Background: There are limited contemporary data on the prevalence and progression of diabetic retinopathy (DR) in urban-dwelling Aboriginal Australians. We therefore compared the prevalence of DR and cumulative incidence of new/worsening DR (NWDR) between Aboriginal and Anglo-Celt Australians with type 2 diabetes (T2D) in the representative community-based Fremantle Diabetes Study Phase II (FDS2).
Methods: From 2008 to 2011, 932 Anglo-Celt and Aboriginal FDS2 participants with T2D underwent comprehensive baseline assessments and were invited to biennial reviews. Ethnic status was based on self-selection, country/countries of birth and parents’ birth, language(s) spoken at home, and country of grandparents’ birth. Fundus photographs were graded according to the Early Treatment Diabetic Retinopathy Study protocol. Prevalence of DR and cumulative incidence of NWDR for each ethnic group, and unadjusted and adjusted odds ratios (ORs), were calculated.
Results: Baseline DR data was available for 911 (97.7%) participants (mean age 66.0 years, median T2D duration 8.4 years, 49.7% males). There were 817 Anglo-Celt and 94 Aboriginal participants. Of these, 56% had follow-up data. Baseline prevalence of any DR was 33.0% in Anglo-Celts and 52.1% in Aboriginals (P<0.001). During 4.2±0.4 years’ follow-up, the cumulative incidence of NWDR was 6.7% and 23.5%, respectively (P<0.001). The unadjusted OR (95% CI) for Aboriginals for any DR and NWDR were 2.21 (1.43-3.39) and 4.32 (1.33-13.98), respectively. These ORs were attenuated after age and sex adjustment (1.21 (1.10-1.33) and 4.1 (1.2-14.1), respectively) but were no longer significant after adjusting for other DR risk factors including HbA1c and systolic blood pressure.
Conclusions: Urban dwelling Aboriginal Australians have substantial DR prevalence and progression, highlighting the need for better access to culturally appropriate management.
J.J. Drinkwater: None. W.A. Davis: Advisory Panel; Spouse/Partner; Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S. Speaker’s Bureau; Self; Boehringer Ingelheim International GmbH. Speaker’s Bureau; Spouse/Partner; Lilly Diabetes, Merck Sharp & Dohme Corp., Mylan, Novo Nordisk A/S, Sanofi-Aventis. Other Relationship; Self; Proteomics International. Other Relationship; Spouse/Partner; Proteomics International. A.W. Turner: None. T. Davis: Advisory Panel; Self; Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S. Speaker’s Bureau; Spouse/Partner; Boehringer Ingelheim International GmbH. Speaker’s Bureau; Self; Lilly Diabetes, Merck Sharp & Dohme Corp., Mylan, Novo Nordisk A/S, Sanofi-Aventis. Other Relationship; Self; Protemics International. Other Relationship; Spouse/Partner; Protemics International.
University of Western Australia; Australian Government Training Program; National Health and Medical Research Council of Australia