WIMJ-March 2012

Vol. 61 (Suppl 1) 1 – 38

March 29 – April 1, 2012

ISSN: 0043-3144 WIMJAD

Supplement

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


Sunset Jamaica Grande ResortOcho Rios, Jamaica

WIMJ Supplement COVER_March 2012:Layout 1 26/03/2012 09:31 AM Page 1

West Indian Medical JournalPublished 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

EDITORIAL BOARD

ChairmanS Ramsewak

Editor-in-ChiefEN Barton

Associate EditorsD CohallDT GilbertA HennisG HutchinsonT Seemungal

Assistant EditorsW AbelMO Castillo-RangelT ClarkeT FergusonJ PlummerPJ RamphalAK SoyiboH Trotman

DeansJM BrandayAH McDonaldS RamsewakR Roberts (Director, UWI Clinical Training Programme)

TreasurerE RobinsonT AlleyneF BennettC Christie-SamuelsIW CrandonN DuncanY FugitaF Henry (CFNI)J Hospedales (PAHO)T JonesGC Lalor (ICENS)W McLaughlin

MO OwolabiA PearsonDT Simeon (CHRC)MF Smikle, Y Zhao

Editorial Advisory BoardB Bain, B Barnett, J Bennett, V Boodhoo, M BoyneFC Brosius IIIG BurkettW De La HayeH DaisleyD Eldemire-ShearerC EscofferyLF FerderJP FigueroaJ FrederickB HanchardN KissoonM LeeA McCaw-BinnsC OgunsaluOO OguntibejuA OjoH ReidGR SerjeantWH SwanstonAAE VerhagenM VoutchkovRJ WilksR Young

Past EditorsJL Stafford 1951–1955JA Tulloch 1956–1960D Gore 1961CP Douglas 1962D Gore 1963–1966P Curzen 1967RA Irvine 1967–1969TVN Persaud 1970–1972GAO Alleyne 1973–1975V Persaud 1975–1995D Raje 1995–1996WN 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.

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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: [email protected], 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



The University of the West Indies (UWI)

and

The University of Technology (UTech)

present


Theme: New Frontiers in Diabetes Management



Editor-in-ChiefProfessor EN Barton

Scientific EditorsProfessor The Hon EY St A Morrison

Professor E Albert Reece


The University of the West Indies (UWI)and

The University of Technology, Jamaica (UTech)

present


THEME: New Frontiers in Diabetes Management



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 SessionSir Alister McIntyre Distinguished Lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

2nd Scientific SessionIndicators for Susceptibility to Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

3rd Scientific SessionThe Natural Path and Chronic Disease: The Rise of the Ancient Healing Arts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

4th Scientific SessionOpening of Satellite Conference on Wellness at the Workplace andThe Sir Philip Sherlock Distinguished Lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

5th Scientific SessionIntegrated Management of Chronic Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

6th Scientific SessionNutraceuticals in the Management of Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

Caribbean Endocrine Society Concurrent Satellite Symposium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

7th Scientific SessionCornerstones in Diabetes Management and Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

8th Scientific SessionNew Trends in the Treatment of Metabolic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29

9th Scientific SessionNew and Upcoming Trends in the Treatment of Type 2 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

10th Scientific SessionThe Most Hon Hugh Lawson Shearer Memorial Lecture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

West Indian Med J 2011; 60 (Suppl. 1):

11th Scientific SessionTreating Diabetic Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

12th Scientific SessionLandmark in Diabetes Understanding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

Poster Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

4

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General Information

Registration/Information/General Assistance

Registration/Information/General Assistance

Registration Desk (The Conference Reception Area)Thursday, March 29 – Saturday, March 317:30 am – 4:30 pm

Exhibits (The Grande Hall)Thursday, March 29 – Saturday, March 319:00 am – 4:00 pm

Poster Viewing (The Grande Hall)Thursday, March 29 – Saturday, March 319:00 am – 4:00 pm

Judging of Posters (The Grande Hall)Saturday, March 31, 5:00 pm

AudienceThe information presented is directed mainly at the members of the healthcare team but is also designed to facilitate under-standing amongst the general public.

Duality of InterestThe participant (denoted by an asterisk (*) next to his/her name in the programme) has indicated that he/she has a relation-ship which, in the context of his/her participation in this professional education programme, could be perceived to representa relevant duality of interest. The relationship is between the participant and a pharmaceutical company, biomedicalmanufacturer, or other corporation whose products or services are directly related to the subject matter of this professionaleducation programme. Relevant dualities include employment by an individual concerned, ownership of stock, membershipon a committee or the board of directors, receiving honoraria or consulting fees, or receiving grants or funds from suchcorporation.

Continuing Medical Education CreditsThe Caribbean College of Family Practitioners recognizes this programme for 14.25 credit hours.


My dear Conferencistas,

The time is here again when we assemble to review what’snew, hear what’s being used by the advanced crew and bidold practices adieu. The University Diabetes Outreach Pro-gramme (UDOP) 2012 promises to take a comprehensiveand holistic approach to the understanding and manage-ment of this condition. We expect to hear of the latestresearch findings in new drugs, neutraceuticals, technolo-gical applications and complementary alternative methodsin the management of diabetes.

This year we celebrate 18 years of staging this con-ference and this is within the context of our island’s 50th

anniversary of independence. We are proud that we havebeen able to keep the ‘show’ on the road and to maintainrelatively high standards, earning us the title of the largestand the best medical conference in the Caribbean. We con-tinue to evolve and the programme also takes on newapproaches from year to year.

In addition to the Sir Alister McIntyre and the SirPhilip Sherlock distinguished awardees and lectures, theMost Hon Hugh Lawson Shearer Memorial lecture is nowembodied within the sessions and for the first time we areintroducing the Landmark lecture, which yours truly willdeliver.

For the first time too, we are able to acknowledge agold sponsor in Merck Sharp and Dohme pharmaceuticalcompany. It is more liaisons like these that are needed toreally put the conference on a more sustainable path.

We have listened to your comments and do endeav-our to reduce the sessions so as to allow for greater net-working and an earlier closure each day.

The objectives of this conference, under the theme‘New Frontiers in Diabetes Management’ are:

C To update the healthcare team on the new drugsentering the marketplace.

C To review a number of alternative approacheswhich have been scientifically appraised.

C To assess the full spectrum of the pathology thatunderlies the diabetes process.

C To review the latest in technology support in themanagement of diabetes.

As such there is something for everyone … from themembers of the healthcare team (inclusive of persons withdiabetes) to the family, friends and support groups in thewider community.

For the young at heart, there is the social programmewhich never fails to excite and involve much participation,culminating in the ‘Saturday nite fling’. That is followedby the early Sunday morning walk/run, and this year weintend to expand it with the participation of some of ourhigh profile athletes and ensure we make the statement ofthe role in exercise in managing the condition.

And so we look forward to another few days of goodcamaraderie, learning and networking.

See you March 29 – April 1.

One “luv” and WALK GOOD!

Professor the Hon Errol Morrison, OJDirector, University Diabetes Outreach Programme(UDOP)

FOREWORD


MESSAGE FROM THE EDITOR-IN-CHIEF


The Editorial Board of the West Indian Medical Journalwishes to congratulate the University Diabetes OutreachProgramme on its 18th Annual International Conference.The theme this year is New Frontiers in DiabetesManagement and the conference deals appropriately withethnomedicine and some of the ancient healing arts as wellas more modern treatment modalities. The elderly repre-sent a significant proportion of the Caribbean populationand it is salutary to see diabetes care in the elderly beingaddressed in the Hugh Lawson Shearer DistinguishedLecture.

The Journal wishes the conference organizers andcollaborators success in this endeavour to further educatepatients and healthcare practitioners on this very commonchronic disease – diabetes.

Professor Everard N BartonEditor-in-ChiefWest Indian Medical JournalFaculty of Medical SciencesThe University of the West Indies, Kingston 7Jamaica, West Indies

WELCOMES YOU


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

Acknowledgements and Exhibitors


Alverston Bailey, MB, BS, MROAssociate ProfessorOccupational HealthSchool of Public Health and Health TechnologyUniversity of Technology, Jamaica

Perceval Bahadosingh, PhDTechnical DirectorBio-Tech R&D InstituteJamaica

Michael Banbury, MB, BSPhysicianMedical Associates Hospital andMedical CentreJamaica

Alberto Barceló, MD, MScAdvisor on Non-communicable DiseasesPan American Health OrganizationWashington, DC, USA

Brian Berman, MDProfessor, Family and Community MedicineDirector, Centre for Integrative MedicineUniversity of Maryland School of MedicineUSA

Owen BernardMSSCh, MBChA, Dip Crys, MHPC (UK)Executive DirectorDiabetes Association of JamaicaJamaica

Michael Boyne, MD, FRCP (C)EndocrinologistTropical Metabolism Research UnitThe University of the West IndiesMona, Kingston 7, Jamaica

Lenore T Coleman, Pharm D, CDEPresident and FounderHealing Our Village Inc, USA

Sonia Davidson, MB, BS, DPHWellness Institute forAllied Health and WellnessCollege of Health SciencesUniversity of Technology, Jamaica

