Controlling non-insulin-dependent diabetes mellitus in developing countries

The epidemiological transition has brought an increasing burden of chronic non-communicable disorders to middle- and even low-income countries. This paper reviews the problem with particular reference to non-insulin-dependent diabetes mellitus (NIDDM) in the English-speaking Caribbean region. Surveys conducted over the last three decades have documented a high prevalence of NIDDM in a number of communities and evidence has accumulated to support the control of obesity and physical inactivity in the primary prevention of non-insulin-dependent diabetes. The problem of introducing and monitoring suitable interventions on a long-term basis in high-risk populations in different cultures has yet to be addressed. The impact of diabetes on health status in developing countries has not been well documented but it is clear that there are high levels of acute illness from disorders of glycaemic control, long-term disability from blindness and limb amputation and premature mortality from stroke, coronary heart disease and renal disease. Present evidence suggests that improving the quality of preventive clinical management can be the most immediately productive approach to controlling health problems from diabetes. Achieving this objective within the social, organizational and resource constraints of the Caribbean presents a range of problems. Identifying the most cost-effective means of improving existing services is therefore the most immediate research priority for NIDDM in the English-speaking countries of the Caribbean.