Comparing metabolic control and complications in type 2 diabetes in two Pacific Islands at baseline and following diabetes care intervention.

AIM: To compare metabolic control and complications in people with type 2 diabetes in Nauru and the Solomon Islands before and after a project intervention. METHODS: This follow-up study compared metabolic control and complications in a cohort of 216 people with diabetes (81 from Nauru and 135 from the Solomon Islands) at baseline and 15 months following a project intervention (upgrading and equipping the existing diabetes centres, and providing training and clinical support systems) aimed at improving the quality of clinical diabetes care. Subjects were screened using a standardised protocol which gathered information on demographics, treatment, physical and biochemical parameters and their outcomes. RESULTS: At follow-up, glycaemic control had improved and mean HbA1c had decreased in study participants in both Nauru (mean difference (MD) = -0.9 ± 2.3%) and the Solomon Islands (MD = -0.6 ± 1.4%), P < 0.001. Mean blood pressure was reduced in the Solomon Islands (systolic MD = -11.6 ± 19.2 mmHg and diastolic MD = -5.4 ± 10.5 mmHg), P < 0.001. There were no significant changes in mean blood lipids or albumin-creatinine ratio. Overall the percentage of subjects achieving recommended clinical targets increased. However these percentages remained low, e.g. 23.5% of participants in Nauru and 20.7% in the Solomon Islands achieved an HbA1c target <7% (53 mmol/mol). A trend towards lower complications rates of foot problems was observed but there were no significant changes in the prevalence of other diabetes complications. CONCLUSIONS: This study indicates improved metabolic control but little change in diabetes complications 15 months after intervention. Efforts to improve and evaluate the ongoing quality and accessibility of diabetes care in Pacific Island settings need to be further strengthened.

Counting the Cost of Diabetes in the Solomon Islands and Nauru.

AIM: To determine the costs associated with diabetes to governments, people with diabetes and their carers, and its impact on quality of life in two Pacific Island countries--the Solomon Islands and Nauru. MATERIALS AND METHODS: This cross-sectional cost of illness study was conducted on 330 people with type 2 diabetes (197 from the Solomon Islands and 133 from Nauru) using a structured cost of illness survey questionnaire adapted from the Australian DiabCo$t study. Quality of life was measured by the EQ-5D Visual Analogue Scale. RESULTS: There were 330 respondents (50% female; mean duration of diabetes 10.9 years; mean age 52.6 years). The estimated annual national cost of diabetes incurred by the Solomon Islands government was AUD 12.8 million (AUD 281 per person/year) and by Nauru government was AUD 1.2 million (AUD 747 per person/year). The major contribution to the government costs was inpatient services cost (71% in the Solomon Islands and 83% in Nauru). Annual expenditure for diabetes was approximately 20% of the governments' annual health care expenditure. Considerable absenteeism and retirement from work due to diabetes was found. CONCLUSIONS: This study found substantial public and personal costs associated with diabetes. The findings provide objective data on which health policy, funding and planning decisions about the prevention and control of diabetes in the Solomon Islands and Nauru can be reliably based and subsequently evaluated.

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

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.

Diabetes related amputations in Pacific Islands countries: a root cause analysis of precipitating events.

AIM: To identify precipitating events and factors preceding diabetes related amputations in Pacific Islands countries (PICs). METHODS: Using a root cause analysis approach, a questionnaire seeking information on events leading up to amputation was administered to a convenience sample of 85 people with diabetes in three PICs (Solomon Islands, Nauru and Vanuatu) who had a lower limb amputation in the previous five years. RESULTS: There were 85 participants (36% females) with a mean age of 54.1 years and a mean diabetes duration of 10.5 years prior to amputation. The first event was trauma and an infected wound in 55% and a blister in another 41%. Half (51%) did take any action soon after the initial trigger event. The major reasons leading to the amputation included delaying treatment (42%), use of traditional treatments (18%) and insufficient knowledge about foot care (11%). 36% of participants had not received foot care information prior to the amputation and 19% did not attend anywhere for regular treatment. CONCLUSIONS: This study identified key precipitating events and underlying factors which contribute to diabetes related amputations and which, if addressed successfully, have the potential to reduce amputations rates.