Winston Davidson, MD, DTM&H (Liverpool)Head, School of Public Health andHealth TechnologyUniversity of Technology, Jamaica

Jennifer EllisHuman Resource ManagerUniversity of Technology, Jamaica

The Most Hon Denise Eldemire-ShearerMB, BS, PhDWHO/PAHO Collaborating Centre onAgeing and Healthc/o Department of Community Health and PsychiatryThe University of the West IndiesMona, Kingston 7, Jamaica

The Hon Fenton FergusonMinister of HealthMinistry of HealthJamaica

James R Gavin III, MD, PhDCEO and Chief Medical OfficerHealing Our Village, IncClinical Professor of MedicineEmory University School of MedicineNational Programme DirectorHarold Amos Medical Faculty Development ProgrammeChairman of the BoardPartnership for a Healthier America, Inc, USA

Patrick HyltonGroup Managing DirectorNational Commercial BankJamaica

Speakers and Faculty

11

Beverley King, RN, MScActing HeadSchool of NursingCollege of Health SciencesUniversity of Technology, Jamaica

Glen Lalljie, MDConsultant CardiologistCoastal Internal Medicine and CardiologyMontego Bay, Jamaica

Lurline Less, BSc, MPhilChairmanNorth American and Caribbean RegionInternational Diabetes Federation, BrusselsExecutive ChairThe Diabetes Association of JamaicaJamaica

Henry Lowe, CD, JP, PhD, FRSHExecutive ChairmanEnvironmental Health FoundationFounder/Executive ChairmanBio-Tech R&D InstituteJamaica

The Hon Dr Wykeham McNeilMinister of Tourism and EntertainmentMinistry of Tourism and EntertainmentJamaica

Luis Mejia, MD, PhDClinical PharmacologistBiochemistry and PharmacologySan Juan Bautista School of MedicinePuerto Rico

The Hon Errol Morrison, OJMD, PhD, FACP, FRCP, FRSM (UK), FRSH, FJIMDirectorUniversity Diabetes Outreach ProgrammePresident, University of Technology, Jamaica

Sebastian Peter, MB, BS, DMEndocrinologistBahamas

Dalip Ragoobirsingh, PhD, FRSPHProfessor of Medical Biochemistry and DiabetologyDirector, UWI (Mona) Diabetes Education ProgrammeHead, Biochemistry SectionDepartment of Basic Medical SciencesThe University of the West IndiesMona, Kingston 7, Jamaica

E Albert Reece, MD, PhD, MBAVice President for Medical AffairsUniversity of MarylandJohn Z and Akiko K Bowers Distinguished Professor andDean, University of MarylandSchool of Medicine, Maryland, USA

Cliff Riley, PhDAssociate DeanCollege of Health SciencesUniversity of Technology, Jamaica

Daniel Sarpong, PhDJackson State UniversityJackson, Mississippi, USA

Alan Shuldiner, MDAssociate Dean and DirectorProgramme in Personalized and Genomic MedicineDirector of the Division of Endocrinology,Diabetes and MetabolismUniversity of Maryland School of MedicineMaryland, USA

Cecil White, JP, BSc, MBA, PMPVice Pesident – OperationsNational Health Fund (NHF)Jamaica

Janice Wissart, BSc, MPhil, MATCollege of Health SciencesUniversity of Technology, Jamaica

Rosemarie Wright-Pascoe, MB, BS, DM, FACP, FRCP(UK)Senior LecturerDepartment of MedicineThe University of the West IndiesMona, Kingston 7, Jamaica

Donna-Marie Wynter-Adams, BSc, MPhilPhD candidateCollege of Health SciencesUniversity of Technology, Jamaica


CARES – Caribbean Endocrine Society

DM – Diabetes Mellitus

EHF – Environmental Health Foundation

NHF – National Health Fund

UDOP – University Diabetes Outreach Programme

WIMJ – West Indian Medical Journal

Abbreviations Used in Text


Thursday, March 29, 2012

7:30 am – 11:00 am REGISTRATION

OPENING CEREMONY

10:45 am – 11:00 am Welcome Professor the Hon Errol Morrison, OJ

11:00 am – 11:15 am Opening Remarks Patrick Hylton

11:15 am – 11:45 am Keynote Address The Hon Dr Wykeham McNeil

1st SCIENTIFIC SESSION

Sponsor: University ofTechnology,Jamaica (UTech)

The Sir Alister McIntyreDistinguished Award

11:45 am – 12:00 noon Citation E Albert Reese

Presentation of Plaque Sir Alister McIntyre

12:00 noon – 12:45 pm Sir Alister McIntyre Brian BermanDistinguished Lecture“Integrative practices for diabetesmanagement”

12:45 pm – 2:00 pm LUNCH AND VIEWING OF EXHIBITS

2nd SCIENTIFIC SESSIONSponsor: National Health

Fund (NHF)

Indicators for Susceptibilityto Diabetes Mellitus Chair: Cecil White

2:00 pm – 2:20 pm NHF performance review Cecil White

Programme

14

2:20 pm – 3:00 pm The new genomic science andimplications for diabetes care Alan Shuldiner

3:00 pm – 3:30 pm COFFEE AND VIEWING OF EXHIBITS(coffee break sponsored by Organo Gold)

3rd SCIENTIFIC SESSIONSponsor: Wellness Institute

School of Allied Healthand Wellness, College ofHealth Sciences, UTech

Roundtable – The Natural Path and Chronic Disease:The Rise of the Ancient Healing Arts

Chair: Sonia Davidson

3:30 pm – 4:30 pm Naturopathy, Oriental, energyand herbal medicine

Panel: Derek Senior, Rupika Delgoda,Cherri Taylor, Tracy Ann Brown

5:00 pm – 7:00 pm WELCOME COCKTAIL

Friday, March 30, 2012

4th SCIENTIFIC SESSIONChair: Jennifer Ellis

9:00 am – 9:30 amOpening of Satellite Conferenceon Wellness at the Workplace

Keynote Address The Hon Dr Fenton Ferguson

Satellite Symposium resumes in the Portland Ballroom A

Sponsor: EnvironmentalHealth Foundation(EHF)

The Sir Phillip Sherlock DistinguishedLecture

Chair: Alverston Bailey

9:30 am – 9:40 am Citation

15

9:40 am – 10:30 am The Sir Phillip Sherlock Distinguished Henry LoweLecture

“Anti-diabetic Caribbean plants:Natural remedies and their futurepotential role in diabetes management”

10:30 am – 11:00 am COFFEE AND VIEWING OF EXHIBITS

5th SCIENTIFIC SESSIONSponsor: Pan American Health

Organization (PAHO)

Integrated Management of ChronicDiseases

Chair: Lurline Less

11:00 am – 11:30 am Improving chronic illness care Alberto Barceló

11:30 am – 12:00 noon Chronic disease electronic Cecil Pollardmanagement system

6th SCIENTIFIC SESSION

Sponsor: Bio-Tech R&DInstitute

Nutraceuticals in the Managementof Diabetes

Chair: Cliff Riley

12:00 noon – 12:30 pm Impact of nutraceutical products on global Winston Davidsonhealth trends: A public health perspective

12:30 pm – 1:00 pm Hypoglycaemic properties of Bixa orellana Perceval Bahadosingh(annatto) extract: Exploitation for its usein diabetes management

1:00 pm – 2:30 pm LUNCH

Wound Care Workshophosted by Baptist Health South FloridaGrande 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

2:00 pm – 2:10 pm Welcome and Remarks Michael Boyne

16

SESSION 1 Frailty and Sex Hormone Replacement

Chair: Michael Boyne

2:10 pm – 2:45 pm Frailty: a new endocrine disorder? Anne Cappola

2:45 pm – 2:55 pm Question and answer period

2:55 pm – 3:10 pm Hormone replacement therapy: Diane Hislop-ChestnutWhich woman and what regimen?

3:10 pm – 3:25 pm Testosterone replacement and late-onset Marshall Tulloch-Reidhypogonadism


3:35 pm – 4:00 pm COFFEE BREAK

SESSION 2 Vitamin D and Thyroid Disease in the Elderly

Chair: Michael Banbury

4:00 pm – 4:20 pm Vitamin D deficiency: Nicole TilluckdharryWhat do the new guidelines say?

4:20 pm – 4:40pm Subclinical thyroid disease: Anne CappolaA common problem in the elderly


SESSION 3 Clinical Corner

Chair: Patrice Francis

5:10 pm – 5:25 pm Prevention of diabetes Type 2 in Marilyn C MosesCuraçao: When and where do we start?

