 (Suppl. 1): 24
Hypoglycaemic Properties of Bixa orellana (Annatto) Extract: Exploitation for its Use in Diabetes Management Perceval Bahadosingh1,2,3, Henry IC Lowe1,3,4, Cliff Riley4, Andrew Wheatley2, Errol St A Morrison4 1Bio-Tech R&D Institute, 2Biotechnology Centre, The University of the West Indies, Kingston, Jamaica, 3Environmental Health Foundation and 4College of Health Sciences, University of Technology, Kingston, Jamaica
Studies have revealed that Bixa orellana (annatto) crude extract has significant hypoglycaemic properties with a mechanism of action similar to that of sulphonylureas. The hypoglycaemic activity resulting from the non-polar extract was demonstrated in streptozotocin-induced diabetic dogs at a dosage of 80 mg/kg body weight. Reduction in plasma glucose, glucagon and C-peptide levels as well as an increase in insulin sensitivity were reported. Owing to this, a solid dosage nutraceutical product supplemented with key minerals and vitamins was developed to aid in the management of hyperglycaemia in diabetic individuals. Extensive biochemical analyses have demonstrated that the supplement significantly reduces blood glucose levels in normoglycaemic individuals and therefore may be useful in persons affected with insulin resistance and hyperglycaemia. CARES SYMPOSIUM Frailty: A New Endocrine Disorder? Anne Cappola
The frailty syndrome represents a condition of extreme vulnerability to external stressors that places individuals at high risk for morbidity, mortality and functional decline. We have studied the relationship between hormonal abnormalities and frailty using a standardized definition that includes parameters of unintentional weight loss, exhaustion, weakness, slowness and low physical activity. I will present data that suggest dysregulation across multiple hormonal axes in the frailty syndrome, which poses therapeutic challenges to designing hormonal interventions for frailty. The type of intervention may also differ based on whether the treatment goal is to prevent frailty in those at risk (the prefrail) or to improve the status of those who are
already frail. The future of therapeutics in the frailty syndrome will be discussed.
and the latest recommendations for testosterone replacement therapy in this population will be discussed.
Hormone Replacement Therapy: Which Woman and What Regimen? Dianne Hislop-Chestnut
Vitamin D Deficiency: What Do the New Guidelines Say? Nicole Tilluckdharry
Hormone replacement therapy (HRT) has been used to treat the vasomotor symptoms of menopause for decades. Up to the 1990s, it was also used to modify the cardiovascular risk in postmenopausal women. However, since the Women’s Health Initiative (WHI) Study, which showed that HRT has potential adverse cardiovascular effects, many clinicians and women have shied away from using HRT. This presentation will briefly outline the biological effects of oestrogen deficiency including the climacteric symptoms. It will discuss the potential benefits of HRT in reducing the occurrence and severity of these symptoms protecting against other age-related disorders such as osteoporosis. The presentation will also examine the risks of HRT including the risks of breast cancer, cardiovascular disease and stroke. Within the context of these potential benefits and risks, the presentation will identify which women should be considered for HRT, which form of HRT is most suitable for particular patients and alternatives to HRT.
Vitamin D deficiency is very prevalent worldwide, and is linked to several chronic, inflammatory and autoimmune diseases including diabetes and cancer. It is not clear how common it is in Caribbean populations, but the prevalence may be low. However, certain groups may be at high risk eg the elderly, hospitalized patients, institutionalized persons and individuals who already have chronic illnesses. Measurement of serum 25-hydroxyvitamin D concentration is probably the best method to make the diagnosis, although there has been controversy about the cut-off value. More studies are needed in the Caribbean to quantify the possible effects of vitamin D levels on chronic diseases that are hypothesized to be associated with vitamin D deficiency. The most recent consensus guidelines by the Endocrine Society about prevention by nutrition, and treatment of deficiency using supplements will be discussed in this lecture. Subclinical Thyroid Disease: A Common Problem in the Elderly Anne Cappola
Testosterone Replacement and Late-onset Hypogonadism Marshall Tulloch-Reid
Subclinical thyroid dysfunction is found in up to 15% of people aged 70 years and older. Controversy surrounds the issue of whether untreated subclinical thyroid dysfunction has sufficiently important and reversible consequences in the elderly to justify screening and treatment. It has been suggested by some that the reference range should be adjusted in older adults, whereas others advocate universal screening and treatment using the current range. An update of recent findings in the field and a management strategy will be provided.
