Diabetes in the Caribbean: Trouble in paradise

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 complications 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 factors 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.