5:25 pm – 5:40 pm A child diagnosed with congenital Stephanie Clato-Day Scarlettadrenal hyperplasia

5:40 pm – 5:50 pm Vote of thanks and closure of conference Carlisle Goddard

7th SCIENTIFIC SESSIONSponsor: College of Health Sciences,

University of Technology,Jamaica

Cornerstones in Diabetes Managementand Diagnosis

Chair: Beverley King

17

2:30 pm – 2:50 pm Current approaches and techniques Janice Wissartin the diagnosis and management ofdiabetes mellitus

2:50 pm – 3:20 pm Sound brain in a sound body: Donna-Marie Wynter-Adamsthe neuroscience of wellness

3:20 pm – 3:40 pm Community empowerment on diabetes Lurline Lessthrough diabetes self-managementtraining programme

3:40 pm – 4:00 pm Pharmaco-economic burden of diabetes Daniel Sarpongmellitus: Applications and methods

4:00 pm – 5:00 pm VIEWING OF EXHIBITS

Saturday, March 31, 2012

8th SCIENTIFIC SESSIONNew Trends in the Treatment ofMetabolic Syndrome

Chair: Rosemarie Wright-Pascoe

9:00 am – 9:40 am Challenges in lipid management – Glen LalljeAchieving more intensive treatmentgoals

9:40 am – 10:00 am Biology of incretins: Physiology Luis Mejiaand pharmacology

9th SCIENTIFIC SESSIONNew and Upcoming Trends in theTreatment of Type 2 Diabetes


10:00 am – 10:40 am The role of incretin physiology in Michael Boyneglucose metabolism

10:40 am – 11:00 am Lipid abnormalities in patients with Luis Mejiachronic kidney disease

Presentation to Gold Sponsor – Merck Sharpeand Dohme

11:00 am – 11:30 am COFFEE AND VIEWING OF EXHIBITS

18

10th SCIENTIFIC SESSIONSponsor: The Hugh Lawson

Shearer FoundationChair: Alverston Bailey

The Most Hon Hugh Lawson ShearerMemorial Lecture

11:30 am – 12:30 pm Diabetes in older persons The Most Hon Denise Eldemire-Shearer

12:30 pm – 2:00 pm LUNCH

11th SCIENTIFIC SESSIONTreating Diabetic Complications

Chair: Sebastian Peter

2:00 pm – 2:30 pm The link between diabetes Lenore Colemanand heart disease

2:30 pm – 3:00 pm Strategies to improve medication Lenore Colemanadherence

3:00 pm – 4:00 pm VIEWING OF EXHIBITS

12th SCIENTIFIC SESSION The Hon Errol Morrison Distinguished Lecture

Landmark in Diabetes Understanding

Chair: Dalip Ragoobirsingh

4:00 pm – 5:00 pm The unitarian hypothesis of the aetiology Prof The Hon Errol Morrison, OJof diabetes mellitus

Report on Judging of PostersJudges: Professor E Albert Reece,Dr Alverston Bailey and Professor Dalip Ragoobirsingh

6:00 pm COCKTAILS

10:00 pm – 2:00 am Reggae-Soca PartyGrande Hall, Sunset Jamaica Grande Resort, Ocho Rios

Sunday, April 1, 2012

Sponsor: Splenda/Victoria MutualBuilding Society/UTechRoad to Olympic Glory

Chair: Owen Bernard

6:30 am FUN-RUN-WALK


Integrative Practices for Diabetes Management

The rising tide of Type 2 diabetes incurs an unacceptablehuman and societal toll throughout the world. Research hasrevealed that healthy lifestyle practices can prevent thedevelopment of Type 2 diabetes and that control of bloodpressure, blood sugar levels and lipids improves outcomesof the disease. Nevertheless, the worldwide incidence ofType 2 diabetes continues to increase and management ofthe disease with current medical treatments is suboptimal,particularly among persons of low socio-economic statusand minority populations. A more comprehensive treat-ment approach and creative preventive solutions for thispublic health crisis are necessary. The practice of integra-tive medicine appears to be one such solution, as this styleof medicine offers an expansive set of evidence-basedmodalities that are known to aid both the prevention andtreatment of Type 2 diabetes. Integrative therapies such asnutraceuticals, therapeutic diets, herbs and spices, andmind-body modalities are successfully being used in boththe prevention and treatment of Type 2 diabetes with

increasing frequency. This presentation will focus uponrecent evidence that demonstrates how the intertwining ofpersonalized medicine, healthy behaviours and integrativetreatment modalities can reduce the tremendous burden ofType 2 diabetes.

Previous AwardeesProf Jean-Philippe Assal (Switzerland) 1999Prof Harry Keen (UK) 2000Prof Jasbir Bajaj (India) 2001Prof Phillip James (UK) 2002Dr Richard Kahn (USA) 2003Dr James Gavin III (USA) 2004Dr Alexander Kalache (Brazil) 2005Dr Jean Yan (Switzerland) 2006Prof Jean-Marie Ekoe (Canada) 2007Dr Alberto Barcelo (USA) 2008Dr Robert Gallo (USA) 2009Dr Prakash Gupta (India) 2010Prof Lloyd Johnston (USA) 2011

1st Scientific Session: The Sir Alister McIntyre Distinguished Lecture

Sir Alister McIntyre Distinguished Awardee for Integrative MedicineBrian Berman

Chair: Errol Morrison


NHF Performance ReviewCecil White

In 2003, the government of Jamaica established theNational Health Fund (NHF) as an additional mechanism tofund healthcare. The NHF provides drug subsidies andother direct forms of assistance to beneficiaries; grant fund-ing to institutions for approved projects, and health infor-mation to promote healthy lifestyle behaviours. This paperwill examine the NHF’s intervention, and review its inter-vention in the treatment of chronic diseases over the pasteight years. It will outline the framework of the NHFmodel, provide an overview of the financing mechanism,and review the healthcare spending experience. Specialemphasis will be placed on the NHF’s involvement in thetreatment of and the support provided for diabetes mellitus.The paper will conclude with the description of a study thatwas designed to examine the impact of an NHF programmethat provides support for diabetics.

The New Genomic Science and Implications forDiabetes CareAlan Shuldiner

Advances in knowledge of sequence variation across thehuman genome have provided unprecedented opportunitiesfor the discovery of the genetic underpinnings of diabetesand related disorders. To date, causative variants in genesfor more than a dozen monogenic syndromes of diabetesare known. Common susceptibility variants are known formore than 40 loci for Type 2 diabetes and 50 loci for Type1 diabetes. Some of these loci have unveiled novel targetsfor the design of new drugs. In addition, decreasing costs ofhigh-throughput genomic technologies have made possiblewhole genome genotyping and sequencing of DNA fromindividual patients, which will allow physicians to betterpredict individual disease risk as well as responses to med-ications, diet and lifestyle interventions. This presentationwill review the rapidly advancing field of genomic and per-sonalized medicine, and how implementation of this newknowledge may be used to individualize patient care toimprove treatment and prevention of diabetes and relateddisorders.

2nd Scientific Session

Chair: Cecil White

Indicators for Susceptibility to Diabetes Mellitus


Naturopathy, Oriental, Energy and Herbal MedicinePanellists: Derek Senior, Rupika Delgoda, Cherri Taylor,Tracy Ann Brown

International health policy-makers have proposed 25parameters of quality of life, with which a country’s healthstatus should be evaluated. The proposal is based on a con-cern that the fact of more people living longer does not givethe whole picture. How people are utilizing the additionalyears is also important.

The ageing populations are experiencing an increasein health conditions usually associated with ageing butwhich have their genesis through the life cycle. Chronic,non-communicable, lifestyle related diseases such ashypertension, diabetes, heart disease, arthritis and cancerdominate and take a great toll on quality of life.

The concept of wellness has emerged as a distinctidentity as increasing numbers of research findings provid-ed the evidence for the multi-factorial nature of diseaseoccurrence. Seven to eight influences of wellness calleddimensions, were identified as physical, mental (intellectu-al) emotional, environmental, occupational, financial,social and spiritual. In identifying these dimensions, healthprofessionals are being asked to take into consideration thetotal person when evaluating health status and managingpatients.

Wellness philosophy reinforces the need for a teamapproach to ensuring human well-being. Wellness placesself-responsibility and self-care high on the agenda ofhealthcare. It also emphasizes the proactive approachthroughout the continuum of the natural history of any dis-ease and it introduces gender-specific and age-specificinterventions. Domains such as the family, domicile,school, workplace, media, places of worship, retirementvillages, assisted living, penal and special needs institutionsrequire tailored approaches to wellness interventions.Health institutions worldwide are re-orienting themselvesto become wellness facilitators and coaches rather than dis-pensers of care. In that respect they have been reaching outto cultures that have had a tradition of healthcare whichemphasizes self-reliance and addresses the whole person:mind, body and spirit. The general public, by its increasedutilization of ancient unconventional healing practices, isindicating to mainstream medicine that it requires morethan is currently being offered by it. This panel will exam-ine some of the issues which influence this demand andprovide a synopsis of the contribution of disciplines fromfour major categories.

3rd Scientific Session

Roundtable – The Natural Path and Chronic Disease:The Rise of the Ancient Healing Arts

Chair: Sonia Davidson


Anti-diabetic Caribbean Plants: Natural Remedies andtheir Future Potential Role in Diabetes ManagementHenry Lowe

Diabetes mellitus is one of the commonest diseases affect-ing citizens of both the developed and developing coun-tries. The International Diabetes Federation estimates that194 million people live with diabetes worldwide, account-ing for 5.1% of the adult population and it is projected toaffect 333 million persons by 2025. In Jamaica, there areabout 400 000 people suffering from diabetes with a result-ant high mortality rate. The disease, which is characterizedby hyperglycaemia, is also an important factor in accelerat-ing cardiovascular and cerebrovascular associated diseasesand other long-term complications including retinopathy,nephropathy and peripheral and autonomic neuropathy.