There is an increase in the prevalence of hypogonadism in men as they age, with one study reporting that 50% of men in their 80s had low serum testosterone concentrations. The diagnosis of late-onset hypogonadism can be difficult to make in elderly men because of the increase in sex hormone binding globulin concentration that occurs with ageing (resulting in higher concentrations of total serum testosterone) and the lack of reliable commercial assays for measuring the metabolically active free testosterone. The hypogonadal state results in changes in bodily function typically associated with ageing. These include reduced sexual function, bone mineral density, muscle mass, muscle strength, cognitive function and a worsening cardiovascular risk profile. It is therefore not surprising that testosterone therapy has been considered as one means of reversing the physiological changes that accompany ageing in men. However, evidence to support the routine use of testosterone in asymptomatic older men with low or low normal serum testosterone is weak, and comes mainly from small clinical trials, which have utilized variable inclusion criteria and differing testosterone treatment regimens. In this presentation, an approach to diagnosing lateonset hypogonadism in the elderly man will be reviewed
Prevention of Diabetes Type 2 in Curaçao: When and Where Do We Start? Marilyn C Moses
Curaçao is one of the largest Leeward Antilles in the Caribbean with a population of approximate 140 000. Obesity, the main cause of Type 2 diabetes, is growing worldwide at a high rate and consequently the Type 2 diabetes patient group will only become larger. With the ageing of Curaçao’s population, 30% of the population having an income below the poverty level and Curaçao being in the world’s top three countries with the
25
A Child Diagnosed with Hyperplasia Stephanie Clato-Day Scarlett
most dialysis patients per million inhabitants, it is important that measures be taken not only to reduce the costs of the healthcare system of Curaçao but also to improve the quality of life of the population. Prevention is still to be given more prominence on the agenda of the Curaçao government. In the older diabetes patients, primary prevention is not possible anymore, although in some cases with some effort diabetes in an early stage can be cured. Prevention of obesity is not merely raising awareness. All efforts in Curaçao to fight obesity in adults up till now have failed. Already we are confronted with its legacy leaving us another health problem, which is obesity in children. For successful obesity prevention, risk factors need to be identified and assessed periodically. The interventions need to be tuned to the needs and possibilities of the individual and his/her direct environment. The interventions need to apply strategies to guarantee sustainability of the achieved result and healthcare providers involved in the activities need to have good collaboration with the family physician.
Congenital
Adrenal
A 10-year five-month old male child was diagnosed at age six weeks with congenital adrenal hyperplasia (CAH) – salt wasting form. He is also known to be asthmatic. Maintenance medications were cortisone acetate, fludrocortisone and 6% NaCl, Ventolin MDI and Becotide MDI. He had been hospitalized for urinary tract infection at two months of age, bronchiolitis at four months of age, tuberculosis at eight years. Despite adequate nutrition and relative control of his CAH, his weight and height remained below the 3rd percentile. The presentation will seek to: C Put his height into perspective taking account of his medical issues C Outline the steps taken to investigate his growth/short stature C Explore treatment options currently available to him, if any. Growth hormone therapy – to treat or not to treat?
26
7th Scientific Session
Cornerstones in Diabetes Management and Diagnosis Chair: Beverley King Current Approaches and Techniques in the Diagnosis and Management of Diabetes Mellitus Janice Wissart
The diagnosis of diabetes mellitus (DM) is established by direct demonstration of hyperglycaemia under defined conditions. For many years, measurement of fasting blood glucose (FBG) or the performance of an oral glucose tolerance test (OGTT) were the recommended methods for the demonstration of hyperglycaemia. In 2009, the international expert committee on diabetes mellitus also recommended the measurement of HbA1C as a diagnostic measure. Management of DM involves the achievement of glycaemic control for the purpose of preventing both acute and debilitating complications of the disorder. HbA1C continues to be the major indicator of long-term glycaemic status and a measure of risk for the development of diabetes-related complications. The use of portable glucose meters for the measurement of blood glucose concentrations added the additional dimension of ‘self monitoring’ for better management of patients with DM. The search for better means of monitoring and controlling glycaemia led to the development of devices for “continuous” in vivo monitoring of glucose concentration. Current real-time devices approved by the FDA include the Guardian Real-Time and the Free-style navigator that allows patients to read both current glucose concentrations and trends. Emerging technologies include continuous non-invasive glucose analyses devices. Genetic and autoimmune markers are not useful in diagnosis and management of DM. Albuminuria, formally called microalbuminuria, is a well established risk marker associated with kidney disease. Sound Brain in a Sound Body: The Neuroscience of Wellness Donna-Marie Wynter-Adams
For years, the medical community has focussed on the peripheral and cardiovascular effects of diabetes. In recent times, the ‘light bulb’ has gone off and the central effects are being recognized and studied. Diabetes and its clinical markers, such as use of diabetic medications and duration with the disease, have been linked to impaired West Indian Med J 2012; 61 (Suppl. 1): 27
