title: Burden and spectrum of disease in people with diabetes in Tonga.
abstract: METHODS
  National Diabetes Centre, Tonga.
  
  
  OBJECTIVE
  To describe the diabetes patient profile and disease spectrum, assess the impact of diabetic care and evaluate diabetes-attributable adverse outcomes.
  
  
  METHODS
  Retrospective descriptive study of patients registered in the National Diabetes Registry from its inception in May 2004 to 2012, and review of the National Deaths Registry (2011-2012).
  
  
  RESULTS
  Of 4653 patients with diabetes mellitus (DM) identified, 95.8% had type 2 DM, 0.2% type 1, 1.2% gestational DM and 2.9% pre-DM. Of the 4409 patients with type 2 DM, 64.7% were female, 82.7% were aged ⩾40 years, 25.3% had hypertension and 53.3% were obese. Among those in care for >2 years, no positive impact on body mass index or glycosylated haemoglobin could be demonstrated, but there was significant improvement in hypertension control. Morbidity included lower limb amputations in 272 (6.1%) patients. DM was listed as a contributory cause of death due to sepsis (15/30, 50.0%), kidney failure (16/28, 57.1%), stroke (7/16, 43.8%) and ischaemic heart disease (20/59, 33.9%).
  
  
  CONCLUSIONS
  DM was associated with high levels of morbidity and mortality. DM care improved hypertension control, but had little impact on other comorbid conditions. Enhanced monitoring and greater patient involvement should improve care; creative strategies are required to prevent and reduce obesity.
authors.affiliation: National Diabetes Centre, Nuku'alofa, Tonga.
authors.forename: V
authors.initials: V
authors.lastname: Matoto
authors.affiliation: Secretariat of the Pacific Community, Noumea, New Caledonia.
authors.forename: K
authors.initials: K
authors.lastname: Viney
authors.affiliation: Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Roseveare
authors.affiliation: The Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Colaguiri
authors.affiliation: Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: B J
authors.initials: BJ
authors.lastname: Marais
keywords: Tonga; diabetes; disease burden; disease spectrum