Search

Abstract: Aim: To determine diabetic retinopathy prevalence and severity among remote Indigenous Australians. Methods: A cross‐sectional diabetic retinopathy screening study of Indigenous adults with Type 2 diabetes was conducted by locally trained non‐ophthalmic retinal imagers in a remote Aboriginal community‐controlled primary healthcare clinic in Central Australia and certified non‐ophthalmic graders in a retinal grading centre in Melbourne, Australia. The main outcome measure was prevalence of any diabetic retinopathy and sight‐threatening diabetic retinopathy. Results: Among 301 participants (33% male), gradable image rates were 78.7% (n = 237) for diabetic retinopathy and 83.1% (n = 250) for diabetic macular oedema, and 77.7% (n = 234) were gradable for both diabetic retinopathy and diabetic macular oedema. For the gradable subset, the median (range) age was 48 (19–86) years and known diabetes duration 9.0 (0–24) years. The prevalence of diabetic retinopathy was 47% (n = 110) and for diabetic macular oedema it was 14.4% (n = 36). In the fully gradable imaging studies, sight‐threatening diabetic retinopathy prevalence was 16.2% (n = 38): 14.1% (n = 33) for clinically significant macular oedema, 1.3% (n = 3) for proliferative diabetic retinopathy and 0.9% (n = 2) for both. Sight‐threatening diabetic retinopathy had been treated in 78% of detected cases. Conclusions: A novel telemedicine diabetic retinopathy screening service detected a higher prevalence of ‘any’ diabetic retinopathy and sight‐threatening diabetic retinopathy in a remote primary care setting than reported in earlier surveys among Indigenous and non‐Indigenous populations. Whether the observed high prevalence of diabetic retinopathy was attributable to greater detection, increasing diabetic retinopathy prevalence, local factors, or a combination of these requires further investigation and, potentially, specific primary care guidelines for diabetic retinopathy management in remote Australia. Clinical Trials registration number: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN 12616000370404. [ABSTRACT FROM AUTHOR]

BACKGROUND/OBJECTIVES:Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) have previously shown that dietary patterns are observable by 3 years. However, it is not clear when dietary patterns emerge. We aimed to describe dietary patterns in early life and their associations with maternal and infant sociodemographic characteristics.SUBJECTS/METHODS:Principal component analysis was applied to diet questionnaires of ALSPAC participants at 6 months (n=7052) and 15 months (n=5610) to extract dietary patterns. The sociodemographic factors associated with dietary patterns were investigated using regression analyses.RESULTS:Four dietary patterns were extracted at both 6 and 15 months. A traditional-style pattern characterized by home-prepared meats, vegetables and desserts, a second pattern characterized by ready-prepared baby foods and a third pattern characterized by discretionary foods such as biscuits, sweets and crisps were identified at both ages. At 6 months, the fourth pattern was characterized predominantly by breastfeeding and at 15 months, by contemporary-style foods including herbs, legumes, nuts, raw fruit and vegetables. Higher maternal age and education, number of siblings and lower body mass index (BMI) was associated with higher scores on the breastfeeding or meat, vegetables and desserts patterns, whereas higher discretionary food pattern scores were associated with younger maternal age, lower education, higher BMI and more siblings. Associations between sociodemographic factors and the ready-prepared baby food pattern scores were inconsistent across ages.CONCLUSIONS:Dietary patterns emerge from infancy and are associated with sociodemographic characteristics. [ABSTRACT FROM AUTHOR]