cognitive function and increased risk of Alzheimer’s disease and other types of dementia. Several studies show that the effects of diabetes, whether hypoglycaemia or hyperglycaemia, are more evident in older patients. Studies indicate that post-mortem results from Alzheimer’s patients show the presence of oxidative metabolic products associated with hyperglycaemia. A new area of diabetic research is on the neural effects of diabetes with the aim of perhaps developing more effective medications for the disease. Insulin receptors in the brain have been shown to play an important role in the regulation of normal glucose functioning. Scientists have discovered that by enhancing the brain’s normal insulin response in the hypothalamus, blood sugar reduction could be enhanced and less insulin utilized. Research has also found that there is an abnormality in the pain fibre innervation of the pancreas in diabetic rats. Protein from these pain fibres were used to reverse diabetes in in vivo studies. After spending over JA$4.5 billion on the medication and tests for just over 90 000 beneficiaries with diabetes in the National Health Fund in 2010 and with an increasing ageing population, the Jamaican medical community will be eager to understand the neural effects of diabetes and the possible implications of diabetes on maintaining sound brain and body. Community Empowerment on Diabetes through Diabetes Self-management Training Programme Lurline Less, Tamu Davidson Sadler, Ron Page International Diabetes Federation – North American Region, Ministry of Health, Jamaica
Non-communicable diseases (NCDs) account for 63% of deaths worldwide with 80% of deaths occurring in low- or middle-income countries. Diabetes was the fourth leading cause of NCD death in 2008, accounting for 1.3 million deaths globally. It is one of the major causes of premature illness and death worldwide. It is estimated that approximately 224 712 (13.6%) Jamaicans between the age group 15–74 years have diabetes (Jamaica Health and Lifestyle Survey 2008 using WHO definition). Diabetes imposes life-long demands on those affected and their families. Persons living with diabetes spend most of their time in the home, workplace and their com-
Pharmaco-economic Burden of Diabetes Mellitus: Applications and Methods Daniel Sarpong
munities. Therefore, they need to be able to self-manage their illness by: monitoring their blood glucose, taking their medication as prescribed, engaging in physical activity and healthy eating habits. Outcomes are largely based on the decisions they take and their environment. It is of paramount importance that persons with diabetes receive standardized and high quality training to manage their illness and the community be empowered to provide this supportive environment. In light of this, the Diabetes Association of Jamaica, in collaboration with the Ministry of Health, developed a training programme for community health-workers to be trained as lay diabetes educators and diabetes navigators using a Teach back Training of Trainers (TOT) methodology. The curriculum includes diabetes medical, lifestyle management and psychosocial support. The improvement in diabetes self-management will be evaluated by looking at patient blood glucose monitoring, eating pattern and physical activity; the targets are an improvement of 0.6% to 1% change in biochemical and 10–15% improvement in other indicators in 12 months.
The World Health Organization (WHO) estimates that 346 million people worldwide have diabetes mellitus (DM). More than 80% of diabetes-related deaths occur in low- and middle-income countries; and diabetes deaths are projected to double between 2005 and 2030 from the deaths of 3.4 million people in 2004. Deaths attributable to DM are 3.8 million annually. Diabetes mellitus is a major culprit for coronary and vascular related morbidities and mortalities. These complications or adverse secondary sequelae of DM can be prevented or delayed with intensive treatment and glucose control. The economic impact of DM and its complications affects individuals, families, health systems and countries. During the period 2006–2015, WHO estimates that China will lose $558 billion in foregone national income due to heart disease, stroke and diabetes. The United States of America (USA) national economic burden of pre-diabetes and diabetes reached $218 billion ($153 billion in higher medical costs and $65 billion in reduced productivity) in 2007. The average annual cost per case is $2864 for undiagnosed DM, $9975 for diagnosed DM ($9677 for Type 2 and $14 856 for Type 1) and $443 for pre-diabetes (medical costs only). The rising cost of DM care is unbearable, even for advanced and industrialized countries and is devastating for poor and/or developing countries. In the USA, about one in every five healthcare dollars is attributed to DM. In Latin America, families pay 40–60% of DM-related costs out-of-pocket. The gradient of the rising incidence of DM and the corresponding economic burden adds urgency to the need for adequate allocation of scarce resources. It is imperative that those nations greatly impacted by DM derive the best estimates of its economic burden. The use of pharmacoeconomic models on DM offers assistance to pharmacy and therapeutic (P&T) committees in healthcare systems and pharmacy councils (PCs) of developing countries in making more informed decisions in terms of drug formulary (or essential drug lists) for the system or country. The decisions of the P&T and PCs should be based on the long-term benefits of reduced micro and macrovascular complications and changes in drug utilization patterns and immediate drug budget impact. Hence, this research paper presents cost-of-illness analysis and cost-effectiveness analysis in assessing the economic burden of DM in both developed and developing countries. Sources of data to compute economic burden of DM and cost-saving strategies are also discussed.
