The prevalence of diabetes complications and associated risk factors in Pacific Islands countries

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Abstract

Aim

To determine the prevalence of diabetes complications and associated risk factors among people with type 2 diabetes in three Pacific Island countries, Nauru, Solomon Islands and Vanuatu.

Methods

This cross-sectional study was carried out on a sample of 459 people with diabetes. Subjects were screened for complications using a standardised protocol which gathered information on demographics, physical and biochemical parameters.

Results

Of the 459 subjects, 47% were female, mean age was 54 years and mean duration of diabetes was eight years. The prevalence of diabetes complications was significantly higher in Nauru compared with the Solomon Islands and Vanuatu – microalbuminuria 71%, 36% and 51% respectively (P < 0.001), retinopathy 69%, 40% and 42% respectively (P < 0.001), and abnormal foot sensation 30%, 23% and 19% respectively (P = 0.036). The prevalences of hypertension, overweight/obesity and poor glycaemic control were high. The percentages of subjects achieving recommended clinical targets were low. Microalbuminuria was significantly associated with duration of diabetes, hypertension and glycaemic control. Diabetic retinopathy was significantly associated with duration of diabetes whereas abnormal foot sensation was significantly associated with duration of diabetes and glycaemic control.

Conclusions

This study found a high prevalence of diabetes complications and associated risk factors, which indicate the need to improve diabetes care and strengthen preventive efforts to reduce complications.

Introduction

The magnitude of the global health burden of diabetes [1], [2] and its negative implications for human development and achievement of global development goals [3], [4] is well documented. The vast majority of this burden is due to complications of diabetes and accounts for substantial costs [5], [6].

Many studies from a range of countries have reported the prevalence of complications and related risk factors among people with diabetes. Diabetes complications can be prevented through proven cost effective interventions [7], [8]. Multi-risk factor interventions which include lifestyle changes and pharmacological therapy have been shown to reduce the risk of diabetes complications by up to 50% [9], [10].

The risk of microvascular complications is reduced by intensive glycaemic control [11] and tight blood pressure control [12]. Regular risk factor assessment in the primary care setting minimises hospitalisation due to diabetes complications [13], and improvements in systems of diabetes care, screening and treatment programmes for diabetes improve diabetes clinical outcomes [14], [15].

Pacific Island countries (PICs) have a limited capacity to deliver effective diabetes prevention and care [16], [17] and the proportion of people with diabetes who practice self care is low [18]. Despite anecdotal reports of high rates of diabetes complications in PICs, a formal literature search yielded no recent peer-reviewed literature on the prevalence of diabetes complications in these countries. Consequently, as part of a larger capacity building project, we aimed to (i) determine the prevalence of diabetes complications and associated risk factors in people with diabetes in three PICs: Nauru, the Solomon Islands and Vanuatu, and (ii) assess the control of risk factors against recommended clinical targets.

Section snippets

Subjects, materials and methods

This cross-sectional study was carried out on a convenience sample of 459 people with known diabetes (100 from Nauru, 160 from the Solomon Islands, and 199 from Vanuatu) to determine the prevalence of diabetes complications and associated risk factors. Subjects attending the diabetes clinics in each country during a one week period, which co-incided with a visit by an Australian diabetes team, were screened using a standardised protocol. Data were collected on age, gender, age at diagnosis,

Results

Table 1 shows the demographic details of the 459 people (mean age 54 years, mean age at diagnosis 46 years, and mean duration of diabetes eight years) screened for complications and associated risk factors by country. Overall there were 244 (53%) males (mean age 53.9 years) and 215 (47%) females (mean age 54.1 years). Subjects in Nauru were younger than those in the Solomon Islands and Vanuatu but had the longest duration of diabetes. The percentage treated with diet alone in Nauru, Solomon

Discussion

This study found a high prevalence of diabetes complications and associated risk factors among people with diabetes, and a low rate of subjects achieving standardised clinical targets in all three PICs.

The prevalence of microalbuminuria, an indicator of future nephropathy, found in this study was 71%, 36% and 51% in Nauru, Solomon Islands and Vanuatu respectively which overall was higher than in previous studies in PICs (23.4% in Samoa [19], 33.3% in Pacific Islanders in South Auckland [20] and

Conflict of interest

None known or perceived.

Acknowledgements

The World Diabetes Foundation funded the overarching diabetes capacity building projects in Nauru, Vanuatu and the Solomon Islands under which this study was undertaken. These projects were conducted in partnership with the Ministries of Health of the Solomon Islands, Nauru and Vanuatu, the International Centre for Eyecare Education at the University of New South Wales, the Australia and New Zealand Society of Nephrologists. Additional support was provided by University of Sydney's Medical

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