Diabetes mellitus: a challenge for the countries of the region

PAHO recently convened a meeting of experts on diabetes mellitus for purposes of underlining the importance of the disease as a health problem and developing recommendations to assist the countries of the Region in establishing control programs. Existing data on the prevalence of diabetes mellitus in different countries are not comparable, since population samples are not always representative and diagnostic criteria vary. Ten different countries set the prevalence figure at anywhere from 1.2 to 6.9 per cent. Mortality from diabetes reveals only part of the problem, largely because of registration difficulties. The figures that are available, however, show that the situation is very serious in several Carribbean countries; that is, Barbados, Trinidad and Tobago, and Jamaica rank first, second, and third, respectively, among 22 countries in the Americas. The data now available on morbidity and mortality, expected population growth, and probably increases in the relative size of older population groups lead to the assumption that diabetes mellitus, together with its complications, will become an increasingly serious problem in the Region over the next 10 to 15 years. Programs for the control of diabetes mellitus should include educational campaigns for patients, the public, and health professionals; early detection of the disease in high-risk groups; registration and followup of cases and the organization of systems for providing comprehensive care. Promotion of basic, clinical, and epidemiologic research directed at local problems and seeking to acquire a better understanding of the nature of the disease and its complications is also highly recommended. Naturally, each country should adapt current methods of treatment to local socioeconomic and cultural circumstances, especially with regard to dietary therapy, prescribed insulin dosage, and use of the controversial oral hypoglycemic drugs. Despite the important contribution that research can make to a better understanding of diabetes mellitus, it is the health authorities, the patients, and the public who still have the major task of coping with this increasingly prevalent disease, which more and more is revealing the consequences of its chronic nature and complications in our Region.