–94– Insulin Accepted for publication December 4, 2008. 1557-0843/$ - see front matter © 2009 Excerpta Medica Inc. All rights reserved. Diabetes in the Caribbean: Trouble in Paradise Michael S. Boyne, MD Tropical Medicine Research Institute, University of the West Indies, Mona, Jamaica INTRODUCTION The Caribbean refers to a large geopolitical region of the Americas situated on the Caribbean Plate and consists of the Caribbean Sea, its islands, and the surrounding coasts. The region consists of hundreds of islands and islets enclosing the Caribbean Sea, stretching ~2500 miles, but the islands are no more than 160 miles wide at any point. The presence of European colonial powers in the region for hundreds of years has made the Caribbean a melting pot of ethnic groups, languages, and social customs. This article focuses on the English-speaking (Anglophone) nations and thus covers Anguilla, Antigua and Barbuda, the Bahamas, Barbados, Belize, the British Virgin Islands, the Cayman Islands, Dominica, Grenada, Guyana, Jamaica, Montserrat, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Surinam, Trinidad and Tobago, the Turks and Caicos Islands, and the US Virgin Islands. The total popula- tion of the Anglophone nations is ~14.5 million, and the per-capita income (2005 US $, World Bank) ranges widely, from $1010 to $10,920. Tourism is a major source of income for many Caribbean nations. Caribbean people have moderate geographic mobility. Hence, several million people live outside of the region, mostly in the United States, Canada, and the United Kingdom. Although the ancestry of the ethnic groups in the region is varied (eg, African, Caucasian, Indian, Chinese, Middle Eastern), most individuals in the Anglophone Caribbean have West African ancestry as a remnant of the African slave trade and therefore identify themselves as black. Still, there was some intermingling of the races, and genetic admixture stud- ies showed rates of 10% to 15% for non-African ancestry. 1 Like many developing nations, Caribbean countries are undergoing significant demographic changes. As such, these countries have a double burden of infectious/communicable diseases (eg, HIV/AIDS) and chronic, noncommunicable diseases (especially diabetes), and these diseases are assum- ing epidemic proportions. 2 Few reviews of diabetes in this population have been conducted; however, this article sum- marizes the available information on the epidemiology of diabetes, the types of diabetes, the etiologic factors and com- plications of diabetes, and the public health burden associ- ated with diabetes in the Caribbean. METHODS An extensive PubMed literature search was conducted for the period 1951 to 2008 using the search terms diabetes, glu- ABSTRACT Background: Many developing countries, including countries of the English-speaking Caribbean, are undergoing an epidemiologic transition and experiencing rapid increases in the prevalence of diabetes. Objectives: This article examines the epidemiology of diabetes, the types of diabetes, the etiologic factors and com- plications of diabetes, and the public health burden associated with diabetes in the Caribbean. Methods: An extensive PubMed literature search was conducted for the period 1951 to 2008 using the search terms diabetes, glucose intolerance, Caribbean, Jamaica, Barbados, Trinidad, Bahamas, Guyana, and the names of all the other English-speaking Caribbean countries. Results: Four hundred articles were identified in the literature search. Of these, 131 original articles were selected for inclusion in this review. Prevalence rates for diabetes ranged from 11% to 18% of the population in several countries. The prevalence of atypical diabetes (ketosis-prone diabetes) may be declining because of increases in the proportions of the population with type 2 diabetes mellitus. Ecologic studies show an east-to-west gradient from West Africa to the Caribbean for obesity and obesity-related diseases. The steep increase in the prevalence of obesity and the increase in sedentarism in Caribbean societies are the main risk factors driving the diabetes epidemic. The roles of early-life origins (specifically, in infants with low birth weight and rapid catch-up growth and/or macrosomic infants) and genetic fac- tors await further clarification in this population. Diabetic foot, nephropathy, and stroke are common complications. Conclusions: In the English-speaking Caribbean, diabetes is a major public health burden that threatens the gross domestic product of these developing island nations. Macroeconomic initiatives are needed to start the combat against diabetes. (Insulin. 2009;4:94–105) © 2009 Excerpta Medica Inc. Key words: diabetes, Caribbean, African, Indian, obesity, complications.