SUNDAY 6TH JULY, 2014 – UWI TODAY
9
Diabetes mellitus is a group
of metabolic diseases
characterised by hyperglycaemiawhich result fromdefects
in insulin secretion, insulin action or both. Currently there
aremore than 150million people with diabetes worldwide
and it is estimated that this number will double by 2025.
More than 90% of diabetics have type 2 diabetes mellitus
(T2DM). Most of this increasing burden of diabetes and
its complications will be borne by developing countries.
In Trinidad and Tobago 60 years ago, acute infectious
disease was the main cause of morbidity and mortality.
By the 1960s, the island was already experiencing one
of the highest prevalence rates of T2DM in the Western
Hemisphere. The prevalence now is estimated to be
approximately 15-20%, whichmeans that about 160,000 of
the population are afflicted with diabetes. A study in 1968
by Poon-King et al showed that T2DM was rare in those
aged<20 years butwithin the last decade a striking increase
in the number of childrenwith obesity andT2DMhas been
observed, reflecting a trend seen in North America, Europe
and Asia. Pilot data from the Paediatric Endocrine Clinic,
Mount Hope, Trinidad support our clinical impression that
there are many cases of undiagnosed T2DM in the young.
Given its prevalence within the snowballing obesity
epidemic, earlier diagnosis and appropriatemanagement is
likely to bemore cost-effective than treating complications
that accrue from undiagnosed or under-treated disease,
potentially adding many years of improved quality of life.
The objectives of this study spearheaded by Professor
Surujpaul Teelucksingh were to assess the prevalence of
diabetes mellitus in schoolchildren in Trinidad using mass
urinary screening for persistent glycosuria and the cost-
effectiveness of this exercise. Children from the island of
Tobago were not screened in this study. As such it is an
eye opener not just for Trinidad but also for the Caribbean
region where obesity is getting to be epidemic, highlights
the‘diabesity’problemencountered in adult life and fosters
the metabolic syndrome.
A cross-section of primar y and secondar y
schoolchildren at 415 schools in the seven school districts
in Trinidad was surveyed during January to June 2009.
Childrenwere instructed to collect an earlymorning sample
of urine at home (taken before breakfast) and bring it to
school for glucose testing using the UriScanH urine strip.
This convenient strategy was chosen for the following
reasons: to ensure that students collected urine in a safe
and comfortable environment (their homes) and to delay
the time lag between collection and testing—a fresh
sample collected at home and presented soon after arrival
at school was a practicable solution.
Urine was tested at schools by trained personnel
according to themanufacturer’s instructions. Childrenwith
a positive result for the first sample were asked to provide
a second sample for testing by different trained personnel.
Those with consecutively positive samples were invited to
the hospital for an OGTT. The OGTT was performed in the
morning after an 8-hour fast.
Thiscross-sectionalsurveyofschoolchildreninTrinidad
found the prevalence of T2DM to be 10.4/100,000, of pre-
diabetes to be 7.5/100,000 and of T1DM to be 1.5/100,000.
This exceeds ourworst expectations.We anticipatedfinding
one positive glucose test for every 10,000 children screened
but obtained an overall prevalence of 3.2/10,000. In Japan,
where a similar screeningmethod has been employed, the
annual incidence of T2DM was only 2.63/100,000 in 6-15
year-olds for the period 1974-2002.
The increase inT2DM in children is causally influenced
by the alarming increase in childhood obesity which is
now classified as an epidemic. This increase in obesity
is also apparent in Trinidad and Tobago where there
has been a significant increase in obesity over the last
decade. A cross-sectional study by Batson et al in 2001
demonstrated a prevalence of 5%obesity in schoolchildren
attending secondary schools in Trinidad and Tobago. By
comparison, in an ongoing study one decade later, the
observed prevalence of obesity was 15% (unpublished
observations).
The rising prevalence of obesity, the increasing
frequency of diagnosis of diabetes in children and
the prospect of a more meaningful impact from early
intervention make schoolchildren a prime target for
screening. Recognition and awareness of the problem can
halt adult diabetes and demote Trinidad’s ranking as the
fifth ‘fattest’ nation globally.
that “Burger King has worked with us along these
lines,” as he described how “they now have more
salads and water on their menu,” and that they
had been identifying the calorie count for each
item. “The Ministry is developing cartoons and
videos where healthy foods are heroes and bad
foods are the villains. Freddy French Fries will be
the villains,” the Minister said.
But there has been little done by way of State
intervention to impose controls in the food and
beverage industry. Who regulates the amount of
sugar in those insidious soft drinks? Who is to
staunch the torrent of highly processedmeats and
snacks?What can be done to shift the culture away
from the refined carbohydrates such as white flour
and white rice? What about controlling the fare
in schools—eliminating the junk, expanding the
school feeding programme, putting in lunchroom
facilities—instilling a different culinary culture?
It is true that culture shifts are slow and face
much resistance. More than 50 years ago, DrTheo
Poon-King and a research team conducted a year-
long survey that ended in July 1962, screening
23,900 people and finding 448 diabetics in T&T.
He noted then that diabetes was more common
in Trinidad than in North America and Great
Britain. Today, the mortality rates from diabetes
and cardiovascular disease are higher than in
North America (the US and Canada).
Dr Poon-King had gone further; past the
theory that it was simply a diet high in fats that
contributed to the large number of diabetics. He
found that it was refined carbohydrates that were
the real culprit.
(Continued on Page 10)
This is an edited extract from a published paper on the screening process done by UWI researchers:
Yvonne Ann Batson, Professor Surujpal Teelucksingh,
Dr Rohan Maharaj, Dr Brian Cockburn, Dr Virendra Singh and Sasha Balkaran
.
To read more of the paper, please visit our website at
Screening for diabetes
in schoolchildren
“
14 million
people
die before age
70 from NCDs
(in particular
cardiovascular
& chronic resp
diseases, diabetes
and cancers)”
World Health Organisation
(WHO)
