International Journal of Epidemiology, Vol 24, S53-S59, Copyright © 1995 by International Epidemiological Association
MC Gulliford
The epidemiological transition has brought an increasing burden of chronic
non-communicable disorders to middle- and even low-income countries. This
paper reviews the problem with particular reference to
non-insulin-dependent diabetes mellitus (NIDDM) in the English-speaking
Caribbean region. Surveys conducted over the last three decades have
documented a high prevalence of NIDDM in a number of communities and
evidence has accumulated to support the control of obesity and physical
inactivity in the primary prevention of non-insulin-dependent diabetes. The
problem of introducing and monitoring suitable interventions on a long-term
basis in high-risk populations in different cultures has yet to be
addressed. The impact of diabetes on health status in developing countries
has not been well documented but it is clear that there are high levels of
acute illness from disorders of glycaemic control, long- term disability
from blindness and limb amputation and premature mortality from stroke,
coronary heart disease and renal disease. Present evidence suggests that
improving the quality of preventive clinical management can be the most
immediately productive approach to controlling health problems from
diabetes. Achieving this objective within the social, organizational and
resource constraints of the Caribbean presents a range of problems.
Identifying the most cost- effective means of improving existing services
is therefore the most immediate research priority for NIDDM in the
English-speaking countries of the Caribbean.
ARTICLES
Controlling non-insulin-dependent diabetes mellitus in developing countries
Commonwealth Caribbean Medical Research Council, Port of Spain, Trinidad.
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