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Diagnosis and Management of the Diabetes Epidemic in the Pacific Islands

Diagnosis and Management of the Diabetes Epidemic in the Pacific Islands

During the past 20 years, diabetes and other non-communicable diseases (NCDs) have been on the rise in the Pacific Island countries, having overtaken infectious diseases such as tuberculosis, pneumonia and malaria as the greatest causes of mortality in the region.

Today, NCDs account for 70 to 75 percent of all deaths in the Pacific Islands, underscoring the importance of increasing access to point-of-care diagnostics for disease management.1  In the late 1970s and early 1980s, patients with diabetes and other NCDs occupied less than five percent of hospital beds. Today, in most Pacific Island countries, diabetes and other NCDs account for up to 40 to 50 percent of hospitalized patients, especially in surgical wards. The incidence is much higher in Micronesian and Polynesian countries than in their neighboring Melanesian counterparts.2,3

It is vital that Pacific Island countries increase awareness and uptake of preventative programs and early diagnosis of diabetes and other NCDs.

There are more than 10 million people living in Pacific Island countries, excluding Australia and New Zealand. As these countries develop, the incidence of diabetes and other NCDs is also increasing. This is due to a variety of factors, such as the replacement of traditional diet staples with imported, processed foods.  Unfortunately, these countries lack the variety of drugs, diagnostic equipment and hospital facilities required to deal with this epidemic. There are no subsidized government programs for treatment; whenever local drug supplies run out, patients must wait for the next government supply order or order them privately and shoulder the full cost out of pocket.

When I was a medical student, diagnostics for measurement of venous and capillary blood sugar and hemoglobin A1C (HbA1c) were scarce or unavailable in Pacific Island countries. Instead, the presence of glycosuria (excretion of glucose in the urine) was commonly used for diagnosis of diabetic antenatal patients in hospital wards. Although circumstances have improved somewhat, it is still common to run out of laboratory reagents. For example, in the Solomon Islands there are only three HbA1c diagnostic machines for a population of 600,000. When test kits run out at government-run health facilities, blood specimens must be sent to Brisbane, Australia for testing at great cost.

To further complicate matters, in many Pacific Islands countries the regulations and policies governing procurement and distribution of treatments and diagnostics by government institutions are scant compared to the regulatory infrastructure in other countries. Given the looser regulatory environment, government resources are more susceptible to corruption. To address this problem, overseas donors like AusAID and NZAID frequently bypass government institutions and provide aid directly to rural communities where the bulk of the population lives.

People with diabetes in Pacific Island countries typically present with later stages of the disease, often experiencing poor eyesight, numbness of the legs, and other vascular complications. Some patients are skeptical of their diagnosis and try home herbal remedies before turning to traditional Western medicine. Local government hospitals often do not have the facilities to deal with late-stage diabetes patients experiencing cardiac, renal and other diabetes complications, so these patients may be cared for by their extended families with little to no standard medical intervention. Given these circumstances, it is vital that Pacific Island countries increase awareness and uptake of preventive programs and early diagnosis of diabetes and other NCDs. If caught early, diabetes can be treated and managed. It is ultimately much less costly and easier for Pacific Island countries to deal with early stage disease than the later complications of diabetes.

  1. The World Bank. Pacific Islands: Non-Communicable Disease Roadmap. July 2014. Available at: http://www.worldbank.org/en/news/feature/2014/07/11/pacific-islands-non-communicable-disease-roadmap. Accessed on May 2, 2017.
  2. Nauru, Kiriabati, FSM, Fiji, Samoa, Tonga, etc.
  3. PNG, Solomon Islands, and Vanuatu, etc.

   

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