RESULTS A thirty-nine item questionnaire covering all six modules of the trainers manual was used as an evaluation tool to measure any change in knowledge before (Pre-test) and after all training workshop (Post-test). This tool was administered to all categories of trainees – trainers, lay educators and lay navigators. Mean scores from the post-test for all categories of trainees showed an improvement to the mean score of their pre-test. The mean score on the pre-test was 95% while the mean score on the post-test was 99% for the training of trainers. Similar improvement in the mean score was observed for both the pre-test (80%) and post-test (90%) for the lay navigators training. Ninety-five per cent of participants of the lay educators training felt very confident that they will be able to use the information covered in the training when they returned to their jobs. Further assessment will look at evaluating the improvement in diabetes self-management at the end of 12 months.
28
8th Scientific Session
New Trends in the Treatment of Metabolic Syndrome
Chair: Rosemarie Wright-Pascoe
Challenges in Lipid Management: Achieving More Intensive Treatment Goals Glen Lalljie Statins are very effective lipid-lowering agents. However, randomized controlled trials have shown that regression in coronary atherosclerosis only occurs when low density lipoprotein (LDL) cholesterol is lowered to < 1.8 mmol/L. In clinical practice, few patients, especially those with diabetes, achieve such LDL cholesterol levels on statin therapy, hence atherosclerosis continues to progress. A more effective lipid-lowering strategy is to treat the two main sources of cholesterol simultaneously: production in the liver – inhibited by statins, and absorption in the intestine – inhibited by ezetimibe. The co-administration of a statin and ezetimibe provides consistently greater reduction in LDL cholesterol through dual inhibition of both cholesterol production and absorption compared with single inhibition of cholesterol production by statin alone. This strategy may allow more patients to achieve regression of atherosclerosis.
West Indian Med J 2012; 61 (Suppl. 1): 29
Biology of Incretins: Physiology and Pharmacology Luis Mejia
Type 2 diabetes mellitus (T2DM) develops as a consequence of progressive β-cell dysfunction in the presence of insulin resistance. None of the currently available T2DM therapies is able to change the course of the disease by halting the relentless decline in pancreatic islet cell function. Recently, dipeptidyl peptidase 4 (DPP-4) inhibitors, or incretin enhancers, have been introduced in the treatment of T2DM. This class of glucose-lowering agents enhances endogenous glucagon-like peptide 1 (GLP-1) and glucosedependent insulinotropic polypeptide (GIP) levels by blocking the incretin-degrading enzyme DPP-4. Dipeptidyl peptidase-4 inhibitors may restore the deranged isletcell balance in T2DM, by stimulating meal-related insulin secretion and by decreasing postprandial glucagon levels. Moreover, in rodent studies, DPP-4 inhibitors demonstrated beneficial effects on (functional) β-cell mass and pancreatic insulin content. Studies in humans with T2DM have indicated improvement of islet-cell function, both in the fasted state and under postprandial conditions, and these beneficial effects were sustained in studies with a duration of up to two years. However, there is at present no evidence in humans to suggest that DPP-4 inhibitors have durable effects on β-cell function after cessation of therapy. Long-term, large-sized trials using an active blood glucose lowering comparator followed by a sufficiently long washout period after discontinuation of the study drug are needed to assess whether DPP-4 inhibitors may durably preserve pancreatic islet-cell function in patients with T2DM.
9th Scientific Session
New and Upcoming Trends in the Treatment of Type 2 Diabetes
The Role of Incretin Physiology in Glucose Metabolism Michael Boyne
The elucidation of incretin physiology has led to a new understanding of the pathogenesis of Type 2 diabetes. Incretins are hormones from the gastrointestinal tract that are released in response to meals. Glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP) are the beststudied incretins and are involved in the regulation of islet function. They inhibit glucagon release and potentiate insulin secretion, which improves glucose homeostasis and reduces hepatic glucose output. Incretins may promote satiety and thus weight loss through peripheral and central mechanisms. Gastric inhibitory peptide also has actions on adipose tissue and thus may affect energy storage. For unclear reasons, the effects of incretins are reduced in Type 2 diabetes. Thus, the pharmacological manipulation of incretin biology, by inhibiting the degrading enzyme of DPP-4 (dipeptidyl peptidase-4), or by using GLP-1 receptor agonists, reduces hyperglycaemia. It is not clear though if incretins prevent the natural decline in beta-cell function that is characteristic of diabetes, although data from animal experiments are promising. At present, novel drugs based on incretin physiology are used for the management of Type 2 diabetes and their role in the treatment of obesity is being investigated.
