Diabetic Retinopathy in Nauruans

Abstract

An epidemiologic survey of the whole adult Micronesian population of Nauru in the Central Pacific conducted in 1982 has confirmed that Nauruans, along with Pima Indians, suffer the highest rate of abnormal glucose tolerance yet recorded. To establish the morbid effects of hyperglycemia in this population, all responders to the diabetes survey were concurrently examined for diabetic retinopathy. In diabetic subjects, the crude prevalence of retinopathy was 24%. Specific rates were determined at various levels of the following characteristics: age, two-hour post-load plasma glucose, body mass index, duration of diabetes, and systolic blood pressure. Prevalence was found to rise with increasing two-hour plasma glucose and duration, to fall with increasing body mass index, and to have a quadratic relationship with age and systolic blood pressure. The multiple logistic regression model was used to determine whether the selected characteristics were significant in increasing the risk of retinopathy. Body mass index and systolic blood pressure did not contribute significantly to this risk after controlling for age. Increasing two-hour plasma glucose significantly increased the risk of retinopathy, and duration of disease was the strongest predictor variable. This study shows that the consequences of hyperglycemia in this Micronesian population are comparable to those already documented in European and American Indian communities.

High Prevalence of Diabetic Retinopathy and Nephropathy in Polynesians of Western Samoa

“…Duration of diabetes and level of glycemia have consistently been related to both the prevalence (2)(3)(4)(5)17,19) and incidence (4,(27)(28)(29) of retinopathy and to the prevalence of albuminuria (2,9,21,24) and the incidence of proteinuria (4) in diverse populations. In Western Samoa, 82% of NIDDM subjects had a known duration of 0-4 years, and only 7% had a duration of 10 years or more.…”

“…Most research suggests that BP is important with respect to both the occurrence and the severity of DR (17,27,31), but some studies have not found a significant association with the prevalence (3,5,19) or incidence (29) of retinopathy.…”

“…Macro vascular diseases are more closely related to ethnicity and lifestyle factors than diabetes per se (2), whereas the microvascular complications retinopathy and nephropathy are direct sequelae of diabetes, associated with hyperglycemia and duration of disease (2)(3)(4)(5)(6)(7).…”

Causes of blindness and the results of cataract surgical intervention in the Micronesian islands: a retrospective study

“…Their lifestyle has changed from hunting, gathering, and subsistence agriculture to a modernized lifestyle that is characterized by sedentary occupations and energy-dense processed foods. For example, the population of the small central Pacific island of Nauru of Micronesia has the second highest recorded incidence of non-insulin-dependent diabetes mellitus (NIDDM) in epidemiological studies [4][5][6][7]. NIDDM now affects almost twothirds of the adults between 55 and 64 years of age in Nauru [8].…”

“…NIDDM now affects almost twothirds of the adults between 55 and 64 years of age in Nauru [8]. There has been a significant increase in the incidence of diabetic retinopathy in Nauru, which requires immediate and effective treatment [4,5]. However, given that these Micronesian countries are still developing financially and that there is a shortage of proficient medical staff, there has been insufficient eye care for the inhabitants of Micronesia for a long period of time.…”