Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 9

9 - A NON-LABORATORY BASED SCORE FOR DETECTING DYSGLYCEMIA IN A PREDOMINANTLY BLACK CARIBBEAN POPULATION

Saturday, Apr 27
11:30 AM – 12:00 PM

Objective :

To develop a diabetes risk score for undetected dysglycemia (prediabetes/undiagnosed diabetes) in Jamaicans.  


Methods :

Participants, 15-74 years old, from the 2008 Jamaica Health and Lifestyle Survey were administered a standardized questionnaire and had blood pressure and anthropometric measurements performed. Fasting capillary blood glucose was used to identify participants with prediabetes and undiagnosed diabetes (ADA criteria). Logistic regression was used to identify significant predictors of dysglycemia. A final model was developed from stepwise forward regression and the risk score developed using coefficients from independent variables. Cut points were determined using Area Under Receiver Operating Characteristic Curve (AUROCC), sensitivity and specificity. 


Results :

Of the 2 340 participants examined 2% had undiagnosed diabetes and 7% had prediabetes. Age > 40 years old (OR[ 95%CI]=1.55[1.10–2.19]), Non-Black (vs Black) race (OR[95%CI]=2.32[1.37– 3.94]), hypertension (OR[95% CI]=1.63[1.12—2.37]), overweight/obesity (BMI 25.0-29.9 kg/m2(OR[95% CI]=1.40[ 0.93–2.11]), ≥30kg/m2(OR[95% CI]=1.83[1.20 –2.81])) and male sex (OR[95%CI]=1.86[1.29 –2.69]) were included in the final model. Each predictor variable was given a value of 1, with the exception of BMI (1- 25 - 30 kg/m2 ; 2- ≥30kg/m2). AUROCC for the score was 0.68 (95%CI=0.61-0.76) for undiagnosed diabetes and 0.63(95% CI=0.59–0.67) for dysglycemia. A score of ≥2 out of 6 was the best cut point for detecting diabetes (sensitivity 90%; specificity 38%) and dysglycemia (sensitivity 78%, specificity 39%). 


Discussion :

Use of this score could improve detection and prevention efforts to address the Caribbean’s high diabetes burden. 


Conclusion :

The Jamaican diabetes risk score is a valid tool for dysglycemia screening in Jamaicans.Validation in other Caribbean populations is encouraged.

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Daniel O. Nepaul

Candidate M.Sc. in Epidemiology
Caribbean Institute for Health Research, The University of West Indies, Kingston, Jamaica
Kingston, Kingston, Jamaica

Dr. Nepaul is a conscientious, focused, organized and hard working physician and young researcher. His skills include: primary care and emergency medicine patient care. His experiences in varied patient care specialties have allowed him to realize his ardent interest in Internal Medicine. He has graduated medical school at the University of the West Indies, Mona campus, with honors and is currently a candidate for the Masters in Epidemiology degree at the University of the West Indies. Dr. Nepaul currently works at the Heart Institute of the Caribbean, Kingston, Jamaica, as a Medical Officer and Research Associate.

Trevor S. Ferguson

Senior Lecturer in Clinical Epidemiology
Caribbean Institute for Health Research, The University of West Indies, Kingston, Jamaica

Dr. Trevor Ferguson is a Senior Lecturer in Epidemiology at CAIHR and Honorary Consultant in General Internal Medicine at the UHWI. Dr. Ferguson is part of the Chronic Disease Research Group at the Epidemiology Research Unit and conducts research in the fields of cardiovascular disease, epidemiology, and diabetes.

Dr Ferguson pursued his undergraduate medical degree at the University of the West Indies (UWI), and was awarded the Bachelor of Medicine, Bachelor of Surgery (MBBS) degree in 1995. He later completed specialist training, leading to a Doctor of Medicine (DM) degree in Internal Medicine, at the same institution. Dr Ferguson then went on to obtain a Master of Science (MSc) degree in Epidemiology from the London School of Hygiene and Tropical Medicine, through the University of London External Programme, and was elected to Fellowship in the American College of Physicians in 2011.He is currently pursuing a Doctor of Philosophy (PhD) in Epidemiology at UWI. Dr. Ferguson joined the Institute in 2004, and currently serves as coordinator for the MSc Epidemiology Programme, and as an investigator in several research projects, including the Jamaica 1986 Birth Cohort Study, the United States of America (US)-Caribbean Alliance for Health Disparities Research (USCAHDR), and the Jamaica Amputation Prevention Project. Dr Fergusons research is primarily in the field of cardiovascular disease and diabetes epidemiology, with a particular focus of the early life and life-course determinants of hypertension.

