Diabetic retinopathy and nephropathy in Fiji: Comparison with data from anAustralian diabetes centre

Background: As part of a project to improve diabetes care in Fiji, we asses sed the magnitude of problems posed by diabetic retinopathy in that country and compared the findings with those from an Australian diabetes centre. T he relationship between diabetic retinopathy and nephropathy was also exami ned in a subset of patients. Methods: A medical team from Australia screened a total oi 446 type 2 diabe tic patients (ethnicity: Fijian/lndian 16/84%) fdr diabetic retinopathy in live towns from the Western Division of Viti Levu, Fiji. The findings were compared with data obtained from 1659 type 2 diabetic patients who had atte nded an Australian diabetes centre (ethnicity: Indian/Anglo-Celtic 12/88%). In both cohorts, retinopathy was assessed by direct fundoscopy and a spot urine sample was collected for determination of albuminuria (defined as a c oncentration > 50 mg/L). Results: The prevalence of diabetic retinopathy increased linearly with dur ation of diabetes. It was higher in Fiji, even when cases from the same eth nicity (i.e. Indians) and duration were compared (P < 0.05). Extrapolation of the data points suggests a delay in the diagnosis of diabetes in Fiji. O f those patients with retinopathy in Fiji, more than half had moderate to s evere non-proliferative diabetic retinopathy or proliferative diabetic reti nopathy, significantly higher than patients in the Australian cohort (chi(2 ) = 29.2; P < 0.0001). Retinopathy was not a predictor of albuminuria in Fi jian Indians (chi(2) = 0.4; P = 0.5). In contrast, Australian Indians with retinopathy had significantly more albuminuria (chi(2) = 10.2; P = 0.001). Conclusions: Severe diabetic retinopathy is common in both ethnic groups in Fiji. A delay in the diagnosis of diabetes as well as poor glycaemic contr ol are possible factors. The availability of laser therapy is important to prevent loss of vision, but it is also essential that appropriate training of health professionals is integrated with a programme of diabetic complica tion screening to support this form of therapy.