West Indian Med J 2012; 61 (Suppl. 1): 30
Chair: Michael Banbury
Lipid Abnormalities in Patients with Chronic Kidney Disease Luis Mejia
Cardiovascular disease is increased in patients with chronic kidney disease (CKD) and is the principle cause of morbidity and mortality in these patients. Dyslipidaemia, while common in these patients, is usually not characterized by elevated cholesterol, except in those patients with massive proteinuria. Qualitatively, increased triglycerides and reduced high density lipoproteins (HDL) are most frequently described. Extensive abnormalities in the metabolism of apolipoprotein (apo) B-containing lipoproteins have been demonstrated, including those derived from the gut (apoB48) as well as those derived from hepatic synthesis (apoB100). Decreased enzymatic delipidation, in addition to reduced receptor removal of these lipoproteins, results in increased concentrations of these apo B-containing moieties, and in particular, their atherogenic remnants. Abnormalities in apo-A-containing lipoproteins are also present and these changes may contribute not only to the lower levels of HDL seen, but also to the proinflammatory state that is frequently present in CKD patients. As a result, therapeutic strategies designed to modify atheroscleroticcaused outcomes in CKD may require multiple approaches.
10th Scientific Session
The Most Hon Hugh Lawson Shearer Memorial Lecture
Chair: Alverston Bailey
Diabetes in Older Persons Denise Eldemire-Shearer
Caribbean populations are ageing while experiencing the epidemiologic transition. Issues associated with diabetes in older persons are of increasing importance given that increasing numbers of older persons are living longer with diabetes and the associated complications. The paper discusses diabetes in older persons and how symptoms and management change with age.
West Indian Med J 2012; 61 (Suppl. 1): 31
The paper further examines the multiple difficulties faced by older persons, families and caregivers due to the combined additive effects of diabetes, the ageing process and the associated changes accompanying both. Special attention will be paid to the development of cognitive impairment and the role of diabetes in development of same. The interplay between diabetes, co-morbidity, polypharmacy and social and economic factors will be discussed. Finally, the paper discusses management challenges including self-care and health promotion in older diabetics.
11th Scientific Session
Treating Diabetic Complications Chair: Sebastian Peter The Link between Diabetes and Heart Disease Lenore Coleman
Cardiovascular disease (CVD) remains the most important cause of morbidity and mortality in patients with Type 2 diabetes. Primary prevention through lifestyle changes remains a top priority since there is clear evidence that patients with Type 2 diabetes are at increased risk for both myocardial infarction and stroke. The data from Haffner et al, looking at 1373 diabetes-free individuals compared to 1059 diabetic subjects followed for seven years, clearly demonstrated that the risk for infarction was similar. Based on this data, we know that patients with Type 2 diabetes need to be aggressively managed to achieve evidence based glycaemic targets. Increased CVD risk in patients with diabetes is related to premature and extensive atherosclerosis often involving smaller, more distal vessels. When studied, patients with diabetes have an increased plaque burden and evidence of more vulnerable plaques that are more susceptible to rupture. In addition, the plaque area is usually occupied by macrophages with increased T-cell infiltration. We know that the pathogenesis of atherosclerosis-related disease in Type 2 diabetes is multifactorial. Dyslipidaemia is strongly correlated with insulin resistance and hyperinsulinaemia. Dyslipidaemia should be treated independently from blood glucose control and in most cases should be the primary focus in the management of Type 2 diabetes patients with coronary artery disease (CAD). The major goal of therapy in the management of dyslipidaemia is the reduction of low density lipoprotein (LDL) cholesterol levels and other apolipoprotein-B containing lipoproteins. In most cases, statins are considered the drug of choice due to the large number of randomized clinical trials showing their benefits in reducing both morbidity and mortality. These trials have demonstrated the overwhelming benefits of statins in reducing the incidence of major CVD events in Type 2 diabetes patients with or without established CVD. After intensive LDL-cholesterol reduction, the next lipoprotein for intervention is the high density lipoprotein (HDL)-cholesterol. Though the number of randomized clinical trials (RCT) is lacking to guide with management
West Indian Med J 2012; 61 (Suppl. 1): 32
of HDL-cholesterol, observational studies have provided evidence of an inverse relationship between HDL levels and cardiovascular disease. Analyses of the statin trials have shown that baseline HDL-cholesterol remains an important predictor of CVD in both placebo and statin treated patients. The most effective drug currently available to increase HDL-cholesterol is niacin. Niacin lowers LDL-cholesterol and triglyceride levels and increases HDL-cholesterol levels by 20%. Most studies use niacin at doses of 2 grams per day. Niacin is the only clinically available drug that lowers lipoprotein (a) levels. Unfortunately, the use of niacin is limited due to its poor tolerability and propensity to cause flushing. The extended release form of niacin is better tolerated. When considering the use of combination therapy for the management of lipids in people with Type 2 diabetes, there are limited data. There are published studies looking at the combination of fenofibrate/simvastatin, simvastatin/ sitagliptin and ezetimide/simvastatin. The clinical efficacy of these combination products will be discussed. Strategies to Improve Medication Adherence Lenore Coleman