Novie O. Younger-Coleman

Statistician and Senior Lecturer in Biostatistics
Caribbean Institute for Health Research, The University of West Indies, Kingston, Jamaica

Novie Younger-Coleman is a qualified Statistician and Senior Lecturer in Biostatistics in the Epidemiology Research Unit of the TMRI. She is also First Vice President of The Jamaica Statistical Society.
Following completion of her undergraduate degree in Agriculture at the University of the West Indies (St. Augustine) and two years of teaching at the Elim Agricultural School (St. Elizabeth, Jamaica) Dr. Younger-Coleman went on to pursue the M.Sc. in Biometry at the University of Reading followed by the Ph.D. in Applied Statistics at the Nottingham Trent University. She subsequently completed 1 year of post-doctoral work in the Department of Biometry and Epidemiology of the Medical University of South Carolina (MUSC) focused on "Measures of Explained Residual Variation for Linear and Logistic Regression" and "Random Effects Models in the Analysis of Repeated Measurements Data".
Dr Younger-Coleman joined the TMRI in 1999. She has served as coordinator for the Research Skills Training Programme of the Epidemiology Research Unit; taught Biostatistics to M.Sc. Epidemiology and M.Sc. Nutrition candidates; provided supervision and guidance in statistical data analysis for the research work of Ph.D. candidates; and continued to provide support for the research and data analysis agenda of the TMRI.

Rainford J. Wilks

Professor of Epidemiology
Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica

Rainford Wilks is a Professor of Epidemiology, an Epidemiologist, and a Consultant Physician in the Caribbean Institute for Health Research (CAIHR), the Department of Medicine of the University of the West Indies (UWI) and the University Hospital of the West Indies (UHWI). He is also Director of the UWI Clinical Epidemiology Unit (CEU) of the CanUSACLEN branch of the International Clinical Epidemiology Unit (INCLEN).
Professor Wilks completed medical school at the University of the West Indies followed by residency in internal medicine. He completed a Master’s degree in Epidemiology at the London School of Hygiene and Tropical Medicine and became a member of the Royal College of Physicians, UK.
Rainford Wilks joined the Tropical Metabolism Research Unit (TMRU) in 1989 and became founding director of the Epidemiology Research Unit (ERU) when it was formed as part of the Institute in 1999. He developed the MSc and PhD programmes in Epidemiology and led research programmes in HTLV1 epidemiology, the Spanish Town Study of chronic non-communicable diseases, the Jamaica Health and Lifestyle Surveys (JHLSI & JHLSII), the Jamaica Youth Risk and Resiliency Survey (JYRRBS), the 1986 birth cohort follow-up and the Jamaican leg of the United States Caribbean Health Disparities Research (USCAHDR). He is the Principal of the epidemiology of HTLV1; epidemiology of cardiovascular diseases and their risk factors and co-investigator of the Burden of cardiovascular diseases and their risk factors, in particular, testing interventions to empower population and health systems through community participation.

Marshall K. Tulloch-Reid

Professor of Epidemiology and Endocrinology and Director of the Epidemiology Research Unit of the Caribbean Institute for Health and Research
Caribbean Institute for Health and Research, The University of the West Indies, Kingston Jamaica

Marshall Tulloch-Reid is Professor of Epidemiology and Endocrinology and Director of the Epidemiology Research Unit of the TMRI. He is also Co-Director of the Caribbean Branch of the US Cochrane Centre.
Professor Tulloch-Reid is a medically qualified Epidemiologist and Endocrinologist. Following medical school at the University of the West Indies (Mona) he went on to pursue the MPhil in Epidemiology at the University of Cambridge and the DSc in Epidemiology at the Netherlands Institute for Health Sciences. He completed training in Internal Medicine at the Howard University Hospital in Washington DC and Fellowship training in Endocrinology, Diabetes and Metabolism at the National Institutes of Health Inter Institute Endocrinology Training Programme (NIDDK) in Bethesda, Maryland and Phoenix, Arizona. Professor Tulloch-Reid joined the then TMRI in 2003. He has served as coordinator for the MSc Epidemiology programme and is involved in the Jamaica Health and Lifestyle Surveys, the 1986 birth cohort, the Spanish Town Study and studies of youth onset diabetes. He is currently PI on two NIH grants involving designed to improve our understanding of cardiovascular disease and cancer by building regional capacity through a regional centre of excellence and a cohort created from the Jamaica Health and Lifestyle Study. His research interests include the identification of risk factors for chronic diseases throughout the life course and improving approaches for the prevention & treatment of these disorders.