An Estimation of the Prevalence of Diabetes Mellitus and Diabetic Retinopathy Amongst Adults in Timor-Leste

Abstract

 

Purpose

 

Once considered an affliction of rich countries, diabetes mellitus is increasingly seen throughout the world. One of the serious microvascular complications of diabetes mellitus is diabetic retinopathy, an important cause of blindness worldwide.<br /> <br /> This study aims to estimate the prevalence of diabetes, and diabetic retinopathy, in Timor-Leste, one of the world’s newest and poorest countries.

 

Methods

 

Data collection took place March 2013 to May 2014 at the Sentru Matan Nasional (National Eye Centre) in Dili, Timor-Leste. Patients being assessed for cataract surgery had a point-of-care HbA1c measurement. Ocular examination, blood pressure, demographic, medical and family history data were also collected.

 

Results

 

A total of 283 patients were included. The mean age was 63.6 years (range 20-90 years). The mean HbA1c was 6.1%, range 4.2-14.0.<br /> <br /> Forty-three patients (15.2%) were identified as having diabetes mellitus. The mean HbA1c in this subset was 9.5%. Of patients identified with diabetes, 62.8% were newly diagnosed. Of those with known diabetes, 68.8% were receiving treatment of any kind including lifestyle modification, and the mean duration of known disease was 4.9 years.<br /> <br /> Diabetic retinopathy was identified in 8 patients (18.6%), of whom half had no previous diagnosis of diabetes. No proliferative diabetic retinopathy was found, though severe non-proliferative diabetic retinopathy was found in one patient who had not previously been diagnosed with diabetes.

 

Conclusions

 

This study estimates the prevalence of diabetes at 15% in adults in Timor-Leste, with a prevalence of retinopathy of 19% amongst people with diabetes. Although this likely represents an over-estimate, due to the age of the population tested and the relationship of cataract to diabetes, our estimate is in line with regional estimates and indicates that diabetes is an important potential source of blindness, as well as mortality, in Timor-Leste.<br /> <br /> With the majority of people with diabetes undiagnosed, point-of-care testing is a valuable tool. Further investment is required in expanding testing, as well as in prevention and treatment, as well as screening for and treatment of diabetic retinopathy. Diabetes presents an important challenge for a fragile health system, and along with other non-communicable diseases, a threat to hard-won economic gains.