Differences in glycemic control and cardiovascular risk in primary care patients with type 2 diabetes in West Indies

Abstract

There are limited resources and facilities at primary care clinics in most developing countries. Medical professionals are often faced with the challenges of providing standard health care delivery in the absence of adequate resources. We aimed to evaluate the long-term glycemic control and risk of cardiovascular disease in multi-ethnic groups of diabetic patients attending primary care clinics in Trinidad. One hundred and ninety-one (127 females, 64 males, mean age 56.6 years) patients with type 2 diabetes (mean duration 9.2 years) attending primary care clinics in Trinidad were studied after a 12 to 14-h overnight fast. Weight, height, waist and hip circumferences, and blood pressure were measured, and a blood sample was taken for glucose, glycated hemoglobin, total cholesterol, triglycerides, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol. and creatinine determinations. About 85% of patients had glycated hemoglobin levels >7.0%, 31% had central obesity, 49% had diastolic blood pressure >83 mmHg, while 40% had a total-cholesterol/high-density lipoprotein-cholesterol ratio greater than 6. In comparison with males, female patients had significantly higher levels of total-cholesterol and low-density lipoprotein-cholesterol independent of obesity (P<0.01) while male patients of East Indian descent had the highest risk of cardiovascular disease compared with males of any other ethnic group (P<0.01). In conclusion patients with type 2 diabetes attending primary care clinics in Trinidad had poor glycemic control. Female and male patients of Indian ethnic group were at the highest risk of cardiovascular disease. Efforts at strict glycemic control and protection against microvascular complications should be intensified at primary care levels.