Collaborative study may help prevent diabetes in developing countries

Jun 12, 2017

ITDI student group

Faculty from OHIO and group of students from OHIO and PUCE in Loja Providence in Ecuador.

ITDI student examining patient

The data collection team included students from OHIO and PUCE from Ecuador.

A newly published study by researchers from Ohio University’s Heritage College of Osteopathic Medicine, the College of Health Sciences and Professions, and the Pontifical Catholic University of Ecuador at Quito (PUCE), is a step forward in the battle against chronic diseases in Ecuador. It also showcases how the close and strengthening relationship between OHIO and PUCE, including student team members from both institutions, is improving health prospects in that country.

While excess weight and other obesity-related non-communicable diseases are of growing concern in low-middle income countries in Latin America, there is limited research on risk factors associated with type 2 diabetes mellitus in adolescents. The study investigated the prevalence of overweight, obesity, prediabetes, diabetes and metabolic syndrome in adolescents in Ecuador.

The study, “Cardiometabolic risk factors, metabolic syndrome and pre-diabetes in adolescents in the sierra region of Ecuador,” [1] was launched in 2015 by a small group of researchers across the Heritage College, CHSP and PUCE, and was recently published in Diabetology & Metabolic Syndrome Journal.  It is the fruit of a collaborative effort to determine pre-diabetes risk factors in adolescents in southern Ecuador, which will be fundamental in developing additional research and designing effective health strategies.

The research team included:

  • Sharon Casapulla, Ed.D., Director of Education and Research for the Heritage College Office of Rural and Underserved Programs, Director of the Rural and Urban Scholars Pathways (RUSP) Program, and Assistant Professor of Family Medicine
  • Cheryl Howe, Ph.D., Associate Professor of Exercise Physiology, OHIO School of Applied Health Sciences and Wellness
  • Gabriela Rosero, instructor at PUCE
  • Darlene Berryman, Ph.D., Executive Director of the Diabetes Institute and Professor of Biomedical Sciences
  • Mario Grijalva, Ph.D., Director of the Heritage College’s Infectious and Tropical Disease Institute and Professor of Microbiology
  • Edgar Rojas, MPh., Professor at PUCE
  • Masato Nakazawa, Biostatiscian, Ohio University
  • Jay Shubrook, D.O., former Heritage College Associate Professor of Family Medicine, now Professor and Diabetologist, Director of Clinical Research and Diabetes Services, Touro University, California College of Osteopathic Medicine and Director of Diabetes Services for the Solano County, California Health Systems  

The first data collection team, led by Rosero, Casapulla and Howe, and including students from PUCE and OHIO, travelled to Quito over spring break in 2015. The second group travelled back to Ecuador in the summer of 2015 as part of the Tropical Disease Research Program and collected additional data in schools in Loja province. 

Over 430 adolescents were included in the study. Ohio medical, nursing and exercise physiology students and PUCE nursing and nutrition students participated in the entire process, side-by-side with faculty researchers. Their contributions included setting up the research site, documenting consent from participants, taking anthropometric data and blood pressure, and conducting fitness testing.

The study had some notable findings. It is well known that excess weight is the major modifiable risk factor for type 2 diabetes mellitus and other non-communicable diseases. However, excess weight may not be as predictive of diabetes risk as once thought.  It was determined that use of HbA1c identified more adolescents with prediabetes than did fasting blood glucose. The HbA1c measure is an attractive screening tool for prediabetes in developing countries. Although rates of obesity in Ecuadorian adolescents are low, there is significant evidence to suggest that prediabetes is permeating the smaller urban centers. Traditional screening tools may underestimate this risk.

The research also highlighted the collaborative partnership between OHIO and PUCE. “It was a complex project to pull off and required strong logistical coordination,” said Casapulla, lead author of the journal article. “We are grateful for the support and assistance provided by the staff at CISeAL in Ecuador throughout the study. With this support we were able to create a meaningful learning experience for all of the Ohio and PUCE students, as well as contribute new knowledge to the field of diabetes research and adolescent health.”

This study and publication represent an important milestone in a new collaboration formed between the Diabetes Institute (DI) and the Infectious and Tropical Disease Institutes (ITDI) at Ohio University, the Center for Research on Health in Latin America (CISeAL) at PUCE, and Touro University in California. This collaboration reaffirms that working across intuitions, geographies and cultures is essential to foster interactions and address global health complexities. Funding was provided for this project from the Research and Scholarly Awards Committee (RSAC) fund and the Ohio University Heritage College of Osteopathic Medicine Konnkeker Fund. Funding was also provided by the Diabetes Institute (DI), the Infectious and Tropical Disease Institutes (ITDI), the Center for Research on Health in Latin America (CISeAL) at PUCE, and Touro University in California.

Researchers from PUCE also reiterate the importance of this publication, “In Ecuador there are few studies in this category,” said Rojas, investigator at CISeAL. “Those show that the approach to chronic diseases should be initiated in adolescents, so the risk factors can be identified in time for intervention purposes. This study also shows the importance of inter-university and interdisciplinary cooperation to study these types of pathologies.

As well, it is important to note the participation of the Diabetes Institute at Ohio University in conducting this research. Dr. Berryman, PhD, RD, LD and executive director of the Diabetes Institute at Ohio University expressed “ Chronic disease rates are dramatically increasing in many regions in South America.  Assessing the risk factors associated with these conditions, particularly in adolescents, is critical to inform future research and intervention studies to address this increase.  At the Diabetes Institute, we are thrilled by the enthusiasm of our PUCE/CISEAL collaborators and the support provided our peers at the Infectious and Chronic Disease Institute for completion of this and ongoing studies.”

[1] Casapulla, S., Howe  C., Rosero, MG., Berryman, D., Grijalva, MJ, Rojas, EW., Nakazawa, M., & Shubrook, J.  Cardiometabolic risk factors, metabolic syndrome and pre-diabetes in adolescents in the Sierra Region of Ecuador. Diabetology and Metabolic Syndrome 9(24); 1-9.