The increasing prevalence of diabetes and associatedcomplications not only present significant socio-economicconcerns, but significant challenges for the medical and sci-entific community to provide effective management of thedisease. Additionally, the aetiology and pathophysiologyleading to hyperglycaemia is markedly different among pa-tients with diabetes, which therefore dictates different pre-vention strategies, diagnostic screening and treatmentmethods, which can ultimately reduce the economic burdencaused by this disease.

While much scientific research has been done ondietary management of the disease, traditional medicinesusing herbals have historically been widely used in all cul-tures and despite the significant growth in modern pharma-ceuticals to treat diabetes, these traditional medicines con-tinue to play a significant role in diabetes management. Inrecent years, there has been a resurgence of interest inphyto-medicines and their synthetic alternatives for thetreatment of diabetes not only by academic research scien-tists, but also by the pharmaceutical industry.

Most of these plants have been scientifically valida-ted through research carried out by the leading universitiesin the Caribbean which has revealed that some plants havesignificant positive bioactivity for the treatment of hyper-glycaemia. Examples include Bixa orellana (annatto),Capsicum frutescent (bird pepper), and Dioscorea poly-gonoides (bitter yam). However, most of these scientificbreakthroughs have never been commercialized asnutraceuticals or pharmaceuticals and remain only in thescientific literature.

As a result of this, an extensive literature review hasbeen done and we have compiled all the Caribbean folkloreplants with proven efficacy, based on scientific research,used for the treatment of diabetes. We anticipate that thisresearch will serve as a reference to clinicians and scientiststo expand the research and development of these plants forcommercial drugs and pharmaceuticals for diabetes man-agement. In addition, researchers may utilize this databaseto scientifically investigate those plants for possible valida-tion as practical medication for the management of thisdisease.

Previous Awardees:Prof Rolf Richards (Jamaica/Trinidad) 2000Prof David Picou (Jamaica/Trinidad) 2001Prof Sir George Alleyne, OCC (Jamaica/Barbados) 2002Prof Rene Charles (Haiti) 2003Dr Compton Seaforth (Trinidad) 2004Ron Raab (Australia) 2005Dr Knox Hagley (Jamaica) 2006Prof Lawson Douglas (Jamaica andand Prof George Nicholson (Barbados) 2007Dr Winston Davidson (Jamaica) 2008and Jean-Claude Mbanya (Cameroon) 2009The Rev Ronald Thwaites (Jamaica) 2010Prof Edward Greene (USA) 2011

4th Scientific Session


The Sir Philip Sherlock Distinguished Award


Improving Chronic Illness CareAlberto Barceló

The Chronic Care Model (CCM) is a basic, yet comprehen-sive system for organizing chronic disease care that ispatient-centred as well as evidence and population-based.The CCM has been successfully applied in strategies toorganize and improve chronic care in developed and devel-oping countries. This presentation outlines updates on theapplication of the CCM across the Americas as well as theprogress of the Caribbean Quality of Diabetes CareImprovement Project. This project is an application of theCCM in 10 Caribbean countries (142 centres providingcare for more than 40 000 patients), based on a collabora-tive methodology throughout learning sessions with healthproviders. The project is being implemented in Anguilla,Antigua, Barbados, Belize, Guyana, Grenada, Jamaica, StLucia, Suriname and Trinidad and Tobago. The objectiveof the Caribbean Quality of Diabetes Care ImprovementProject is to strengthen the capacity of health systems andcompetencies of the workforce for the integrated manage-ment of chronic diseases and their risk factors. The projectpromotes the integrated management of chronic diseaseswith a preventive focus, based on equity, the participationof the individual, his or her family, and the community todeveloping resources trained in chronic care and qualityimprovement programmes. Providing tools to health pro-viders and patients is an important part of this project. Onesuch example is the Chronic Care Passport, a patient-heldcard containing a care plan, healthy lifestyle advice, a per-sonalized healthy meal plan and preventive measures forcardiovascular disease, among others.

Chronic Disease Electronic Management SystemCecil Pollard

One of the most well-known clinical information systems,the Chronic Disease Electronic Management System(CDEMS), has been successfully used to improve care forchronic conditions such as diabetes, asthma, congestiveheart failure, depression and geriatrics in more than 300healthcare organizations in the United States of America(USA). The CDEMS is an open-source public domain reg-istry that was first released in 2002. The CDEMS is usedby community health centres, primary care practices, ruralclinics and hospitals.

The benefits of CDEMS are:C User-friendly, no cost transition tool for electronical-

ly monitoring chronic disease healthcareC consistent, standardized organization of patient/pop-

ulation dataC can be easily customized for individual providers or

clinicsC healthcare planning for individual patients with time-

ly reminders for patients and providersC population-based analysis of care for patients with

chronic conditions; improved, proactive patient careC gaps in care identified for action; performance

tracked for practice team and care systemC simple templates for custom reports creation by med-

ical staff; outcomes documented for measuring qual-ity improvement, quality certifications, pay-for-per-formance reimbursements, grant utilization

C user owns dataThis presentation will outline the main characteristics

and benefits of using CDEMS. The presenter will make ademonstration of how CDEMS can be downloaded fromthe internet, customized and used to monitor patients withchronic conditions.


Chair: Lurline Less

Integrated Management of Chronic Diseases


Impact of Nutraceutical Products on Global HealthTrends: A Public Health PerspectiveWinston Davidson1, Perceval S Bahadosingh2,3,4, Cliff KRiley1, Errol St A Morrison1, Henry IC Lowe1,2,3,4,51College of Health Sciences, University of Technology,Kingston, Jamaica, 2Bio-Tech R&D Institute, 3Environ-mental Health Foundation, 4The University of the WestIndies, Kingston, Jamaica and 5University of Maryland,USA

The rising prevalence of chronic non-communicable dis-eases, globally, has prompted people of all ages to exploreand embrace healthier lifestyle options inclusive of compli-mentary/alternative remedies. This has resulted in a signi-ficant increase in the production, development and use ofnutraceutical products to treat/prevent diseases and main-tain good health. Additionally, it has been reported thatover 66% (200 million) of people living in the UnitedStates of America (USA) use at least one type of nutraceu-tical health product on a regular basis.

The use of nutraceuticals as a means to deliver nutri-tional and medicinal benefits has earned tremendous mon-etary and health successes globally. The value of thenutraceutical market in the US is over $86 billion with theEuropean, Japanese and Chinese markets slightly higher.Furthermore, the global nutraceuticals market is projectedto exceed US$243 billion by 2015. This is primarily driv-en by consumer demands and increasing scientific evidencesupporting nutraceutical products. Additionally, risinghealthcare costs, ageing population and growing beautyaffixations are expected to stimulate continued growth inthe nutraceutical market.

This implies that there is great dependency on nutra-ceutical products as persons become more health con-scious, out of a desire to improve and extend their lives.However, this growing trend has implications on publichealth and must be addressed or evaluated urgently. Rigo-rous scientific evaluations must be done to ensure that thecorrect dosage is determined to minimize the risk ofadverse side effects and at the same time provide optimumefficacy towards the particular health concern.

Hypoglycaemic Properties of Bixa orellana (Annatto)Extract: Exploitation for its Use in DiabetesManagementPerceval Bahadosingh1,2,3, Henry IC Lowe1,3,4, CliffRiley4, Andrew Wheatley2, Errol St A Morrison41Bio-Tech R&D Institute, 2Biotechnology Centre, TheUniversity of the West Indies, Kingston, Jamaica,3Environmental Health Foundation and 4College of HealthSciences, University of Technology, Kingston, Jamaica

Studies have revealed that Bixa orellana (annatto) crudeextract has significant hypoglycaemic properties with amechanism of action similar to that of sulphonylureas. Thehypoglycaemic activity resulting from the non-polar extractwas demonstrated in streptozotocin-induced diabetic dogsat a dosage of 80 mg/kg body weight. Reduction in plasmaglucose, glucagon and C-peptide levels as well as anincrease in insulin sensitivity were reported. Owing to this,a solid dosage nutraceutical product supplemented with keyminerals and vitamins was developed to aid in the manage-ment of hyperglycaemia in diabetic individuals. Extensivebiochemical analyses have demonstrated that the supple-ment significantly reduces blood glucose levels in normo-glycaemic individuals and therefore may be useful in per-sons affected with insulin resistance and hyperglycaemia.

CARES SYMPOSIUMFrailty: A New Endocrine Disorder?Anne Cappola

The frailty syndrome represents a condition of extreme vul-nerability to external stressors that places individuals athigh risk for morbidity, mortality and functional decline.We have studied the relationship between hormonal abnor-malities and frailty using a standardized definition thatincludes parameters of unintentional weight loss, exhaus-tion, weakness, slowness and low physical activity. I willpresent data that suggest dysregulation across multiple hor-monal axes in the frailty syndrome, which poses therapeu-tic challenges to designing hormonal interventions forfrailty. The type of intervention may also differ based onwhether the treatment goal is to prevent frailty in those atrisk (the prefrail) or to improve the status of those who are


Chair: Cliff Riley

Nutraceuticals in the Management of Diabetes

25

already frail. The future of therapeutics in the frailty syn-drome will be discussed.

