Rate of Eye Disease Among Indigenous Diabetics A Concern

By Petrina Smith
Tuesday, 11 November, 2014

A retrospective study indicates indigenous Australians are outstripping the wider population when it comes to a serious eye disease caused by diabetes.
Diabetic vitrectomies in South Australia and Northern Territory were found to be more common in indigenous than in non-indigenous Australians with diabetes.  A diabetic vitrectomy is a surgical procedure performed that removes the clouded vitreous gel in the centre of the eye when the disease has progressed to an advanced stage.
The preliminary results were announced by Dr Stewart Lake, Dr Tim Henderson and A/Prof Henry Newland, recipients of the Ophthalmic Research Institute of Australia (ORIA)/RANZCO Eye foundation Indigenous Health Grant.
The authors stated, “Indigenous Australians represent only 5.7% of the total population in SA and NT, but account for 25.2% of patients requiring diabetic vitrectomy, reflecting a drastic over representation of end stage diabetic retinopathy in the Indigenous Australian population”.  Alarmingly, indigenous patients are 10 years younger at the time of surgery.  This is likely to reflect the earlier age of onset of type 2 diabetes in Indigenous Australian populations.
Indigenous patients requiring diabetic vitrectomy have more diabetes related comorbidities than non-indigenous patients requiring the surgery.  A Danish study found that five-year survival rates have shown to be up to 10% lower than the general diabetic population.  The authors stated, “Diabetes patients reaching such severe ocular disease suffer equally advanced microvascular and macrovascular diabetic complications of other organs.  34% of Indigenous patients requiring diabetic vitrectomy were on dialysis at the time of surgery compared to 3.2% of non-indigenous Australians.”
The retrospective clinical audit of vitrectomies performed for diabetic retinopathy in South Australia and Northern Territory will be completed over a 5 year period (2007 to 2011) for both the public and private sector.  Data collection from Flinders Medical Centre and the Royal Adelaide Hospital has been completed so far, with data collection from private surgeons currently in progress.  Preliminary results indicate that 2473 vitrectomies were performed during the audit period for 1916 patients.  Of these total vitrectomies, 454 operations were performed for the management of advanced diabetic retinopathy.
The authors conclude, “The greater rate of diabetic vitrectomy in Indigenous Australians in South Australia and Northern Territory public hospitals is obviously secondary to a complex interplay of environmental and genetic factors, and cannot be explained purely by the well-known traditional risk factors.”   Once the audit in the private sector is completed, it will allow further evaluation of environmental factors including treatments prior to surgery.
There were over one million people with diabetes registered on the National Diabetes Services Scheme in September 2014. The Australian Institute of Health and Welfare recently reported that Indigenous diabetes and chronic kidney disease death rates were over 3 times those of non-Indigenous Australians. The 2008 National Indigenous Eye Health Survey reported that 37% of Indigenous adults have diabetes of which 13% have already lost vision.
Diabetic retinopathy is a complication of diabetes mellitus that damages blood vessels inside the retina at the back of the eye. It commonly affects both eyes and can lead to vision loss if it is not treated.

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