A diabetic hypertension treatment program for the underserved in rural Dominican Republic


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 <7.0 was 79.8%. Conclusion: Utilizing a best practice approach per internationally agreed-upon parameters has been shown here to be not only relevant but capable of improving outcomes in a developing world setting. A model incorporating standard of care, education, and integration of local resources as established suggests that further study is warranted to evaluate the long-term benefits as well as secondary outcomes of this approach to local populations.

Share and Cite:

Cruz, M. , Filipi, L. , Estevez, J. , Marte, E. , Dethlefs, H. , Dowd, R. , Legner, A. , Kottoor, V. and Filipi, C. (2012) A diabetic hypertension treatment program for the underserved in rural Dominican Republic. Open Journal of Internal Medicine, 2, 72-79. doi: 10.4236/ojim.2012.22015.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] World Health Organization (2011) Diabetes. http://www.who.int/mediacentre/factsheets/fs312/en/
[2] Empirica (PowerPoint Slides) (2008) http://www.empirica.com.do/profesores/ffuentes/myfiles/presentaciones/DIABETES%20-%20NIP%20PRESENTATION.pdf
[3] World Health Organization (2011) Fact Sheet No. 317.
[4] Acosta, D., Rottbeck, R., Rodriquez, J., Gonzalez, L.M. and Almanzar, M.R. (2010) The prevalence and social patterning of chronic diseases among older people in a population undergoing health transition. A 10/66 Group cross-sectional population-based survey in the Dominican Republic. http://www.mendeley.com/research/the-prevalence-and-social-patterning-of-chronic-diseases-among-older-people-in-a-population-undergoing-health-transition-a-1066-group-crosssectional-populationbased-survey-in-the-dominican-repu
[5] Personal Communication with Dr. Rodolfo Ortiz, Institute for Latin American Concern, Santiago, 9 or 10 November 2010.
[6] National Bureau of Statistics of the Dominican Republic. The Rural Areas of the Dominican Republic. Statistical Overview. Year 2, No. 9. Monthly Bulletin. Dominican Republic. September 2008. http://www.one.gov.do/index.php?module=articles&func=view&catid=207
[7] Cabellero, E., Ward, K., Ferro, A.M., Grant, R. and Koen, M. (2008) La horotoria de rosa. Joslin Diabetes Center, Boston.
[8] Guzman, J.R., Lyra, R., Aguilar-Salinas, C.A., Cavalcanti, S., Escano, F., Tambasia, M., et al. (2010) Treatment of type 2 diabetes in Latin America: A consensus statement by the medical associations of 17 Latin American countries. Revista Panamericana de Salud Pública, 28, 463-471. doi:10.1590/S1020-49892010001200008
[9] Piette, J.D., Milton, E.C., Aiello, A.E., Mendoza-Avelares, M.O. and Herman, W.H. (2010) Comparison of three methods for diabetes screening in a rural clinic in Honduras. Revista Panamericana de Salud Pública, 28, 49-57. doi:10.1590/S1020-49892010000700008
[10] Garcia, R. and Suarez, R. (2007) Results of a Cuban education strategy in diabetes after 25 years of experience. Revista Cubana de Salud Pública, 33, April-June 2007.
[11] Miccoli, R., Penno, G. and Del Prato, S. (2011) Multidrug treatment of type 2 diabetes: A challenge for compliance. Diabetes Care, 34, S231-S235.
[12] Davies M. (2004) The reality of glycaemic control in insulin treated diabetes: Defining the clinical challenges. International Journal of Obesity and Related Metabolic Disorders, 28, S14-S22.
[13] Himalayan Cataract Project (2009) All about vision. http://www.allaboutvision.com/conditions/cataract-surgery-cost.htm

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.