Hormone Replacement Therapy: Which Woman andWhat Regimen?Dianne Hislop-Chestnut

Hormone replacement therapy (HRT) has been used to treatthe vasomotor symptoms of menopause for decades. Up tothe 1990s, it was also used to modify the cardiovascularrisk in postmenopausal women. However, since theWomen’s Health Initiative (WHI) Study, which showed thatHRT has potential adverse cardiovascular effects, many cli-nicians and women have shied away from using HRT. Thispresentation will briefly outline the biological effects ofoestrogen deficiency including the climacteric symptoms.It will discuss the potential benefits of HRT in reducing theoccurrence and severity of these symptoms protectingagainst other age-related disorders such as osteoporosis.The presentation will also examine the risks of HRT includ-ing the risks of breast cancer, cardiovascular disease andstroke. Within the context of these potential benefits andrisks, the presentation will identify which women should beconsidered for HRT, which form of HRT is most suitablefor particular patients and alternatives to HRT.

Testosterone Replacement and Late-onsetHypogonadismMarshall Tulloch-Reid

There is an increase in the prevalence of hypogonadism inmen as they age, with one study reporting that 50% of menin their 80s had low serum testosterone concentrations.The diagnosis of late-onset hypogonadism can be difficultto make in elderly men because of the increase in sex hor-mone binding globulin concentration that occurs with age-ing (resulting in higher concentrations of total serum testos-terone) and the lack of reliable commercial assays formeasuring the metabolically active free testosterone.

The hypogonadal state results in changes in bodilyfunction typically associated with ageing. These includereduced sexual function, bone mineral density, musclemass, muscle strength, cognitive function and a worseningcardiovascular risk profile. It is therefore not surprisingthat testosterone therapy has been considered as one meansof reversing the physiological changes that accompany age-ing in men. However, evidence to support the routine useof testosterone in asymptomatic older men with low or lownormal serum testosterone is weak, and comes mainly fromsmall clinical trials, which have utilized variable inclusioncriteria and differing testosterone treatment regimens.

In this presentation, an approach to diagnosing late-onset hypogonadism in the elderly man will be reviewed

and the latest recommendations for testosterone replace-ment therapy in this population will be discussed.

Vitamin D Deficiency: What Do the New GuidelinesSay?Nicole Tilluckdharry

Vitamin D deficiency is very prevalent worldwide, and islinked to several chronic, inflammatory and autoimmunediseases including diabetes and cancer. It is not clear howcommon it is in Caribbean populations, but the prevalencemay be low. However, certain groups may be at high riskeg the elderly, hospitalized patients, institutionalized per-sons and individuals who already have chronic illnesses.

Measurement of serum 25-hydroxyvitamin D con-centration is probably the best method to make the diagno-sis, although there has been controversy about the cut-offvalue. More studies are needed in the Caribbean to quanti-fy the possible effects of vitamin D levels on chronic dis-eases that are hypothesized to be associated with vitamin Ddeficiency. The most recent consensus guidelines by theEndocrine Society about prevention by nutrition, and treat-ment of deficiency using supplements will be discussed inthis lecture.

Subclinical Thyroid Disease: ACommon Problem in theElderlyAnne Cappola

Subclinical thyroid dysfunction is found in up to 15% ofpeople aged 70 years and older. Controversy surrounds theissue of whether untreated subclinical thyroid dysfunctionhas sufficiently important and reversible consequences inthe elderly to justify screening and treatment. It has beensuggested by some that the reference range should beadjusted in older adults, whereas others advocate universalscreening and treatment using the current range. An updateof recent findings in the field and a management strategywill be provided.

Prevention of Diabetes Type 2 in Curaçao: When andWhere Do We Start?Marilyn C Moses

Curaçao is one of the largest Leeward Antilles in theCaribbean with a population of approximate 140 000.Obesity, the main cause of Type 2 diabetes, is growingworldwide at a high rate and consequently the Type 2 dia-betes patient group will only become larger.

With the ageing of Curaçao’s population, 30% of thepopulation having an income below the poverty level andCuraçao being in the world’s top three countries with the

26

A Child Diagnosed with Congenital AdrenalHyperplasiaStephanie Clato-Day Scarlett

A 10-year five-month old male child was diagnosed at agesix weeks with congenital adrenal hyperplasia (CAH) – saltwasting form. He is also known to be asthmatic.

Maintenance medications were cortisone acetate, flu-drocortisone and 6% NaCl, Ventolin MDI and BecotideMDI. He had been hospitalized for urinary tract infectionat two months of age, bronchiolitis at four months of age,tuberculosis at eight years.

Despite adequate nutrition and relative control of hisCAH, his weight and height remained below the 3rd per-centile.

The presentation will seek to:C Put his height into perspective taking account of

his medical issuesC Outline the steps taken to investigate his

growth/short statureC Explore treatment options currently available to

him, if any. Growth hormone therapy – to treat ornot to treat?

most dialysis patients per million inhabitants, it is impor-tant that measures be taken not only to reduce the costs ofthe healthcare system of Curaçao but also to improve thequality of life of the population.

Prevention is still to be given more prominence onthe agenda of the Curaçao government. In the older dia-betes patients, primary prevention is not possible anymore,although in some cases with some effort diabetes in anearly stage can be cured. Prevention of obesity is not mere-ly raising awareness. All efforts in Curaçao to fight obesi-ty in adults up till now have failed. Already we are con-fronted with its legacy leaving us another health problem,which is obesity in children.

For successful obesity prevention, risk factors needto be identified and assessed periodically. The interven-tions need to be tuned to the needs and possibilities of theindividual and his/her direct environment. The interven-tions need to apply strategies to guarantee sustainability ofthe achieved result and healthcare providers involved in theactivities need to have good collaboration with the familyphysician.


Current Approaches and Techniques in the Diagnosisand Management of Diabetes MellitusJanice Wissart

The diagnosis of diabetes mellitus (DM) is established bydirect demonstration of hyperglycaemia under defined con-ditions. For many years, measurement of fasting blood glu-cose (FBG) or the performance of an oral glucose tolerancetest (OGTT) were the recommended methods for thedemonstration of hyperglycaemia. In 2009, the internation-al expert committee on diabetes mellitus also recommend-ed the measurement of HbA1C as a diagnostic measure.

Management of DM involves the achievement of gly-caemic control for the purpose of preventing both acute anddebilitating complications of the disorder. HbA1C contin-ues to be the major indicator of long-term glycaemic statusand a measure of risk for the development of diabetes-relat-ed complications.

The use of portable glucose meters for the measure-ment of blood glucose concentrations added the additionaldimension of ‘self monitoring’ for better management ofpatients with DM. The search for better means of monitor-ing and controlling glycaemia led to the development ofdevices for “continuous” in vivo monitoring of glucoseconcentration. Current real-time devices approved by theFDA include the Guardian Real-Time and the Free-stylenavigator that allows patients to read both current glucoseconcentrations and trends. Emerging technologies includecontinuous non-invasive glucose analyses devices. Geneticand autoimmune markers are not useful in diagnosis andmanagement of DM. Albuminuria, formally calledmicroalbuminuria, is a well established risk marker associ-ated with kidney disease.

Sound Brain in a Sound Body: The Neuroscience ofWellnessDonna-Marie Wynter-Adams

For years, the medical community has focussed on theperipheral and cardiovascular effects of diabetes.In recent times, the ‘light bulb’ has gone off and the centraleffects are being recognized and studied. Diabetes and itsclinical markers, such as use of diabetic medications andduration with the disease, have been linked to impaired

cognitive function and increased risk of Alzheimer’s dis-ease and other types of dementia. Several studies show thatthe effects of diabetes, whether hypoglycaemia or hyper-glycaemia, are more evident in older patients. Studies indi-cate that post-mortem results from Alzheimer’s patientsshow the presence of oxidative metabolic products associ-ated with hyperglycaemia.

A new area of diabetic research is on the neuraleffects of diabetes with the aim of perhaps developing moreeffective medications for the disease. Insulin receptors inthe brain have been shown to play an important role in theregulation of normal glucose functioning. Scientists havediscovered that by enhancing the brain’s normal insulinresponse in the hypothalamus, blood sugar reduction couldbe enhanced and less insulin utilized. Research has alsofound that there is an abnormality in the pain fibre innerva-tion of the pancreas in diabetic rats. Protein from thesepain fibres were used to reverse diabetes in in vivo studies.After spending over JA$4.5 billion on the medication andtests for just over 90 000 beneficiaries with diabetes in theNational Health Fund in 2010 and with an increasing age-ing population, the Jamaican medical community will beeager to understand the neural effects of diabetes and thepossible implications of diabetes on maintaining soundbrain and body.

