TITLE:
A diabetic hypertension treatment program for the underserved in rural Dominican Republic
AUTHORS:
Miguel Cruz, Linda Filipi, Josefina Estevez, Evaristo Marte, Han Dethlefs, Rachel Dowd, Andras Legner, Vinayak Kottoor, Charles Filipi
KEYWORDS:
Diabetes; Pre-Diabetes; Hypertension; Treatment; Developing; Country
JOURNAL NAME:
Open Journal of Internal Medicine,
Vol.2 No.2,
June
11,
2012
ABSTRACT: Background: Worldwide, diabetes and hypertension are leading causes of preventable end-organ disease. The prevalence of these diseases in the Dominican Republic is high and the end stage complications common. A treatment program utilizing modern protocols often thought too complex for the rural poor was initiated. Methods: With local government permission, a pilot study utilized Dominican physicians and local healthcare advocates (cooperadores) to obtain medical histories and physical exams as well as to determine healthcare needs specifically for type 2 diabetes and hypertension. A glycosylated hemoglobin (A1c) was used to identify and stratify diabetes patients. Blood pressure parameters per established standards were used to identify patients with hypertension. As indicated, pharmacotherapy was initiated (see treatment protocols), multiple forms of education and awareness building utilized, and a protocol-driven follow-up program maintained under weekly review. Results: In fifteen months, 1405 patients were screened, 229 type 2 diabetes patients, 59 pre-diabetes patients, and 98 hypertension patients were identified and enrolled for education, treatment, and follow-up. Normalization of blood pressure in hypertensives at 6 month follow-up was 78% and reduction of A1c values to