title: An estimation of the prevalence of diabetes mellitus and diabetic retinopathy in adults in Timor-Leste.
abstract: BACKGROUND
  Once 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.
  
  
  METHODS
  From 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  This 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.
authors.affiliation: Sentru Matan Nasional, Hospital Nacional Guido Valadares, Bidau, Dili, Timor-Leste. rosie.dawkins@post.harvard.edu.|Timor-Leste Eye Program, Royal Australasian College of Surgeons, Melbourne, Australia. rosie.dawkins@post.harvard.edu.
authors.forename: Rosie Claire Hewitt
authors.initials: RC
authors.lastname: Dawkins
authors.affiliation: Sentru Matan Nasional, Hospital Nacional Guido Valadares, Bidau, Dili, Timor-Leste. eyeota@gmail.com.|Timor-Leste Eye Program, Royal Australasian College of Surgeons, Melbourne, Australia. eyeota@gmail.com.|Fred Hollows Foundation of New Zealand, Auckland, New Zealand. eyeota@gmail.com.
authors.forename: Genevieve Frances
authors.initials: GF
authors.lastname: Oliver
authors.affiliation: Sentru Matan Nasional, Hospital Nacional Guido Valadares, Bidau, Dili, Timor-Leste. mansuyu@gmail.com.|Timor-Leste Eye Program, Royal Australasian College of Surgeons, Melbourne, Australia. mansuyu@gmail.com.
authors.forename: Manoj
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Sentru Matan Nasional, Hospital Nacional Guido Valadares, Bidau, Dili, Timor-Leste. bpinto@hollows.org.nz.|Fred Hollows Foundation of New Zealand, Auckland, New Zealand. bpinto@hollows.org.nz.
authors.forename: Basilio Martins
authors.initials: BM
authors.lastname: Pinto
authors.affiliation: Sentru Matan Nasional, Hospital Nacional Guido Valadares, Bidau, Dili, Timor-Leste. belmerio@hollows.org.nz.|Fred Hollows Foundation of New Zealand, Auckland, New Zealand. belmerio@hollows.org.nz.
authors.forename: Belmerio
authors.initials: B
authors.lastname: Jeronimo
authors.affiliation: Sentru Matan Nasional, Hospital Nacional Guido Valadares, Bidau, Dili, Timor-Leste. devio_612@yahoo.com.
authors.forename: Bernadete
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Sentru Matan Nasional, Hospital Nacional Guido Valadares, Bidau, Dili, Timor-Leste. suzy.magno74@gmail.com.
authors.forename: Julia
authors.initials: J
authors.lastname: Magno
authors.affiliation: Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia. lara.motta@flinders.edu.au.
authors.forename: Lara Alexandra
authors.initials: LA
authors.lastname: Motta
authors.affiliation: Timor-Leste Eye Program, Royal Australasian College of Surgeons, Melbourne, Australia. nitver3@gmail.com.|Department of Ophthalmology, University of Tasmania, Hobart, Australia. nitver3@gmail.com.|School of Medicine, Sydney University, Sydney, Australia. nitver3@gmail.com.
authors.forename: Nitin
authors.initials: N
authors.lastname: Verma
authors.affiliation: Flinders University International Centre for Point-of-Care Testing, Flinders University, Adelaide, Australia. mark.shephard@flinders.edu.au.
authors.forename: Mark
authors.initials: M
authors.lastname: Shephard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D015995:Prevalence; D012307:Risk Factors; D049648:Timor-Leste / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human