Diabetes in the English-speaking Caribbean

Rates of diabetes mellitus in the English-speaking Caribbean have been rising in recent years, and they are projected to continue climbing in the new millennium. Prevalence rates across countries of the African diaspora mirror levels of Western acculturation, and available data emphasize the importance of obesity as a modifiable risk factor. The population-based Barbados Eye Studies have provided new information about the burden of ocular complications of dia-betes such as retinopathy and lens opacities. Diabetes was shown to increase the risk of lens opacities, and 14 % of prevalent cataract was attributed to diabetes. Persons with type 1 dia-betes were particularly at increased risk of retinopathy, as a result of longer durations of ill-ness and poor glycemic control. Other Caribbean studies have suggested that glycemic control in patients evaluated in various clinical settings is suboptimal, which raises important con-cerns about quality of care. Diabetics are at increased risk of mortality compared with nondi-abetics, and that mortality risk increases with higher baseline levels of glycosylated hemoglo-bin, even among nondiabetics. These data highlight the need for urgent attention to public health and clinical strategies to prevent diabetes in unaffected persons as well as to prevent or reduce the burden of complications among those who are affected. Among the measures tha