An interim report of an intervention strategy for diabetes care in Jamaica

The high prevalence (17.9 percent) of diabetes mellitus and its attendant costs have been recognized for some time. The diabetic public has hitherto been too oriented to seeking health care at the secondary and tertiary health care centers; a much too costly approach. As a part of a wellness promotion thrust as well as an awareness and intervention strategy, a number of health care agencies have collaborated in a training programme of lay diabetes facilitators. This was intended to allow a domino effect of "each one teach one" within the community. This intervention programme was undertaken over an 18 month period. No significant changes were achieved in glycaemia levels. The impact on hospital admissions and community awareness is yet to be assessed. Laboratory results indicated good correlation between glycosuria and hyperglycaemia. This could influence the thrust in maintaining glycosuria assessment alongside blood glucose monitoring. This approach would have a cost benefit for government clinics islandwide. Whilst it may be difficult to identify any one parameter that may be responsible for change, it will be possible to assume that this intervention strategy, the only innovation in the health care delivery modalities, may have contributed.(Au)

The efficacy of acarbose in type 2 diabetes mellitus in Jamaica

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8 percent) did not complete the study and were excluded from further analysis. Six (13 percent) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n=15), [Gp B], oral hypoglycaemic agents, OHAs (n=17), [Gp C], or insulin (n=8), Gp D]. In addition, during the run in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3 month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 ñ 1.1 to 8.4 ñ 0.9 (p<0.027) and, from 11.0 ñ 1.0 to 8.7 ñ 0.7 (p<0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 ñ 1.1 percent to 12.2 ñ 1.0 percent (p<0.016) in Gp B, from 14.8 ñ 1.1 to 11.9 ñ 1.1 percent (p<0.002) in Gp C, and from 14.1 ñ 1.4 to 11.8 ñ 1.4 (p<0.02) in Gp D. Twenty-three per cent (23 percent) of the patients experienced flatulence; 7.5 percent changes in bowel habits and 5 percent, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.(Au)

Diabetes in the peri-menopausal period - position statement

Interrelationship of one with the other includes the high prevalence of diabetes in peri-menopausal and menopausal women, and the adverse impact of the menopause on diabetes. MENOPAUSE AND DIABETES RISK: The risk increases for women predisposed to type 2 diabetes because of the loss of oestrogen, increased adipose tissue and increased insulin resistance. MENOPAUSE AND PRE-EXISTING DIABETES: There is a change in glycaemic control with an increase in marcovascular risk due to comorbidities such as hypertension and dyslipidaemia. DIABETES AND HORMONE REPLACEMENT THERAPY: This results in worsening of hyperlipidaemia with an increased risk of cardiovascular events and deterioration in glycaemic control. The management regime includes assessment and management of dyslipidaemia, renal problems, ophthalmic complications and neuropathy. The objectives are to achieve normal weight and blood pressure whilst maintaining tight glycaemic control as monitored by HbA measurement.(AU)

Antibiotic resistance patterns of gram-negative aerobic bacilli: a Caribbean collaborative study - abstract

As part of a systemic study of antibiotic resistance pattern of bacteria in the Caribbean, organisms were collected from hospital laboratories in Barbados and Trinidad in May-June, 1991. Three hundred and twenty-eight gram-negative aerobic bacilli (BNB) were tested for antibiotic resistance by Kirby-Bauer disc susceptibility test method. The percentage of resistance to ampicillin, carbenicillin and amoxicillin/clavulanic acid was 63 percent, 52 percent and 27 percent, respectively. The gentamicin resistance of GNB was 7.6 percent, and none of the isolates were resistant to amikacin. The percentage resistance of GNB isolates from Trinidad against all antibiotics was higher than the isolates tested from Barbados. Interestingly, 26 percent of isolates obtained from outpatients were resistant to cotrimoxzole as compared to 16 percent in inpatients in Trinidad. A systematic study of antibiotic resistance among gram-negative bacteria in the Caribbean is recommended for prudent use of antibiotics (AU)

Gonococcaemia with arthritis, dermatitis and myocarditis

Six cases of gonococcaemia seen at the University Hospital of the West Indies are described. All presented with polyarthritis and all but one had skin lesions. They varied widely in severity and chronicity and included one case with rigors and myocarditis. Emphasis is placed on the diagnostic value of the scanty skin lesions, and the importance of repeated examination of cervical swabs (Summary)

The use of the R/B tubes in diagnostic bacteriology

The modified R/B, two-tube, rapid identification system was compared with conventional biochemical tests in the identification of 500 strains of different members of the Enterobacteriaceae. The R/B tubes identified 97 percent of the organisms conclusively within 18 hours, the reactions being generally easy to read and interpret. No special skill was required for the use of the media or interpretation of the results. Most of the atypical strains were, however, incorrectly categorized at first screening. R/B tubes are expensive but with the time saved in media preparation, washing and sterilization of glassware and with fewer tubes to inoculate, also with savings in bench and refrigerator space and less need for quality control of media, the expense may be more apparent than real (AU)