There are several gaps in our knowledge about diabetes and other non-communicable diseases (such as hypertension, high cholesterol and cancer) in Jamaica and the Caribbean

For instance while we have some estimates on the number of persons affected by diabetes in Jamaica, we do not know much about how common each type of diabetes is or the rate at which people are developing the disease. We also do not know how many persons with diabetes are affected by eye, kidney or nerve damage, heart disease or amputations or how these complications impact lives and survival. More importantly there are still discoveries to be made for us to understand who is at risk for diabetes, which persons develop certain complications, how it can be prevented or detected early and what treatment are the most effective in reducing complications and early death from this disease. More research is definitely needed in Jamaica and the Caribbean to understand these issues.

Local research is critical

Many of the recommendations that we make on non-communicable diseases are based on studies that have been done overseas. While many of these findings will apply to patients in Jamaica – there are some differences in our setting that make local research critical. One example of this is the use of the HbA1c to diagnose diabetes. The HbA1c result can be affected by iron deficiency anaemia and the presence of abnormal haemgloblins like sickle cell trait. These conditions are very common in Jamaica and so we are not sure if this recommendation is one we should also endorse. There is therefore a need for new tests to detect diabetes that are not affected by these factors and we should be actively involved in developing and evaluating them in our setting.

We can only answer some of these important questions about the care of non-communicable diseases care by doing research that can tell our own story.   The types of studies that we need to answer these questions are often costly and funding typically comes from international agencies through a very competitive application process. While many applications are not successful, with each funded project provides us with a chance to address important knowledge gaps that can help improve the lives of persons living with and affected by non-communicable diseases.

In addition to funding, research also depends on persons willing to participate in these activities. Research volunteers give up their time to answer questions and provide information that is needed to understand these issues. Some studies collecting blood, urine, hair and nails or doing special studies that may not be offered routinely. As researchers we are grateful to those persons who are willing to make this sacrifice to address important knowledge gaps.

Why the LIFE Project?

The University of the West Indies Caribbean Institute for Health Research is conducting several studies to address local health needs and issues. The LIFE project is one of our biggest projects addressing diabetes. This island-wide cohort (follow up study) of Jamaicans will help us to understand risk factors for diabetes as well as high blood pressure, heart disease and cancer.

We plan to enroll 8000 participants for this study. In the LIFE project we collect information on from participants on who they are (age, education, occupation, family history and genetic information), the communities in which they live and how they life (lifestyle practices – eating, drinking, alcohol use, smoking, physical activity, sleep, their work) to see what may put them at risk or even protect them for these chronic illnesses. Volunteers also donate blood, urine, hair and nail samples that can be used to understand how we can identify persons at risk for these conditions and which may help us to develop new tests or treatments that can improve disease outcomes.

With our own data, we can now tell our own story

The information that is provided from the LIFE project and other studies will not only allow us to tell our story but also share our story with others. By comparing our experiences of Jamaicans with those of other black populations in the Caribbean USA, UK and Africa we can better understand what is causing the high burden of chronic diseases and make a difference in the fight against these conditions.

Help us tell our story in the fight against non-communicable diseases by guiding, volunteering, and supporting local research.

(Kingston, Jamaica) – Even though the Coronavirus pandemic has shifted the global focus away from other life threating diseases in some countries, the Caribbean Institute for Health Research (CAIHR) of the University of the West Indies (UWI) remains resolute in playing its part in the fight against the equally devastating epidemics, namely, cancer, cardiovascular diseases and diabetes. These non-communicable diseases (NCD) have consistently been claiming more lives than any other disease, and particularly among Black populations in the United States (US) and many countries within the Caribbean.

In response to this critical issue and the high burden of NCDs in Jamaica, CAIHR through its Living in Full Health (LIFE) Project is increasing health research efforts and embarking on a collaborative cohort approach study, where 8,000 Jamaicans will be enrolled and monitored overtime in order to understand the role of genetics, social, environmental and lifestyle factors in cancer, cardiovascular disease and diabetes. The study is funded by the US National Institutes of Health and was conceptualized as part of ongoing collaborations spearheaded by Professor Marshall Tulloch-Reid (CAIHR), Professor Kimlin Ashing (City of Hope Cancer Center, USA) and Professor Camille Ragin (Fox Chase Cancer Center, USA), all members of the African Caribbean Cancer Consortium (AC3).

The CAIHR Institute officially launched the project on Tuesday, December 15, 2020 at the UWI Regional Headquarters in Kingston.

During his remarks at the Launch Health Minister, Dr. the Hon Christopher Tufton said:

“We need to look no further than at the nexus between NCDs and COVID-19 to sharpen our focus on the scale of the problem and the urgent need for its prioritization. Persons with NCDs, we now know, are more likely to suffer adverse health outcomes, including death, from contracting COVID-19.”

New health research

The Minister added that this new health research builds on the work of the Jamaica Health and Lifestyle 2016/17Survey, which he said underscored the scale of the local NCD challenge. “For example, it revealed that one in three Jamaicans 15 years and older has hypertension, while one in eight has diabetes. At the same time, four of every 10 Jamaicans with either diabetes or hypertension are unaware of their status.”

The 8,000 Jamaicans being studied will primarily be chosen from a sample of men and non-pregnant women, aged 30-70 years, who under the study will be administered questionnaires, have body (weight, height, waist and neck) and blood pressure measurements taken and biological samples such as blood, saliva, urine or nails for evaluation. Permission to review medical reports to help to confirm the presence of certain health conditions will also be requested from participants.

With data showing that Jamaicans form the second largest non-Hispanic Black migrant group to the US, Professor Camille Ragin in her presentation highlighted this as one important reason for the US National Institutes of Health’s call for this type of project proposal. She said, the LIFE Project is mandated to “support a better understanding of the health of people living in the Caribbean and will further enable these cohorts to be used in comparative research on the health of Caribbean immigrants in the US.”

The Jamaican perspective

Many of these research studies in the US have a poor representation of Black and Caribbean people as they are often unwilling to participate, despite the high NCD burden in this population. It is for this reason that Professor Marshall Tulloch-Reid, Director of CAIHR and Co-Principal Investigator of the LIFE Project, while giving an overview of the project, highlighted that, one of the primary objectives of the study is to “identify the best strategies to optimize enrollment and retention of Caribbean nationals in cohort studies.”

This he said while highlighting the importance of the Jamaican perspective on the matter and noted that the inclusion of the ordinary Jamaican voice matters.

Professor Tulloch-Reid said, “Going house to house and inviting persons living in these selected communities to participate in the study is part of the LIFE Project’s method of gathering data to help to ensure a representative sample of all Jamaicans.”

However, he pointed out that the project administration has adapted similar but revised safety methods to meet the coronavirus situation.

The research team

The team of researchers involved in the project include lab scientists, psychologists, behaviour specialists, epidemiologists, statisticians, computing/data specialists and health professionals from the Caribbean and the USA. Members of the public will also have key input in providing reference for the areas they would like the study to address.

The LIFE project will build on the lessons learned from studies already conducted in Jamaica, Barbados, the Bahamas and the USA.

Cohort studies are a very powerful research method that involves collecting information from participants and following them over time to see whether they develop specific conditions. This type of study provides some of the best evidence when putting in place measures to improve healthcare and prevent these conditions among vulnerable groups.

The primary role of CAIHR is to conduct a high-quality research that can inform health policy, programmes and healthcare delivery for regional populations.