DIABETES AND ITS MACROVASCULAR AND MICROVASCULAR MANIFESTA TIONS AMONG MICRONESIAN POPULA TIONS

Abstract

This is a retrospective study. Over a period of 2 years between January 2000 and December 2001, a total of 416 adult diabetic subjects were admitted to various wards of Majuro hospital .The case records of the patients of both genders aged greater than 15 years and irrespective of underlying diseases were reviewed. A definitive diagnosis was made based on clinical features and blood glucose estimations according to American Diabetes Association. There were 3,731 eligible subjects of which 416 were confirmed cases of diabetes mellitus (202 men and 214 women). The overall percentage of diabetes was 11.14%. Diabetes in females was slightly higher than in males. Diabetes significantly increased with age and was highest in 50-64 years. Of all diabetes 97.35% were type 2. Gestational diabetes diagnosed first time during pregnancy was 1.20%. About 33.17% of patients presented with uncontrolled diabetes and in 0.96% ketoacidosis and non-ketotic hyperosmolar state was found. The most common and frequent chronic complications were diabetic foot and gangrene (27.88%), cardiovascular (10.33%) and renal (7.45%) patients. Major and minor amputations were done in 29 and 51 patients respectively. Interestingly malignant otitis externa was found in (1.68%) of patients. The majority of patients (88.46%) improved after admission. The overall mortality rate was 8.89%. This study showed a trend of increasing diabetes with age in both sexes, reaching the highest rate in the fifth and sixth decades of life. Obesity, a high caloric western diet, aging populations and reduced physical activity may be the major precipitating factors.