title: Diabetic eye disease among adults in Fiji with previously undiagnosed diabetes.
abstract: BACKGROUND
  To determine the prevalence and severity of diabetic eye disease among adults aged ≥40 years with unrecognized diabetes in Fiji.
  
  
  METHODS
  Population-based cross-sectional survey using multistage cluster random sampling.
  
  
  METHODS
  1381 (=73.0% participation).
  
  
  METHODS
  Interview-based questionnaire; visual acuity measured; dilated ocular examination performed; glycosylated haemoglobin (HbA1c) concentration determined.
  
  
  METHODS
  Prevalence and grade of diabetic retinopathy/maculopathy.
  
  
  RESULTS
  Sample prevalence of diabetes was 44.8% (95%CI 42.2-47.5%), with 63.4% (95%CI 59.5-67.1%) previously undiagnosed (384/606). Predictors of undiagnosed compared with previously diagnosed diabetes were female gender (P = 0.001), rural residence (P = 0.049) and not having a relative with known diabetes (P < 0.001). Twenty-two retinae of participants with previously undiagnosed diabetes were unexaminable (predominantly cataract). Of the remaining 746 eyes, 3.5% (95%CI 2.4-5.1%) had diabetic retinopathy/maculopathy, 1 (0.1%) had proliferative retinopathy and 4 (0.5%) had active significant maculopathy. Of eyes with diabetic disease, two (7.7%, 95%CI 1.0-25.3%) had diabetes-related vision impairment (3/60; 6/60). Sixteen previously undiagnosed participants (4.2%, 95%CI 2.5-6.7%) had diabetic disease evident in at least one eye: for four (all Melanesian women aged >50 years), this was vision-threatening (1.0%; 95%CI 0.3-2.8). Mean HbA1c (10.7 ± 2.6%) of participants undiagnosed and with diabetes eye disease was higher (P < 0.001) than that of those undiagnosed and without.
  
  
  CONCLUSIONS
  The prevalence of diabetic eye disease was low among this cohort, but where present, severe vision-threatening retinopathy/maculopathy was relatively common. If diabetic eye disease is to be avoided or ameliorated in Fiji, then community awareness of and access to diabetes diagnostic services must improve, particularly for women and rural dwellers.
authors.affiliation: The Fred Hollows Foundation New Zealand, University of Otago, Dunedin, New Zealand. grbrian@tpg.com.au
authors.forename: Garry
authors.initials: G
authors.lastname: Brian
authors.forename: Biu
authors.initials: B
authors.lastname: Sikivou
authors.forename: Konstanze
authors.initials: K
authors.lastname: Fischer-Harder
authors.forename: John
authors.initials: J
authors.lastname: Szetu
authors.forename: Mundi Qalo
authors.initials: MQ
authors.lastname: Qoqonokana
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Ramke
mesh_terms: D000328:Adult; D000368:Aged; D001766:Blindness / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000145:classification / Q000453:epidemiology*; D005260:Female; D005367:Fiji / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014792:Visual Acuity / Q000502:physiology; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human