Comparing metabolic control and complications in type 2 diabetes in two Pacific Islands at baseline and following diabetes care intervention

Aim To compare metabolic control and complications in people with type 2 diabetes in Nauru and the Solomon Islands before and after a project intervention. Methods This follow-up study compared metabolic control and complications in a cohort of 216 people with diabetes (81 from Nauru and 135 from the Solomon Islands) at baseline and 15 months following a project intervention (upgrading and equipping the existing diabetes centres, and providing training and clinical support systems) aimed at improving the quality of clinical diabetes care. Subjects were screened using a standardised protocol which gathered information on demographics, treatment, physical and biochemical parameters and their outcomes. Results At follow-up, glycaemic control had improved and mean HbA1c had decreased in study participants in both Nauru (mean difference (MD) = -0.9 ± 2.3%) and the Solomon Islands (MD = -0.6 ± 1.4%), P < 0.001. Mean blood pressure was reduced in the Solomon Islands (systolic MD = -11.6 ± 19.2 mmHg and diastolic MD = -5.4 ± 10.5 mmHg), P < 0.001. There were no significant changes in mean blood lipids or albumin-creatinine ratio. Overall the percentage of subjects achieving recommended clinical targets increased. However these percentages remained low, e.g. 23.5% of participants in Nauru and 20.7% in the Solomon Islands achieved an HbA1c target <7% (53 mmol/mol). A trend towards lower complications rates of foot problems was observed but there were no significant changes in the prevalence of other diabetes complications. Conclusions This study indicates improved metabolic control but little change in diabetes complications 15 months after intervention. Efforts to improve and evaluate the ongoing quality and accessibility of diabetes care in Pacific Island settings need to be further strengthened.