Non-adherence with prescribed drug regimens is a pervasive medical problem. A recent report by the World Health Organization (WHO) revealed that 50% of patients with chronic disease do not take their medication as prescribed. Poor medication adherence leads to increasingly poor health outcomes for patients and has a significant negative economic impact on healthcare resources. On average, one third to one half of patients do not comply with prescribed treatment regimens. Non-adherence rates are relatively high across disease states, treatment regimens and age groups, with the first several months of therapy characterized by the highest rate of discontinuation. In fact, it has recently been reported that low adherence to beta-blockers or statins in patients who have survived a myocardial infarction results in an increased risk of death. In addition to inadequate disease control, medication non-adherence results in a significant burden to health-
care utilization – the estimated yearly cost is $396 to $792 million. Additionally, between one-third and two-thirds of all medication-related hospital admissions are attributed to non-adherence. Cardiovascular disease, which accounts for approximately one million deaths in the United States of America each year, remains a significant health concern. Risk factors for the development of cardiovascular disease are associated with defined risk-taking behaviours (eg smoking), inherited traits (eg family history), or laboratory abnormalities (eg abnormal lipid panels). A significant but often unrecognized cardiovascular risk factor universal to all patient populations is medication non-adherence. When looking at medication non-adherence, there are multiple factors which contribute to non-adherence. We know that when patients do not take their medications it can contribute negatively to treatment outcomes. This can increase healthcare costs. Through the work done by McHorney and Lapane, we now know that there are 10 tenets (truths) about medication adherence. These are:
C Shed light on the fact that we, as healthcare professionals, need to screen for non-adherence C Demonstrate that there are many common misperceptions regarding adherence C Highlight the problems with effective communication between patients and clinicians C Provide useful insights in the patient’s medication decision-making C Capture the importance of patient’s beliefs in determining adherence behaviours This presentation will cover tactics and strategies that can be used to change medication-taking behaviours and improve medication adherence. These tactics include: C The role of effective communication techniques between providers and patients C Understanding the role of health literacy C The use of motivational interviewing to create ambivalence C The use of “teach-teach back” techniques to validate understanding of medication instructions
33
12th Scientific Session
The Hon Errol Morrison Distinguished Lecture Landmark in Diabetes Understanding
Chair: Dalip Ragoobirsingh
The Unitarian Hypothesis of the Aetiology of Diabetes Mellitus Errol Morrison
The classification of diabetes mellitus (DM) outlines two main Types – 1 and 2. Type 1 is insulin insufficiency whilst Type 2 is mainly due to insulin resistance in the target tissues. Several others have been described: gestational, nutritional, drug-induced and many more, all of which lead to the clinical picture of hyperglycaemia and its attendant adverse outcomes. The Unitarian hypothesis presents an overall cascade of biochemical and physiological interactions which may result from a variety of insults. It underpins the belief that nature, the genetic predisposition which directs potential antibody development, and nurture, the environmental influences such as nutritional status (over- or under-nutrition), infective and toxic attack, can aggravate or initiate aspects of the cascade of reactions leading to hyperglycaemia. The causative agents of diabetes are imputed to be free radicals, oxidizing molecular species and antibodies functioning internally. The corollary to the above must be that any intervention that minimizes the expression of these three would reduce the tendency for the development of diabetes. The Unitarian hypothesis advances the concept that the types of clinical syndromes being described are not necessarily variants of a specific illness but rather manifestations of a central process of membrane damage – > antibody response – > insulin inadequacy (quantitatively or
West Indian Med J 2012; 61 (Suppl. 1): 34
qualitatively), and the future intervention in containing the disease may well lie in focussing on the preservation of membrane integrity. The incidences of adverse events (AEs), serious AEs, deaths, and AEs leading to discontinuation were generally similar between treatment groups. The incidence of drug-related AEs was greater in the nonexposed group, primarily because of the increased incidence of hypoglycaemia. The incidence of gastrointestinal (GI) symptoms was generally higher in the non-exposed group, primarily because of the increased incidence of diarrhoea. The incidence of hypoglycaemia was higher in the non-exposed group compared with the sitagliptin group, primarily because of the use of sulphonylureas as comparator agents. When sitagliptin alone was compared with placebo or agents not known to cause hypoglycaemia, the incidence rates were similarly low. The incidences of cardiovascular AEs, bone fractures and infections were generally similar between the sitagliptin and non-exposed groups. The incidence of Major Adverse Cardiovascular Events (MACE) was similar between treatment groups. The incidences of angioedema, angioedema-related events, and increased alanine aminotransferase or aspartate aminotransferase were similar between the sitagliptin and non-exposed groups. The incidence of overall skin and subcutaneous tissue disorders was modestly higher in the sitagliptin group. The incidences of malignancies were similarly low for both groups. The incidences of pancreatitis and chronic pancreatitis were similar for the sitagliptin and non-exposed groups.
