Abstract
BackgroundOnce considered an affliction of people in high-income countries, diabetes mellitus is increasingly seen as a global epidemic. However, for many countries very little is known about the prevalence of diabetes and its complications. This study aims to estimate the prevalence of diabetes, and diabetic retinopathy, in adults in Timor-Leste.MethodsFrom March 2013 to May 2014, adult patients being assessed for cataract surgery at the Sentru Matan Nasional (National Eye Centre) in Dili, Timor-Leste had a point-of-care HbA1c measurement performed on the DCA Vantage device (Siemens Ltd) under a quality framework. A diagnostic cut-off of 6.5% (48 mmol/mol) HbA1c was used for diagnosis of diabetes. Ocular examination, blood pressure, demographic and general health data were also collected. Diabetic retinopathy assessment was carried out by ophthalmologists.ResultsA total of 283 people [mean age 63.6 years (range 20–90 years)] were tested and examined during the study period. Forty-three people (15.2%) were found to have diabetes, with a mean HbA1c of 9.5% (77 mmol/mol). Of these, 27 (62.9%) were newly diagnosed, with a mean HbA1c of 9.7% (83 mmol/mol) and a range of 6.6–14% (49–130 mmol/mol). Nearly half (48.1%) of people newly diagnosed with diabetes had an HbA1c over 10.0% (86 mmol/mol). Of those with known diabetes, only 68.8% were receiving any treatment. Mean HbA1c for treated patients was 9.9% (85 mmol/mol). Diabetic retinopathy was identified in 18.6% of people with diabetes, of whom half had no previous diagnosis of diabetes.ConclusionsThis study estimates the prevalence of diabetes at 15% in adults in Timor-Leste, a substantial proportion of whom have evidence of diabetic retinopathy. This is consistent with regional estimates. With the majority of patients undiagnosed, and management of people known to have diabetes largely inadequate, point-of-care testing is a valuable tool to assist with diabetes case detection and management. Whilst only a preliminary estimate, our data provides important impetus for further investigation of the prevalence and impact of diabetes in Timor-Leste. It provides guidance that further investment is required in expanding testing, as well as in prevention and treatment.
Highlights
Once considered an affliction of people in high-income countries, diabetes mellitus is increasingly seen as a global epidemic
283 patients were included in the study over a 14-month period between March 2013 and May 2014. This represents a consecutive series of adult cataract patients, with exceptions for periods of time when the HbA1c device was unavailable for testing
The issues around management of diabetes are clearly highlighted by the finding that the group of treated patients had higher mean HbA1c than those that were newly diagnosed at the National Eye Centre
Summary
Once considered an affliction of people in high-income countries, diabetes mellitus is increasingly seen as a global epidemic. This study aims to estimate the prevalence of diabetes, and diabetic retinopathy, in adults in Timor-Leste. Once considered a disease of affluent countries, rates of diabetes are increasing in low- and middle-income countries. It is estimated that worldwide around 346 million people suffer from diabetes, with 80% of these in low- and middleincome countries [1]. Timor-Leste is one of the world’s newest countries, having regained its independence in 1999 following a referendum. It was recognized by the United Nations in 2002. Timor-Leste remains a predominantly rural nation (70.4%), its rate of urbanization (4.18% per year) exceeds its growth rate (2.40% per year), largely driven by migration to Dili in search of cash employment [7]
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