Community Empowerment on Diabetes throughDiabetes Self-management Training ProgrammeLurline Less, Tamu Davidson Sadler, Ron PageInternational Diabetes Federation – North AmericanRegion, Ministry of Health, Jamaica

Non-communicable diseases (NCDs) account for 63% ofdeaths worldwide with 80% of deaths occurring in low- ormiddle-income countries. Diabetes was the fourth leadingcause of NCD death in 2008, accounting for 1.3 milliondeaths globally. It is one of the major causes of prematureillness and death worldwide. It is estimated that approxi-mately 224 712 (13.6%) Jamaicans between the age group15–74 years have diabetes (Jamaica Health and LifestyleSurvey 2008 using WHO definition).

Diabetes imposes life-long demands on those affect-ed and their families. Persons living with diabetes spendmost of their time in the home, workplace and their com-


Chair: Beverley King

Cornerstones in Diabetes Management and Diagnosis

28

Pharmaco-economic Burden of Diabetes Mellitus:Applications and MethodsDaniel Sarpong

The World Health Organization (WHO) estimates that 346million people worldwide have diabetes mellitus (DM).More than 80% of diabetes-related deaths occur in low- andmiddle-income countries; and diabetes deaths are projectedto double between 2005 and 2030 from the deaths of 3.4million people in 2004. Deaths attributable to DM are 3.8million annually. Diabetes mellitus is a major culprit forcoronary and vascular related morbidities and mortalities.These complications or adverse secondary sequelae of DMcan be prevented or delayed with intensive treatment andglucose control. The economic impact of DM and its com-plications affects individuals, families, health systems andcountries. During the period 2006–2015, WHO estimatesthat China will lose $558 billion in foregone nationalincome due to heart disease, stroke and diabetes. TheUnited States of America (USA) national economic burdenof pre-diabetes and diabetes reached $218 billion ($153 bil-lion in higher medical costs and $65 billion in reduced pro-ductivity) 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 forpre-diabetes (medical costs only). The rising cost of DMcare is unbearable, even for advanced and industrializedcountries and is devastating for poor and/or developingcountries. In the USA, about one in every five healthcaredollars is attributed to DM. In Latin America, families pay40–60% of DM-related costs out-of-pocket.

The gradient of the rising incidence of DM and thecorresponding economic burden adds urgency to the needfor adequate allocation of scarce resources. It is imperativethat those nations greatly impacted by DM derive the bestestimates of its economic burden. The use of pharmaco-economic models on DM offers assistance to pharmacy andtherapeutic (P&T) committees in healthcare systems andpharmacy councils (PCs) of developing countries in mak-ing more informed decisions in terms of drug formulary (oressential drug lists) for the system or country. The deci-sions of the P&T and PCs should be based on the long-termbenefits of reduced micro and macrovascular complicationsand changes in drug utilization patterns and immediatedrug budget impact. Hence, this research paper presentscost-of-illness analysis and cost-effectiveness analysis inassessing the economic burden of DM in both developedand developing countries. Sources of data to compute eco-nomic burden of DM and cost-saving strategies are alsodiscussed.

munities. Therefore, they need to be able to self-managetheir illness by: monitoring their blood glucose, taking theirmedication as prescribed, engaging in physical activity andhealthy eating habits. Outcomes are largely based on thedecisions they take and their environment. It is of para-mount importance that persons with diabetes receive stan-dardized and high quality training to manage their illnessand the community be empowered to provide this support-ive environment.

In light of this, the Diabetes Association of Jamaica,in collaboration with the Ministry of Health, developed atraining programme for community health-workers to betrained as lay diabetes educators and diabetes navigatorsusing a Teach back Training of Trainers (TOT) methodolo-gy. The curriculum includes diabetes medical, lifestylemanagement and psychosocial support. The improvementin diabetes self-management will be evaluated by lookingat patient blood glucose monitoring, eating pattern andphysical activity; the targets are an improvement of 0.6% to1% change in biochemical and 10–15% improvement inother indicators in 12 months.

RESULTSA thirty-nine item questionnaire covering all six modules ofthe trainers manual was used as an evaluation tool to meas-ure any change in knowledge before (Pre-test) and after alltraining workshop (Post-test). This tool was administeredto all categories of trainees – trainers, lay educators and laynavigators.

Mean scores from the post-test for all categories oftrainees showed an improvement to the mean score of theirpre-test. The mean score on the pre-test was 95% while themean score on the post-test was 99% for the training oftrainers. Similar improvement in the mean score wasobserved for both the pre-test (80%) and post-test (90%)for the lay navigators training. Ninety-five per cent of par-ticipants of the lay educators training felt very confidentthat they will be able to use the information covered in thetraining when they returned to their jobs.

Further assessment will look at evaluating theimprovement in diabetes self-management at the end of 12months.


Challenges in Lipid Management: Achieving MoreIntensive Treatment GoalsGlen Lalljie

Statins are very effective lipid-lowering agents. However,randomized controlled trials have shown that regression incoronary atherosclerosis only occurs when low densitylipoprotein (LDL) cholesterol is lowered to < 1.8 mmol/L.In clinical practice, few patients, especially those with dia-betes, achieve such LDL cholesterol levels on statin thera-py, hence atherosclerosis continues to progress.

A more effective lipid-lowering strategy is to treat thetwo main sources of cholesterol simultaneously: productionin the liver – inhibited by statins, and absorption in theintestine – inhibited by ezetimibe. The co-administrationof a statin and ezetimibe provides consistently greaterreduction in LDL cholesterol through dual inhibition ofboth cholesterol production and absorption compared withsingle inhibition of cholesterol production by statin alone.

This strategy may allow more patients to achieveregression of atherosclerosis.

Biology of Incretins: Physiology and PharmacologyLuis Mejia

Type 2 diabetes mellitus (T2DM) develops as a conse-quence of progressive β-cell dysfunction in the presence ofinsulin resistance. None of the currently available T2DMtherapies is able to change the course of the disease by halt-ing the relentless decline in pancreatic islet cell function.Recently, dipeptidyl peptidase 4 (DPP-4) inhibitors, or in-cretin enhancers, have been introduced in the treatment ofT2DM. This class of glucose-lowering agents enhancesendogenous glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) levels byblocking the incretin-degrading enzyme DPP-4. Dipep-tidyl peptidase-4 inhibitors may restore the deranged islet-cell balance in T2DM, by stimulating meal-related insulinsecretion and by decreasing postprandial glucagon levels.Moreover, in rodent studies, DPP-4 inhibitors demonstrat-ed beneficial effects on (functional) β-cell mass and pancre-atic insulin content. Studies in humans with T2DM haveindicated improvement of islet-cell function, both in thefasted state and under postprandial conditions, and thesebeneficial effects were sustained in studies with a durationof up to two years. However, there is at present no evi-dence in humans to suggest that DPP-4 inhibitors havedurable effects on β-cell function after cessation of therapy.Long-term, large-sized trials using an active blood glucoselowering comparator followed by a sufficiently long wash-out period after discontinuation of the study drug are need-ed to assess whether DPP-4 inhibitors may durably pre-serve pancreatic islet-cell function in patients with T2DM.


New Trends in the Treatment of Metabolic Syndrome

Chair: Rosemarie Wright-Pascoe


The Role of Incretin Physiology in Glucose MetabolismMichael Boyne

The elucidation of incretin physiology has led to a newunderstanding of the pathogenesis of Type 2 diabetes.Incretins are hormones from the gastrointestinal tract thatare released in response to meals. Glucagon-like peptide-1(GLP-1) and gastric inhibitory peptide (GIP) are the best-studied incretins and are involved in the regulation of isletfunction. They inhibit glucagon release and potentiateinsulin secretion, which improves glucose homeostasis andreduces hepatic glucose output. Incretins may promotesatiety and thus weight loss through peripheral and centralmechanisms. Gastric inhibitory peptide also has actions onadipose tissue and thus may affect energy storage. Forunclear reasons, the effects of incretins are reduced in Type2 diabetes. Thus, the pharmacological manipulation ofincretin biology, by inhibiting the degrading enzyme ofDPP-4 (dipeptidyl peptidase-4), or by using GLP-1 recep-tor agonists, reduces hyperglycaemia. It is not clear thoughif incretins prevent the natural decline in beta-cell functionthat is characteristic of diabetes, although data from animalexperiments are promising. At present, novel drugs basedon incretin physiology are used for the management ofType 2 diabetes and their role in the treatment of obesity isbeing investigated.

Lipid Abnormalities in Patients with Chronic KidneyDiseaseLuis Mejia

Cardiovascular disease is increased in patients with chron-ic kidney disease (CKD) and is the principle cause of mor-bidity and mortality in these patients. Dyslipidaemia, whilecommon in these patients, is usually not characterized byelevated cholesterol, except in those patients with massiveproteinuria. Qualitatively, increased triglycerides and re-duced high density lipoproteins (HDL) are most frequentlydescribed. Extensive abnormalities in the metabolism ofapolipoprotein (apo) B-containing lipoproteins have beendemonstrated, including those derived from the gut (apoB-48) as well as those derived from hepatic synthesis (apoB-100). Decreased enzymatic delipidation, in addition toreduced receptor removal of these lipoproteins, results inincreased concentrations of these apo B-containing moie-ties, and in particular, their atherogenic remnants.Abnormalities in apo-A-containing lipoproteins are alsopresent and these changes may contribute not only to thelower levels of HDL seen, but also to the proinflammatorystate that is frequently present in CKD patients. As a result,therapeutic strategies designed to modify atherosclerotic-caused outcomes in CKD may require multiple approaches.