THEME: DIABETES AND ORAL HEALTH
Poster Presentations 02P – 1
Good Records Management – Better Diabetes Management K Lowe
Objective: Improve research in diabetes management through the development and implementation of a records and information management programme. Method: Personal experience and observation. Results: A systematic creation and maintenance of patient records would help to reduce medical errors, simplify the waiting process and increase overall efficiency. Keeping records in a centralized location is important for better control. Conclusions: Good management of health records facilitates safe storage, rapid retrieval and secure disposition of patient records. For this to be achieved, there needs to be not only efficiency, but consistency of records management practices, which can be improved with the use of technology. 02P – 2
Foot Care and Footwear Practices among Patients Attending a Specialist Diabetes Clinic in Jamaica KA Gayle1, MK Tulloch-Reid1, NO Younger-Coleman1, DK Francis1, SR McFarlane1, RA Wright-Pascoe2, MS Boyne1, RJ Wilks1, TS Ferguson1 1Tropical Medicine Research Institute and 2Department of Medicine The University of the West Indies, Kingston, Jamaica
Objective: 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. Methods: Seventy-two participants (58 women, 14 men) from the UHWI diabetes clinic completed an intervieweradministered 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 between March and September 2010. Data analysis included frequency estimates of the various foot care practices and types of footwear worn. West Indian Med J 2012; 61 (Suppl. 1): 36
Results: Participants had a mean age of 57.0 ± 14.3 years and mean duration of diabetes of 17.0 ± 10.3 years. Only 53% of participants reported ever being taught how to care for their feet. Daily foot inspection was performed by just over 60% of participants. Most participants (90%) reported daily use of moisturizing lotion on the feet but almost 50% used lotion between the toes which is not recommended. Approximately 85% of participants reported wearing shoes or slippers both indoors and outdoors but over 40% reported walking barefoot at some time. Thirteen per cent reported wearing 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 high heel shoes (43% – women only). Conclusion: Over 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. 02P – 3
The Slipping Slipper Sign: High Specificity and Positive Predictive Value for Peripheral Neuropathy among Diabetic Patients KA Gayle, MK Tulloch-Reid, RJ Wilks, TS Ferguson Tropical Medicine Research Institute (Epidemiology Research Unit) The University of the West Indies, Kingston, Jamaica
Objective: To evaluate the ability of the slipping slipper sign to identify diabetic neuropathy in Jamaican patients. Methods: A single question from a questionnaire was used to ascertain the presence of the slipping slipper sign (defined as unknowingly losing a slipper while walking) among 69 patients attending the University Hospital of the West Indies diabetes clinic. Trained nurses also assessed pain, vibration and pressure perception among the same patients in order to detect diabetic neuropathy. Patients were classified as having diabetic neuropathy if any of these tests were abnormal. The sensitivity, specificity and positive predictive value (PPV) for the slipping slipper sign were calculated.
Results: Twenty-eight participants (40.6%) had neuropathy on at least one of the three tests. Eight participants (men = 5, women = 3) reported positive slipping slipper sign. The slipping slipper sign had a sensitivity of 28.6%, specificity of 100% and PPV of 100% for neuropathy on at least one of the three tests. The prevalence of slipping slipper sign increased with the number of neurological abnormalities detected: 0% among those with no abnormal tests, 13% among patients with one abnormal test, 50% among patients with two abnormal tests and 43% in patients with three abnormal tests (p < 0.001 for trend). Conclusion: The slipping slipper sign has high specificity and positive predictive value for diabetic neuropathy but the sensitivity is low. The sign may be a useful adjuvant to conventional method of screening for severe neuropathy and to identify patients who should be advised against wearing slippers.
