How should developing countries manage diabetes?
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Cost of Illness↗
Biomedical subjects
Desmond Williams
Publications and source records attributed to Desmond Williams.
Dietary intake among youth with diabetes: the SEARCH for Diabetes in Youth Study.
OBJECTIVE: To describe dietary intake among a large cohort of youth with type 1 or type 2 diabetes and to compare their intake with current nutrition recommendations. DESIGN: SEARCH for Diabetes in Youth is a multicenter study of diabetes in youth. Diet was assessed among youth aged 10 to 22 years who attended a SEARCH research clinic visit and completed a previous-week food frequency questionnaire that included foods to reflect the ethnic and regional diversity represented by the cohort. SUBJECTS/SETTING: Included were 1,697 youth with physician-diagnosed diabetes mellitus (89% type 1 diabetes, 11% type 2 diabetes), with diabetes mellitus duration of at least 12 months. STATISTICAL ANALYSES: Descriptive data and comparisons with nutrition recommendations were unadjusted. Analyses of covariance with adjustment for total energy, clinic site, sex, race/ethnicity, age, and parental education were used to compare intake according to diabetes type. RESULTS: Percent of energy from total fat was consistent at 37% to 38% across subgroups of age (10 to 14 years, >15 years) and diabetes type (ie, type 1 or type 2). Youth with type 2 diabetes consumed less calcium, magnesium, and vitamin E than youth with type 1 diabetes (P<0.01 for each). Intake of sweetened carbonated beverages among older (aged >15 years) youth with type 2 diabetes was twice that of older youth with type 1 diabetes (P<0.01). Only 6.5% of the cohort met American Diabetes Association recommendations of <10% of energy from saturated fat. Less than 50% met recommendations for total fat, vitamin E, fiber, fruits, vegetables, and grains, although a majority met recommendations for vitamin C, calcium, and iron. CONCLUSIONS: Overall, dietary intake in this large cohort of youth with diabetes substantially failed to meet current recommendations. There is a critical need for improvement in dietary intake in youth with diabetes.
Adolescent↗
Validity of the SMAST in two American Indian tribal populations.
The standardized evaluation of alcoholism and other psychopathologies in minority populations, particularly American Indians, has long been questioned. This study investigated the validity of one of the most commonly applied assessments for alcoholism--the Short Michigan Alcohol Screening Test (SMAST)--in two distinct American Indian tribal groups. We analyzed data collected from 1989 to 1995 from largely community representative samples of 456 Southwestern and 214 Plains Indians ages 21 or older. For comparison, alcohol dependence was diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria from a detailed, modified version of the Schedule for Affective Disorders and Schizophrenia--Lifetime (SADS-L). Accuracy of the SMAST was quantified as sensitivity, specificity, likelihood ratios, and the area under the curve for receiver operating characteristics, using the DSM-III-R diagnosis as the reference. The standard SMAST cutoff score of > or = 3 had a demonstrated sensitivity 86% to 95%, but did not perform well in terms of specificity (23%-47%). Significantly higher cutoff scores (> or = 5 for both genders in the Southwestern tribe and 8 and > or = 6 for men and women in the Plains tribe) were required to demonstrate acceptable levels of specificity in both tribes. The findings suggest that the SMAST is not a valid tool to screen for alcohol misuse in these two tribal populations. The highly elevated and different thresholds required from one population to the next and from one gender to the next constitute a significant obstacle to the use of the instrument.
Adult↗