What
is Diabetes?
Diabetes Mellitus or diabetes or “sugar”
as commonly called in many Caribbean cultures is a metabolic
diseases characterized by hyperglycemia resulting from defects
in insulin secretion, insulin action or both. Blood glucose
levels are regulated by the hormone insulin, which is produced
by the pancreas gland. The primary purpose of insulin is to
help open the cells of the body to receive glucose as a source
of energy. Diabetes occurs when the body either lacks the
ability to produce insulin, or lacks the ability to use insulin
properly (insulin resistance), or both. Without insulin to
“unlock” the entry into cells, glucose builds
up in the blood, and at high levels is passed out in the urine.
Some symptoms of high blood glucose include excessive urination
(polyuria), excessive thirst (polydipsia), weight loss, excessive
hunger (polyphagia), and blurred vision. Diabetes is frequently
not diagnosed until complications appear, and approximately
one third of all persons with diabetes may be undiagnosed.
There are three major types of diabetes.
Type 1 diabetes (formerly known as insulin
dependent diabetes or juvenile onset diabetes) typically occurs
in persons younger than 30 years of age and accounts for approximately
5-10% of all cases of diabetes. Type 1 diabetes is the result
of genetic and environmental factors, as well as an autoimmune
response where the defense system of the body inappropriately
“attack” the pancreas, destroying its insulin-producing
capacity. Persons with Type 1 diabetes require insulin from
an outside source (needle injections or an insulin pump) to
survive.
Type 2 diabetes (formerly known as non-insulin
dependent diabetes or adult onset diabetes) is the form of
diabetes that typically occurs in persons older than 30 years
of age, although a growing number of children and adolescents
are being diagnosed with Type 2 diabetes. Type 2 diabetes
is more common among older adults, persons who are obese and
physically inactive, persons with a family history of diabetes,
and persons of African American, Hispanic, and Native American
ancestry, and some Pacific Island racial/ethnic groups. Type
2 diabetes accounts for about 90-95% of all cases of diabetes.
Gestational Diabetes: About 1-14% of all pregnancies in the US result in the development
of gestational diabetes (GDM) and complicates approximately
4% of all pregnancies. This form of diabetes is usually temporary,
but is believed to increase the risk of developing in later
years.6
Subclinical Diabetes: A separate
category has been established in place of borderline diabetes,
which is now called impaired glucose tolerance (IGT) or impaired
fasting glucose (IFG) and refers to a metabolic stage between
normal glucose and diabetes. Persons in this category have
fasting glucose values between 110 and 125, inclusive, or
2-hour post-glucose load values between 140 and 199, inclusive.
Note that many individuals with IGT are
euglycemic in their daily lives and may have normal or near
normal glycated hemoglobin levels. Individuals with IGT often
manifest hyperglycemia only when challenged with the oral
glucose load use in the standardized oral glucose tolerance
test (OGTT). In the absence of pregnancy IFG and IGT are not
clinical entities but risk factors for future diabetes and
cardiovascular disease. IFG and IGT are associated with the
insulin resistance syndrome also known as syndrome X or the
metabolic syndrome, which is directly involved in the development
of Type 2 diabetes.6
Diagnostic
Criteria: The American Diabetes Association recently
revised their criteria for the diagnosis of diabetes mellitus.
The criteria
used to diagnose diabetes includes:
(1) a fasting (no calorie-containing foods for at least 8
hours) blood glucose value of greater than or equal to 126
mg/dL; (2) a 2-hour post-glucose load (a glucose load consists
of 75 grams of glucose dissolved in water) of greater than
or equal to 200 mg/dL; or (3) symptoms of diabetes and a random
(non-fasting) blood glucose value of greater than or equal
to 200 mg/d:. Each of these tests must be confirmed on a separate
day by a follow-up test.6
Diabetes
in USVI Children age (0-19)
Diabetes mellitus occurs among children
in two major forms, Type 1 and Type 2 as it does among adults.
The onset of Type 1 is usually severe and often requires hospitalization
at the time of diagnosis. Children with Type 1 diabetes will
need insulin injections to manage their blood sugar and avoid
going into diabetic coma. The onset of Type 2 diabetes may
be less severe, and children with Type 2 diabetes may go undiagnosed
for months to years. Because of this possibility, it is important
that children who are obese and have a family history of diabetes
be carefully monitored for the signs of diabetes.
The frequency of Type 1 diabetes among children in the U.S.
Virgin Islands has shown a remarkable increase over the past
two decades. The earliest information documenting the frequency
of Type 1 diabetes in USVI children dates back to 1980 where
the incidence of childhood Type 1 diabetes was 3.7 per 100,000
children among black children and 5.7 per 100,000 children
for all USVI children (1). By 1993 the estimate of the frequency
of Type 1 diabetes among black children age 0-19 in the USVI
was 10.09 per 100,000 on St. Croix and 6.3 per 100,000 on
St. Thomas. Therefore over the 13 year period from 1980-1993,
the incidence of childhood Type 1 diabetes rose 272% on St.
Croix and 170% on St. Croix (2). It is not certain if this
increase represents a true rise in the frequency of Type 1
diabetes or may be the result of an increase in childhood
Type 2 cases that were being classified as Type 1. However,
what is clear is that the incidence of childhood Type 1 diabetes
in the USVI is significantly higher than the rates for neighboring
islands in the eastern Caribbean (Antigua, St. Kitts, British
Virgin Islands, Dominica) (2). Research studies are underway
to determine the reasons for the higher rate of childhood
Type 1 diabetes in the USVI.
There is no available information
on the frequency of Type 2 diabetes for USVI children.
However the trend among USVI children
towards an increase in overweight and obesity may indicate
that childhood Type 2 diabetes will become a significant health
problem in the USVI as it is on the mainland United States.
Lifestyle factors such as fast food eating and physical inactivity
contribute to higher obesity rates in children. Careful monitoring
by parents of their children’s diets and physical activity
levels will be an important aspect of the effort to prevent
childhood Type 2 diabetes in the USVI.
References:
1. Tull ES, Roseman JM, Christian CLE. Epidemiology of childhood
IDDM in the U.S. Virgin Islands from 1979 to 1988: evidence
of an epidemic in the early 1980s and variation by degree
of racial admixture. Diabetes Care 1991; 14:558-64.
2. Tull ES, Jordan O, Simon L, Laws M,
Smith DO, Vanterpool H, Buttler C. Incidence of childhood-onset
IDDM in black African-heritage populations in the Caribbean.
The Caribbean African Heritage IDDM Study (CAHIS) Group. Diabetes
Care;20(3):309-310, 1997 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5227a3.htm |
