Are current guidelines addressing the diabetes challenge in the Caribbean? Lexley M Pinto Pereira 1 , Cecil K Da Silva 2 and Surujpaul Teelucksingh 1 Affiliations: 1 Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and 2 Hackenthorpe Medical Centre, Sheffield, UK Submission Date: 22nd June 2009, Revision Date: 19th July 2009, Acceptance Date: 4th August 2009 ABSTRACT Diabetes is reaching epidemic proportions in Caribbean territories, and steadily increasing rates have been reported in the English-speaking Caribbean. The prevalence of type 2 diabetes is growing in children and adolescents. Studies from Jamaica, Trinidad, and Barbados indicate that glycemic control in patients evaluated in various clinical settings is suboptimal, giving rise to concerns about mortality, morbidity, and quality of care. Acute diabetes-related illnesses inflict a heavy disease burden particularly in ocular complications, renal failure, and amputations, resulting in notable bed occupancy in hospitals. To address the continued poor quality-of-life and disease complications, guidelines for the management of diabetes in primary care in the Caribbean were published in 1996 and a revised version became available in 2006. Following the first edition, studies suggested that disease outcomes were not favorably influenced, and even after the second edition, a report from Trinidad indicated that current standards of care do not meet the recommendations in the guidelines. This paper looks at the quality of care in a Caribbean nation in relation to that advocated in the guidelines and uses examples from a specialty center in Trinidad and a primary care practice in the United Kingdom (UK) to illustrate that guideline-based care can be achieved. Keywords: diabetes, primary care, guidelines, quality of care, disease burden, implementation Correspondence: Lexley M Pinto Pereira, Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago. Tel/fax: +1-868-663-8613; e-mail: lexleyp@gmail.com, Lexley.PintoPereira@sta.uwi.edu INTRODUCTION The Global Epidemic The increasing prevalence of obesity, physical inac- tivity, and fast food consumption coupled with popula- tion growth, aging, urbanization and ‘‘westernization’’ in relatively less developed, middle-income countries undergoing rapid economic development has contrib- uted to a global increase in the diabetic population. The International Diabetes Federation (IDF) estimates that more than 250 million people around the world have diabetes, and each year a further 7 million people will develop the disease [1]. Global projections for the disease epidemic are projected to rise from 171 million in 2000 to 366 million in 2030 [2]. Countries particu- larly affected are North America (57%), South America (85%), India (108%), and Africa (111%) based on a 2003–2025 forecast [3]. A Caribbean Problem Rates of diabetes mellitus in the English-speaking Caribbean have shown rising trends in recent years, reaching epidemic proportions. The World Health Organization (WHO) forecasts a rising prevalence of diabetes for Latin America and the Caribbean (LAC), with an increase from 34 million in 2000 to 64 million in 2025 [4]. The Anglophone or English-speaking Caribbean comprises 10 island-nations, two mainland nations, and five British territories, which together have a combined population of approximately 6.7 million. Trinidad and Tobago, whose economy is primarily based on petroleum, petrochemicals, and natural gas production, is the wealthiest independent country in the Anglophone Caribbean, boasting a high standard of living with high literacy rates. An early study on prevalence of diabetes in the country reported rates of 2.4% and 1.2%, respectively, in East Indian and African descent Trinidadians (who consti- tute the two major ethnic groups) from a sample of 24 000 islanders [5]. The high prevalence rates with related cardiovascular morbidity were still reported two decades later in Trinidadians of Asian extraction in what came to be known as the ‘‘St James Study’’ [6]. Caribbean countries record high prevalence rates of diabetes associated with obesity, with a gender dimorphism favoring females. Diabetes has not spared ASIA-PACIFIC JOURNAL OF ENDOCRINOLOGY REVIEW ARTICLE APJOE 2009; 000:(000). Month 2009 1 www.slm-apjoe.com