RESEARCH LETTER Prevalence of diabetes among adults aged ‡40 years in Timor-Leste Jacqueline RAMKE, 1,3 Lucy LEE 1 and Gary BRIAN 1,2,4 1 The Fred Hollows Foundation New Zealand, Auckland, 2 Dunedin School of Medicine, University of Otago, Dunedin, New Zealand, 3 School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, and 4 Population Health Eye Research Network, Brisbane, Queensland, Australia Keywords: diabetes, HbA1c, Timor-Leste. Timor-Leste is one of the smallest and least economically developed countries in the Southeast Asian region. Malnutrition, maternal and child health diseases, and communicable illnesses are frequent causes of morbidity and mortality. Accordingly, these conditions have been given priority by the country’s Ministry of Health since the nation’s independence in 2002. As has occurred elsewhere in Asia, changing circumstances, such as population growth and aging, urbanization, dietary modification, and increasing obesity and inactivity, 1,2 may suggest that diabetes will become an increasing public health problem in Timor-Leste. The challenge will be to recognize its emergence, plan rational preventative and management strategies, and allocate appropriate resources for these. However, there is no measured baseline from which to assess change: No population survey has been undertaken and the prevalence of diabetes in Timor-Leste is unknown. The Ministry of Health- approved Timor-Leste National Eye Health Survey 2010, a population-based cross-sectional survey to esti- mate the prevalence of blindness among adults aged ‡40 years, 3 afforded an opportunity to examine the occurrence of diabetes. From the survey’s 50 clusters, a representative subset of five urban and seven rural clusters were randomly selected for the present study, with 45 participants in each cluster. 3 The present study observed the tenets of the Declaration of Helsinki and all participants pro- vided informed consent. An interview-based questionnaire elicited whether a previous personal diagnosis of diabetes had been made by a physician. Venous blood was drawn and HbA1c was determined using a COBAS C-311 ana- lyzer with a Tina-quant HbA1c Generation 2 immu- noassay (Roche Diagnostics, Basel, Switzerland). Participants’ height and weight was measured and body mass index (BMI) calculated. Diabetes was determined to be present if HbA1c was ‡6.5%, 4 or if a previous diagnosis by a doctor had been claimed, independent of HbA1c. Data are presented as proportions with 95% confi- dence intervals (CI). National census data (2004) 5 were used to adjust the sample prevalence estimates for the age distribution of those aged ‡40 years across the entire country. Of the 540 people from the 12 clusters evaluated in the present study, 494 (91.5%) had their HbA1c con- centration determined and results are presented for this subset. For this group, the mean HbA1c was 5.6 ± 0.7% (Fig. 1). Six participants (two women, four urban; 1.2% of the sample) reported having dia- betes (as diagnosed by a doctor) and the mean HbA1c for these six participants was 5.7 ± 0.6% (Table 1). Seventeen participants (14 women, six urban; 3.4% of the sample) had HbA1c ‡6.5% but denied a previous diagnosis of diabetes. The mean HbA1c of this group was 7.8 ± 1.9% (Table 1). The sample prevalence of diabetes was 4.7% (95% CI 2.6, 6.7) and most cases (17 ⁄ 23; 73.9%) had not been diagnosed prior to the survey. The age-adjusted prevalence of diabetes among adults aged ‡40 years across all of Timor-Leste was 4.6% (95% CI 2.7, 6.4), Correspondence Jacqueline Ramke, School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia. Tel: +61 2 9385 2517 Fax: +61 2 9313 6185 Email: jramke@gmail.com Received 14 March 2012; revised 26 May 2012; accepted 18 June 2012. doi: 10.1111/j.1753-0407.2012.00217.x Journal of Diabetes 4 (2012) 392–394 392 ª 2012 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd ASIA TRACK