Case Definition

Clinical assessment

  • Assess risk factors: >45 years, overweight,HTN/dyslipidemia, family history4
  • Assess symptoms: polyuria, polydipsia, hunger, weight loss, fatigue1, 3,4
  • Diagnose diabetes if:
    • Fasting (8hrs) BS >120-126mg/dl2,3,4on two occasions1,2,4,
    • Random BS >200mg/dl 1,2,4 and/or symptoms3 on two occasions2

Red Flags

  • Urgent follow-up for random BS >400mg/dl4
  • Hospital for random BS >200mg/dl WITH hypertension, dehydration, altered mental status4,
  • Urine for glucose, ketones or proteins6
    • If 2+ proteinuria on 2 different days, order serum creatinine and potassium. If GFR is <30, refer to nephrology.4

Management

General recommendations

  • Record BP, pulse, BMI4, check and record BS liberally2, 3,6, 10
  • Monitor for complications (vision changes, diabetic neuropathy, diabetic ulcers)4, 6,
  • Lifestyle changes including diet, exercise, weight loss1,4
  • Educate on signs of hypoglycemia and hyperglycemia6

Pharmacologic treatment

  • 1st line: Metformin 500mg BID1,2,4, 6, 8,9,12(may increase after a few weeks9
  • 2nd line: Sulfonylurea (glybenclamide, glyburide, glipizide, glimeprimide)2,4, 6, 8, 9, 11, 12
    • Start if FBS >200 despite lifestyle changes and metformin4

 

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1. Organization A

Locations: Nicaragua
Trips per year: 4
Format of trips: Mobile medical clinics and standing clinics
Setting: Rural
Type of Organization: Secular

2. Organization B

Locations: Guatemala
Trips per year: Variable
Format of trips: Clinics
Setting: Rural
Type of Organization: Secular

3. Organization C

Locations: Haiti
Trips per year: Variable
Format of trips: Clinic
Setting: Urban
Type of Organization: Faith-based

4. Organization D

Locations: Dominican Republic
Trips per year: 3
Format of trips: Clinic
Setting: Rural
Type of Organization: Secular

5. Organization E

Locations: Haiti
Trips per year: 7
Format of trips: Not mentioned
Setting: Rural
Type of Organization: Secular

6. Organization F

Locations: Honduras, Ecuador, Belize, Guyana, Guatemala
Trips per year: 5
Format of trips: Mobile brigades
Setting: Rural and Urban
Type of Organization: Faith-based

7. Organization G

Locations: Ecuador, Guatemala, Dominican Republic
Trips per year: 100 (spread over 6 sites)
Format of trips: Mobile brigades
Setting: Rural and Urban
Type of Organization: Secular

8. Organization H

Locations: Ecuador
Trips per year: 3
Format of trips: Mobile brigades in schools/Clinics in health centers
Setting: Rural
Type of Organization: Secular

9. Organization I

Locations: Honduras
Trips per year: 1
Format of trips: Mobile brigades in 20 villages
Setting: Rural
Type of Organization: Faith-based

10. Organization J

Locations: Jamaica, Haiti
Trips per year: 4
Format of trips: Mobile brigades, Permanent clinics/hospital medicine
Setting: Rural and urban
Type of Organization: Secular

11. Organization K

Locations: Haiti
Trips per year: 4
Format of trips: Clinic
Setting: Rural
Type of Organization: Secular

12. Organization L

Locations: Guatemala, Nicaragua
Trips per year: 3
Format of trips: Mobile clinics
Setting: Rural
Type of Organization: Faith-based

13. Organization M

Locations: Nicaragua, Honduras
Trips per year: 51
Format of trips: Mobile brigades, Hospital-based
Setting: Rural
Type of Organization: Faith-based

14. Organization N

Locations: Guatemala
Trips per year: 12
Format of trips: Hospital
Setting: Rural
Type of Organization: Secular

15. Organization O

Locations: Honduras
Trips per year: Up to 50
Format of trips: Mobile brigades in school and churches
Setting: Rural
Type of Organization: Faith-based

16. Organization P

Locations: Haiti
Trips per year: Variable
Format of trips: Mobile brigades and clinics
Setting: Rural and urban
Type of Organization: Secular

17. Organization Q

Locations: Dominican Republic, Haiti
Trips per year: 12 to 15
Format of trips: Mobile brigades
Setting: Rural
Type of Organization: Secular

18. Organization R

Locations: Honduras, Nicaragua, Panama
Trips per year: Hundreds
Format of trips: Mobile brigades in community centre or school
Setting: Rural
Type of Organization: Secular

19. Organization S

Locations: Honduras
Trips per year: 4
Format of trips: Mobile brigades, Specialty hospital services
Setting: Rural
Type of Organization: Secular

20. Organization T

Locations: Haiti
Trips per year: Approximately 40
Format of trips: Mobile clinics in 14 villages and Standing clinic
Setting: Rural
Type of Organization: Faith-based