adjusting for age, sex and insulin use (p = 0.004). In multinomial logistic regression models adjusted for the same variables, SMBG was also associated with lower odds of having poor glycaemic control (HbA1C > = 9%) compared to good control (HbA1C < 7%); OR 0.24, p = 0.001. Conclusion: Self-monitoring of blood glucose is practised by almost 60% of patients at the UHWI diabetes clinic and is associated with lower HbA1C and decreased odds of having poor glycaemic control. 02P – 5
Correlates of Self-management and Treatment Adherence among Type 2 Diabetics Attending a Private Jamaican clinic: A Pilot Study
DR Brown1, D Akindele2 1University of Medicine and Dentistry of New Jersey, USA and 2University of Technology, Kingston, Jamaica
02P – 4
Many complications of Type 2 diabetes can be prevented through effective management and adherence to recommended treatment. This includes not only regular clinic visits for checking HbA1C, eyes and feet, but also patient selfmanagement and lifestyle changes. However, because patient self-management behaviours are often difficult to maintain, the purpose of this study is to understand factors that are associated with better patient self-management and treatment adherence. Specifically, this study investigated the relationship between patient self-management practices and factors such as patient demographic characteristics, awareness of familial risk and social support. The data come from interviews with Type 2 diabetics seeking treatment at a private Jamaican clinic. Implications are discussed for treatment adherence.
Relationship between Self-monitoring of Blood Glucose and Glycaemic Control among Patients attending a Specialist Diabetes Clinic in Jamaica KK Francis1, NO Younger-Coleman1, MK Tulloch-Reid1, RA Wright-Pascoe2, MS Boyne1, RJ Wilks1, TS Ferguson1 1Tropical Medicine Research Institute and 2Department of Medicine The University of the West Indies, Kingston, Jamaica
Objectives: To describe the frequency of self-monitoring of blood glucose (SMBG) and evaluate its relationship with glycaemic control among patients attending a specialist diabetes clinic in Jamaica. Methods: This cross-sectional study analysed data from 188 patients randomly selected from the University Hospital of the West Indies (UHWI) diabetes clinic. Selfreported data on blood glucose testing practices were obtained using a structured questionnaire. A point-of-care meter (NycoCard© Reader II) was used to measure glycosylated haemoglobin (HbA1c) from a capillary blood sample collected from each participant. Proportions and frequency of SMBG within and across demographic and socio-economic status categories were obtained. Linear and logistic regression analyses were used to evaluate the relationship between SMBG and glycaemic control. Results: Analysis included 143 women and 45 men with mean age of 56 ± 15 years. Approximately 60% (95% CI 52, 67%) of patients performed SMBG with no difference by gender (62% M vs 52% F, p = 0.196). Thirty-one per cent of participants monitored their blood glucose at least once daily and 29% less than once daily. Participants less than forty years old, persons with post-secondary education and those taking insulin were more likely to perform SMBG. Multivariable linear regression showed that performing SMBG was associated with a lower HbA1C after
02P – 6
Investigating the Relationships between the Awareness of Risk Factors of Type 2 Diabetes Mellitus and the Practices and Attitudes of First and Second Year Medical Technology Students at the University of Technology, Jamaica L Mendoza, K Mogg, T Muir, A Passley, A Simpson The College of Health Sciences, University of Technology, Jamaica Background: Type 2 Diabetes Mellitus (DM) has become a universal concern to the health of individuals, especially for formerly unaffected young people, as this disease can cause complications, which can lead to one’s demise. Objective: To investigate the level of relationships/association between the awareness of risk factors of Type 2 DM and the practices and attitudes of first and second year
37
Medical Technology Students at the University of Technology (Utech), Jamaica. Methods: A cross-sectional study was conducted among 54 university students in the age range of 18â&#x20AC;&#x201C;31 years. A 17point questionnaire was administered to assess studentsâ&#x20AC;&#x2122; knowledge of diabetes and food frequency/caloric intake. Knowledge was scored on basic knowledge of Type 2 DM, associated risks factors and influential lifestyle practices. Anthropometric measurements were taken at a scheduled time. Results: The results indicated no direct correlation between studentsâ&#x20AC;&#x2122; knowledge and lifestyle practices. Addi-
tionally, a high intake of high caloric foods was observed among the study population. Physical activity, on the other hand showed a fifty per cent success among the subjects while the anthropometric measurements implied that the majority of the population was not at risk. Conclusion: The increasing prevalence of Type 2 DM constitutes a significant public health burden, placing a greater importance on its prevention. The evidence for the efficacy of lifestyle intervention, including weight management, increased physical activity, dietary compliance, as well as avoiding tobacco abuse should be urgently implemented in the prevention of Type 2 DM.
38
Notes
WIMJ Supplement COVER_March 2012:Layout 1
26/03/2012
Notes
09:31 AM
Page 3
WIMJ Supplement COVER_March 2012:Layout 1
26/03/2012
09:31 AM
Page 4
PRINTED IN JAMAICA BY BCNS PRINTERS LTD