New and Upcoming Trends in the Treatment ofType 2 Diabetes



Diabetes in Older PersonsDenise Eldemire-Shearer

Caribbean populations are ageing while experiencing theepidemiologic transition. Issues associated with diabetes inolder persons are of increasing importance given thatincreasing numbers of older persons are living longer withdiabetes and the associated complications. The paper dis-cusses diabetes in older persons and how symptoms andmanagement change with age.

The paper further examines the multiple difficultiesfaced by older persons, families and caregivers due to thecombined additive effects of diabetes, the ageing processand the associated changes accompanying both. Specialattention will be paid to the development of cognitiveimpairment and the role of diabetes in development ofsame. The interplay between diabetes, co-morbidity, poly-pharmacy and social and economic factors will be dis-cussed. Finally, the paper discusses management chal-lenges including self-care and health promotion in olderdiabetics.



The Most Hon Hugh Lawson Shearer Memorial Lecture


The Link between Diabetes and Heart DiseaseLenore Coleman

Cardiovascular disease (CVD) remains the most importantcause of morbidity and mortality in patients with Type 2diabetes. Primary prevention through lifestyle changes re-mains a top priority since there is clear evidence thatpatients with Type 2 diabetes are at increased risk for bothmyocardial infarction and stroke. The data from Haffner etal, looking at 1373 diabetes-free individuals compared to1059 diabetic subjects followed for seven years, clearlydemonstrated that the risk for infarction was similar. Basedon this data, we know that patients with Type 2 diabetesneed to be aggressively managed to achieve evidence basedglycaemic targets.

Increased CVD risk in patients with diabetes is relat-ed to premature and extensive atherosclerosis often involv-ing smaller, more distal vessels. When studied, patientswith diabetes have an increased plaque burden and evi-dence of more vulnerable plaques that are more susceptibleto rupture. In addition, the plaque area is usually occupiedby macrophages with increased T-cell infiltration. Weknow that the pathogenesis of atherosclerosis-related dis-ease in Type 2 diabetes is multifactorial. Dyslipidaemia isstrongly correlated with insulin resistance and hyperinsuli-naemia. Dyslipidaemia should be treated independentlyfrom blood glucose control and in most cases should be theprimary focus in the management of Type 2 diabetespatients with coronary artery disease (CAD).

The major goal of therapy in the management of dys-lipidaemia is the reduction of low density lipoprotein(LDL) cholesterol levels and other apolipoprotein-B con-taining lipoproteins. In most cases, statins are consideredthe drug of choice due to the large number of randomizedclinical trials showing their benefits in reducing both mor-bidity and mortality. These trials have demonstrated theoverwhelming benefits of statins in reducing the incidenceof major CVD events in Type 2 diabetes patients with orwithout established CVD.

After intensive LDL-cholesterol reduction, the nextlipoprotein for intervention is the high density lipoprotein(HDL)-cholesterol. Though the number of randomizedclinical trials (RCT) is lacking to guide with management

of HDL-cholesterol, observational studies have providedevidence of an inverse relationship between HDL levelsand cardiovascular disease. Analyses of the statin trialshave shown that baseline HDL-cholesterol remains animportant predictor of CVD in both placebo and statintreated patients. The most effective drug currently avail-able to increase HDL-cholesterol is niacin. Niacin lowersLDL-cholesterol and triglyceride levels and increasesHDL-cholesterol levels by 20%. Most studies use niacin atdoses of 2 grams per day. Niacin is the only clinicallyavailable drug that lowers lipoprotein (a) levels. Unfor-tunately, the use of niacin is limited due to its poor tolera-bility and propensity to cause flushing. The extendedrelease form of niacin is better tolerated.

When considering the use of combination therapy forthe management of lipids in people with Type 2 diabetes,there are limited data. There are published studies lookingat the combination of fenofibrate/simvastatin, simvastatin/sitagliptin and ezetimide/simvastatin. The clinical efficacyof these combination products will be discussed.

Strategies to Improve Medication AdherenceLenore Coleman

Non-adherence with prescribed drug regimens is a perva-sive medical problem. A recent report by the World HealthOrganization (WHO) revealed that 50% of patients withchronic disease do not take their medication as prescribed.Poor medication adherence leads to increasingly poorhealth outcomes for patients and has a significant negativeeconomic impact on healthcare resources.

On average, one third to one half of patients do notcomply with prescribed treatment regimens. Non-adher-ence rates are relatively high across disease states, treat-ment regimens and age groups, with the first severalmonths of therapy characterized by the highest rate of dis-continuation. In fact, it has recently been reported that lowadherence to beta-blockers or statins in patients who havesurvived a myocardial infarction results in an increased riskof death. In addition to inadequate disease control, medica-tion non-adherence results in a significant burden to health-


Chair: Sebastian Peter

Treating Diabetic Complications

33

care utilization – the estimated yearly cost is $396 to $792million.

Additionally, between one-third and two-thirds of allmedication-related hospital admissions are attributed tonon-adherence. Cardiovascular disease, which accountsfor approximately one million deaths in the United States ofAmerica each year, remains a significant health concern.Risk factors for the development of cardiovascular diseaseare associated with defined risk-taking behaviours (egsmoking), inherited traits (eg family history), or laboratoryabnormalities (eg abnormal lipid panels). A significant butoften unrecognized cardiovascular risk factor universal toall patient populations is medication non-adherence.

When looking at medication non-adherence, there aremultiple factors which contribute to non-adherence. Weknow that when patients do not take their medications it cancontribute negatively to treatment outcomes. This canincrease healthcare costs.

Through the work done by McHorney and Lapane,we now know that there are 10 tenets (truths) about med-ication adherence. These are:

C Shed light on the fact that we, as healthcare pro-fessionals, need to screen for non-adherence

C Demonstrate that there are many common misper-ceptions regarding adherence

C Highlight the problems with effective communi-cation between patients and clinicians

C Provide useful insights in the patient’s medicationdecision-making

C Capture the importance of patient’s beliefs indetermining adherence behaviours

This presentation will cover tactics and strategies thatcan be used to change medication-taking behaviours andimprove medication adherence. These tactics include:

C The role of effective communication techniquesbetween providers and patients

C Understanding the role of health literacyC The use of motivational interviewing to create

ambivalenceC The use of “teach-teach back” techniques to vali-

date understanding of medication instructions


The Unitarian Hypothesis of the Aetiology of DiabetesMellitusErrol Morrison

The classification of diabetes mellitus (DM) outlines twomain Types – 1 and 2. Type 1 is insulin insufficiency whilstType 2 is mainly due to insulin resistance in the target tis-sues. Several others have been described: gestational,nutritional, drug-induced and many more, all of which leadto the clinical picture of hyperglycaemia and its attendantadverse outcomes.

The Unitarian hypothesis presents an overall cascadeof biochemical and physiological interactions which mayresult from a variety of insults. It underpins the belief thatnature, the genetic predisposition which directs potentialantibody development, and nurture, the environmentalinfluences such as nutritional status (over- or under-nutri-tion), infective and toxic attack, can aggravate or initiateaspects of the cascade of reactions leading to hypergly-caemia.

The causative agents of diabetes are imputed to befree radicals, oxidizing molecular species and antibodiesfunctioning internally. The corollary to the above must bethat any intervention that minimizes the expression of thesethree would reduce the tendency for the development ofdiabetes.

The Unitarian hypothesis advances the concept thatthe types of clinical syndromes being described are not nec-essarily variants of a specific illness but rather manifesta-tions of a central process of membrane damage – > anti-body response – > insulin inadequacy (quantitatively or

qualitatively), and the future intervention in containing thedisease may well lie in focussing on the preservation ofmembrane integrity. The incidences of adverse events(AEs), serious AEs, deaths, and AEs leading to discontinu-ation were generally similar between treatment groups.The incidence of drug-related AEs was greater in the non-exposed group, primarily because of the increased inci-dence of hypoglycaemia.

The incidence of gastrointestinal (GI) symptoms wasgenerally higher in the non-exposed group, primarily be-cause of the increased incidence of diarrhoea. The inci-dence of hypoglycaemia was higher in the non-exposedgroup compared with the sitagliptin group, primarilybecause of the use of sulphonylureas as comparator agents.When sitagliptin alone was compared with placebo oragents not known to cause hypoglycaemia, the incidencerates were similarly low.

The incidences of cardiovascular AEs, bone fracturesand infections were generally similar between the sita-gliptin and non-exposed groups. The incidence of MajorAdverse Cardiovascular Events (MACE) was similarbetween treatment groups.

