Health Surveillance and Disease Prevention and Control / Chronic Diseases / Diabetes

Managing Diabetes in Primary Care in the Caribbean

Caribbean diabetes guidelines

Full-Text Guide (80 pp, PDF, via CHRC)
Preface (text in second column)
Introduction (text in third column)
Aim & Objectives (text in second column)
Overview of Diabetes Mellitus

Section I: Screening and The Diagnosis of Diabetes Mellitus
o Risk Factors for Diabetes Mellitus
o Screening for Type 2 Diabetes Mellitus
o The Screening Test
o Diagnostic Criteria and Classification of Diabetes Mellitus
o Diagnostic Criteria of Impaired Fasting Glucose and Impaired Glucose Tolerance
o The Metabolic Syndrome

Section II: Effective Delivery of Care
o Requirements for the Effective Delivery of Care
o Patient Visits
o The Initial Visit
o Follow-up Visits

Section III: Control of Blood Glucose, Blood Pressure and Blood Lipids
Achieving Glycaemic Control
o Non-pharmacological Management of Hyperglycaemia
o Nutritional management
o Physical activity Table of Contents
o Pharmacological Management of Hyperglycaemia
o Oral Glucose Lowering Agents
o Insulin
Monitoring of Blood Glucose
- Hypoglycaemia
- Conditions in Diabetes Mellitus Requiring Hospital Admission
- Management of Associated Conditions

o Hypertension Management in Adults with Diabetes
o Lipid Management in Adults with Diabetes
o Other Therapeutic Interventions

Section IV: Prevention and Reduction of Complications
o Nephropathy
o Retinopathy
o Neuropathy
o Care of the Foot
o Cardiovascular Disease

Section V: Management of Gestational Diabetes
o Gestational Diabetes Mellitus
o Protocol for Testing for Gestational Diabetes Mellitus
o Post-partum Follow-up

Section VI: Effective Self-Care through Education
o Self-Management Educational Goals

- References & Abbreviations
- Appendices

- Caribbean Health Research Council (CHRC)
- PAHO Diabetes Page

- Diabetes Guidelines in Spanish
(from Latin American Diabetes Association / ALAD)


The Caribbean Health Research Council (CHRC) has a mandate to promote health policy decisions and best practice, based on available evidence. Consistent with this remit, the Council produced and recently updated two manuals: Managing Diabetes in Primary Care in the Caribbean and Managing Hypertension in Primary Care in the Caribbean. These clinical guidelines were distributed throughout the Primary Health Care system of the entire English-speaking Caribbean, targeting all primary-care doctors, nurses, nurse practitioners and other healthcare personnel involved in the care of persons with diabetes and hypertension.

Since then, there have been significant advances in the management of these two conditions. Consequently, there is a need for updated manuals that would take into account the most recent international guidelines and regional expert opinions on the management of high blood pressure, diabetes, obesity and related dyslipidemia.

These manuals are geared to the culture, economic situation and health care systems in the Caribbean and are designed to serve as key tools in improving patient care. Special situations and local conditions (cultural and economic) may call for modified strategies, but the most important goal is to ensure that these diseases are managed effectively—thus reducing morbidity and mortality.

It is hoped that the collaboration among CHRC, PAHO, regional opinion leaders, and other agencies will accelerate a more effective and comprehensive approach to the prevention and control of chronic noncommunicable diseases.

Aim: To produce a unified, evidence-based approach to the management of diabetes in the Caribbean.


  • To prevent or delay the onset of diabetes mellitus and co-morbid conditions of obesity, hypertension and dyslipidaemia.
  • To promote earlier diagnosis of diabetes mellitus.
  • To improve the quality of care of persons with diabetes mellitus.
  • To prevent and treat acute and long-term complications of diabetes mellitus.
  • To promote education and empowerment of the patient, family and community, and healthcare worker.

Diabetes prevalence has been increasing in most countries of the Region of the Americas. It is estimated that more than 1 in 10 of the adult population of the Region is affected; rising to 1 in 5 in persons over 40 years of age. With current trends and without effective interventions, this prevalence is expected to rise.

Diabetes mellitus is one of the leading health problems in the Caribbean, contributing significantly to morbidity and mortality and adversely affecting both the quality and length of life.

In the Caribbean, higher prevalence in women correlates with higher levels of obesity. There is evidence to suggest that the prevalence of Type 2 diabetes is increasing in children and adolescents, which is also likely to be due to an increasing prevalence of obesity in these groups. Consistent with other reports, a study conducted in Trinidad and Tobago showed that persons of South Asian origin had a higher prevalence of diabetes than other ethnic groups, highlighting the relevance of ethnicity as a risk factor.

Diabetes more often affects people of lower socioeconomic status who carry a greater disease burden for many reasons including limited access to or utilization of health care, poor nutrition, and suboptimal physical activity. The disease also places a heavy economic burden on already limited healthcare resources in the Caribbean. Costs are related directly to treatment of the disease and its complications, and indirectly to loss of earning power in those affected.

WHO estimated the worldwide prevalence of diabetes in adults to be around 173 million in 2002 and predicted that there will be at least 350 million people with Type 2 diabetes by 2030. At present about two-thirds of persons with diabetes live in developing countries and the majority of new cases will originate from these areas. The global increase in the incidence of diabetes is related to high levels of obesity associated with a change from traditional diets, diminishing levels of physical activity, population ageing and increasing urbanization.