DIABETES MELLITUS IN THE TROPICS

Abstract

Many diseases of temperate climates when seen in a tropical environment appear in a different guise. This is due more to the differences in age structure and culture of the population than to the climatic environment. Diabetes mellitus is no exception, and this book shows how diabetes occurs mainly in a West Indian population but also in the global tropics and among many different races and cultures. Among underdeveloped peoples diabetes is becoming more common, perhaps due to more changes in age structure, but also to a real increase in the disease. The incidence of diabetes from many parts of the world is given with evident racial differences in many parts. These figures have been obtained by personal contact and are as accurate as such figures can be. The reasons for the increase in the disease are discussed, including diet, heredity, obesity, and parity. The clinical features of the J-type of young, underweight, insulin-dependent individual who does not become ketotic are described. The rarity of diabetic coma in many areas is described, but this complication is becoming more common. The influence of pregnancy and sepsis on the disease is discussed. In the management of diabetes in tropical areas the necessity of adapting the treatment to local conditions and diet is deemed essential, and the difficulties of management of diabetics in an illiterate, poor rural community are by no means underestimated. A list of suitable dietetic regimes is given for various areas where these are applicable, but poverty makes many of these regimes almost impossible to institute. Where financial and administrative support is available, good advice is given on establishing diabetic clinics in tropical areas, and it is apparent that given enthusiasm these can work very well in many unpromising circumstances. This is a practical and useful book for anyone who practices under the conditions so ably described in the text. P. E. C. MANSON-BAHR