The incidences of angioedema, angioedema-relatedevents, and increased alanine aminotransferase or aspartateaminotransferase were similar between the sitagliptin andnon-exposed groups. The incidence of overall skin andsubcutaneous tissue disorders was modestly higher in thesitagliptin group. The incidences of malignancies weresimilarly low for both groups. The incidences of pancreati-tis and chronic pancreatitis were similar for the sitagliptinand non-exposed groups.


The Hon Errol Morrison Distinguished LectureLandmark in Diabetes Understanding

Chair: Dalip Ragoobirsingh

THEME: DIABETES AND ORAL HEALTH


02P – 1

Good Records Management – Better DiabetesManagementK Lowe

Objective: Improve research in diabetes managementthrough the development and implementation of a recordsand information management programme.Method: Personal experience and observation.Results: A systematic creation and maintenance of patientrecords would help to reduce medical errors, simplify thewaiting process and increase overall efficiency. Keepingrecords in a centralized location is important for better con-trol.Conclusions: Good management of health records facili-tates safe storage, rapid retrieval and secure disposition ofpatient records. For this to be achieved, there needs to benot only efficiency, but consistency of records managementpractices, which can be improved with the use of technolo-gy.

02P – 2

Foot Care and Footwear Practices among PatientsAttending a Specialist Diabetes Clinic in JamaicaKA Gayle1, MK Tulloch-Reid1, NO Younger-Coleman1,DK Francis1, SR McFarlane1, RA Wright-Pascoe2,MS Boyne1, RJ Wilks1, TS Ferguson11Tropical Medicine Research Institute and 2Department ofMedicine The University of the West Indies, Kingston,Jamaica

Objective: To estimate the proportion of patients at theUniversity Hospital of the West Indies (UHWI) diabetesclinic who engage in recommended foot care and footwearpractices.Methods: Seventy-two participants (58 women, 14 men)from the UHWI diabetes clinic completed an interviewer-administered questionnaire on foot care practices and typesof footwear worn. Participants were a subset of a sex-stra-tified random sample of clinic attendees and were inter-viewed between March and September 2010. Data analy-sis included frequency estimates of the various foot carepractices and types of footwear worn.

Results: Participants had a mean age of 57.0 ± 14.3 yearsand mean duration of diabetes of 17.0 ± 10.3 years. Only53% of participants reported ever being taught how to carefor their feet. Daily foot inspection was performed by justover 60% of participants. Most participants (90%) report-ed daily use of moisturizing lotion on the feet but almost50% used lotion between the toes which is not recommend-ed. Approximately 85% of participants reported wearingshoes or slippers both indoors and outdoors but over 40%reported walking barefoot at some time. Thirteen per centreported wearing special shoes for diabetes while over 80%wore shoes without socks at some time. Although muchlarger proportions reported wearing broad round toe shoes(82%) or leather shoes (64%), fairly high proportionsreported wearing pointed toe shoes (39%) and high heelshoes (43% – women only).Conclusion: Over 60% of patients at the UHWI diabeticclinic engage in daily foot inspection and other recom-mended practices, but fairly high proportions reported footcare or footwear choices that should be avoided.

02P – 3

The Slipping Slipper Sign: High Specificity and PositivePredictive Value for Peripheral Neuropathy amongDiabetic PatientsKA Gayle, MK Tulloch-Reid, RJ Wilks, TS FergusonTropical Medicine Research Institute (EpidemiologyResearch Unit)The University of the West Indies, Kingston, Jamaica

Objective: To evaluate the ability of the slipping slippersign to identify diabetic neuropathy in Jamaican patients.Methods: A single question from a questionnaire was usedto ascertain the presence of the slipping slipper sign(defined as unknowingly losing a slipper while walking)among 69 patients attending the University Hospital of theWest Indies diabetes clinic. Trained nurses also assessedpain, vibration and pressure perception among the samepatients in order to detect diabetic neuropathy. Patientswere classified as having diabetic neuropathy if any ofthese tests were abnormal. The sensitivity, specificity andpositive predictive value (PPV) for the slipping slipper signwere calculated.

Poster Presentations

37

Results: Twenty-eight participants (40.6%) had neuropa-thy 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%, speci-ficity of 100% and PPV of 100% for neuropathy on at leastone of the three tests. The prevalence of slipping slippersign increased with the number of neurological abnormali-ties detected: 0% among those with no abnormal tests, 13%among patients with one abnormal test, 50% amongpatients with two abnormal tests and 43% in patients withthree abnormal tests (p < 0.001 for trend).Conclusion: The slipping slipper sign has high specificityand positive predictive value for diabetic neuropathy butthe sensitivity is low. The sign may be a useful adjuvant toconventional method of screening for severe neuropathyand to identify patients who should be advised againstwearing slippers.

02P – 4

Relationship between Self-monitoring of Blood Glucoseand Glycaemic Control among Patients attending aSpecialist Diabetes Clinic in JamaicaKK Francis1, NO Younger-Coleman1, MK Tulloch-Reid1,RA Wright-Pascoe2, MS Boyne1, RJ Wilks1, TS Ferguson11Tropical Medicine Research Institute and 2Department ofMedicine The University of the West Indies, Kingston,Jamaica

Objectives: To describe the frequency of self-monitoringof blood glucose (SMBG) and evaluate its relationship withglycaemic control among patients attending a specialistdiabetes clinic in Jamaica.Methods: This cross-sectional study analysed data from188 patients randomly selected from the UniversityHospital of the West Indies (UHWI) diabetes clinic. Self-reported data on blood glucose testing practices wereobtained using a structured questionnaire. A point-of-caremeter (NycoCard© Reader II) was used to measure glyco-sylated haemoglobin (HbA1c) from a capillary blood sam-ple collected from each participant. Proportions and fre-quency of SMBG within and across demographic andsocio-economic status categories were obtained. Linear andlogistic regression analyses were used to evaluate the rela-tionship between SMBG and glycaemic control.Results: Analysis included 143 women and 45 men withmean age of 56 ± 15 years. Approximately 60% (95% CI52, 67%) of patients performed SMBG with no differenceby gender (62% M vs 52% F, p = 0.196). Thirty-one percent of participants monitored their blood glucose at leastonce daily and 29% less than once daily. Participants lessthan forty years old, persons with post-secondary educationand those taking insulin were more likely to performSMBG. Multivariable linear regression showed that per-forming SMBG was associated with a lower HbA1C after

adjusting for age, sex and insulin use (p = 0.004). In multi-nomial logistic regression models adjusted for the samevariables, SMBG was also associated with lower odds ofhaving poor glycaemic control (HbA1C > = 9%) comparedto good control (HbA1C < 7%); OR 0.24, p = 0.001.Conclusion: Self-monitoring of blood glucose is practisedby almost 60% of patients at the UHWI diabetes clinic andis associated with lower HbA1C and decreased odds of hav-ing poor glycaemic control.

02P – 5

Correlates of Self-management and TreatmentAdherence among Type 2 Diabetics Attending a PrivateJamaican clinic: A Pilot StudyDR Brown1, D Akindele21University of Medicine and Dentistry of New Jersey, USAand 2University of Technology, Kingston, Jamaica

Many complications of Type 2 diabetes can be preventedthrough effective management and adherence to recom-mended treatment. This includes not only regular clinic vis-its for checking HbA1C, eyes and feet, but also patient self-management and lifestyle changes. However, becausepatient self-management behaviours are often difficult tomaintain, the purpose of this study is to understand factorsthat are associated with better patient self-management andtreatment adherence. Specifically, this study investigatedthe relationship between patient self-management practicesand factors such as patient demographic characteristics,awareness of familial risk and social support. The datacome from interviews with Type 2 diabetics seeking treat-ment at a private Jamaican clinic. Implications are dis-cussed for treatment adherence.

02P – 6

Investigating the Relationships between the Awarenessof Risk Factors of Type 2 Diabetes Mellitus and thePractices and Attitudes of First and Second YearMedical Technology Students at the University ofTechnology, JamaicaL Mendoza, K Mogg, T Muir, A Passley, A SimpsonThe College of Health Sciences, University of Technology,Jamaica

Background: Type 2 Diabetes Mellitus (DM) has becomea universal concern to the health of individuals, especiallyfor formerly unaffected young people, as this disease cancause complications, which can lead to one’s demise.Objective: To investigate the level of relationships/associ-ation between the awareness of risk factors of Type 2 DMand the practices and attitudes of first and second year

38

Medical Technology Students at the University ofTechnology (Utech), Jamaica.Methods:A cross-sectional study was conducted among 54university students in the age range of 18–31 years. A 17-point questionnaire was administered to assess students’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 scheduledtime.Results: The results indicated no direct correlationbetween students’ knowledge and lifestyle practices. Addi-

tionally, a high intake of high caloric foods was observedamong the study population. Physical activity, on the otherhand showed a fifty per cent success among the subjectswhile the anthropometric measurements implied that themajority of the population was not at risk.Conclusion: The increasing prevalence of Type 2 DM con-stitutes a significant public health burden, placing a greaterimportance on its prevention. The evidence for the effica-cy of lifestyle intervention, including weight management,increased physical activity, dietary compliance, as well asavoiding tobacco abuse should be urgently implemented inthe prevention of Type 2 DM.

Notes �

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