Diabet. Med. 27, 660–665 (2010) Aim The standardized cardiovascular disease death rate for the Greek population in Crete has increased since the 1960s, unlike the all-cause and cardiovascular disease death rate for Australia’s Greek migrant population, which has remained paradoxically low. A small window of opportunity remains in which the vascular profile of this interesting atypical migrant population can be characterized. This study assessed whether ethnicity modulates the risk of diabetic retinopathy in Greek-born migrants to Australia. Methods The study design was a community-based cross-sectional study of diabetic retinopathy in 107 Greek-born and Australian-born men with Type 2 diabetes, aged 44–83 years. Diabetic retinopathy was assessed by mydriatic three-field retinal photography. Results Prevalence of diabetic retinopathy was lower in Greek-born than in Australian-born participants (22 and 37%, respectively). Despite having a higher mean systolic blood pressure level (148 vs. 137 mmHg), Greek-born men had a significantly lower risk of diabetic retinopathy than Australian-born men, after adjusting for age, duration of diabetes, glycated haemoglobin, systolic blood pressure, diastolic blood pressure, albumin to creatinine ratio, and total cholesterol and triglyceride levels [odds ratio 0.32 (0.10–0.99); r2 = 0.41, P = 0.047]. Conclusion Greek ethnicity may confer some protection against diabetic retinopathy to Australia’s Greek-born migrants, an effect not explained by established risk factors for diabetic retinopathy. A small window of opportunity remains in which to elucidate the ethnicity-related exposures that modulate vascular risk in this older migrant population. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe relationships of retinal vascular calibre with plasminogen activator inhibitor-1 (PAI-1) and other cardiovascular risk factors in people with type 2 diabetes. Methods: We recruited 112 community-based persons aged 44–83years with type 2 diabetes, photo-documented retinal status using a digital fundus camera, and measured traditional and novel vascular risk factors. Retinal arteriolar and venular calibre and the arterio–venous ratio (AVR) were determined from fundus photographs using a validated computer-assisted method. Results: In adjusted linear regression models, PAI-1 activity was strongly associated with all measures of retinal vascular calibre: positively with arterioles (p =0.005) and AVR (p =0.001), and inversely with venules (p =0.001). In addition, wider arterioles were independently associated with waist-hip ratio (p <0.0001), HDL-C (p =0.015), and lower systolic blood pressure (p =0.042), whereas narrower venules were associated with older age and a higher albumin excretion rate. Neither arteriolar nor venular calibre was associated with plasma total homocysteine or C-reactive protein concentration. Conclusion: Retinal vascular calibre is independently associated with PAI-1 activity in type 2 diabetes. This finding supports a role for PAI-1 activity in the microvasculature of persons with type 2 diabetes and may explain the link between retinal vascular calibre and cardiovascular disease. [Copyright &y& Elsevier]

The article examines the relative protection of Greek migrants from premature coronary heart disease (CHD) mortality. Greek migrants residing in Australia continue to have one of the lowest all-cause mortality rates of any migrant group in Australia. It is possible that dietary factors could be protecting Greek migrants from premature CHD mortality in the presence of diabetes.

Background -- Factor (principal components) analysis of dietary intake identifies patterns of food consumption in populations, and may be a more useful (comprehensive and meaningful) approach to investigating a potential diet-disease link than conventional single nutrient analyses, particularly for diseases like diabetic retinopathy (the major cause of preventable blindness in the developed world) where there is no known specific relationship to diet. Objective -- To identify the patterns of food consumption that may protect against the onset of diabetic retinopathy. Design -- This cross-sectional study identified patterns of dietary intake in 407 men and women, mean age 64 years, about half with Type 2 diabetes and equally divided between Greek-born and Australian-born. Factor analysis, a data reduction technique, generated variables representing patterns of dietary intake from a list of the 121 foods in the food frequency questionnaire, administered at the clinical data-collection visit. Retinopathy was photo-documented and graded according to a validated protocol by one assessor, masked to other participant data. Outcomes -- Of the identified 9 patterns of dietary intake, one pattern of food consumption was inversely associated with prevalent diabetic retinopathy, after adjusting for established retinopathy risk factors and confounders of dietary intake. This 'Very Greek" pattern of food intake correlated positively with the intake of, in order of importance, onions/leeks, olive oil, garlic, and feta cheese, and inversely with cream/ butter/margarine, and was also inversely associated with prevalent hypertriglyceridemia and hyperhomocysteinemia. Conclusions -- Factor analysis identified a "Very Greek" Mediterranean-style pattern of dietary intake that was protective against diabetic retinopathy and may also be cardio-protective. [ABSTRACT FROM AUTHOR]

Aim: There is a wealth of data concerning the health behaviours of Indigenous Australians, but the health behaviours of Indigenous Australians with diabetes are not systematically documented. At the clinical level, understanding a person's health behaviours can help identify and address barriers to diabetes care and promote good clinical outcomes. Methods: We used a novel survey tool to systematically collect health behaviour data on Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional well‐being (SNAPE) from Indigenous Australians with Type 2 diabetes in a remote primary care setting in Alice Springs. Results: At least one of the five surveys in the SNAPE tool was completed by 210 participants: 30% male, mean age 52.6 years (range 22.9 – 87.4). Fifty per cent of men and 23% of women were current smokers (P < 0.001). None of the participants reported an adequate intake of vegetables. Only 9.6% reported an adequate fruit intake. Some 49% of men and 32% of women consumed alcohol in the past year (P = 0.022), and 46% of drinkers were considered high‐risk or likely‐dependent drinkers. On average, participants walked 10 min or more at a time 6.0 days a week and spent 4.8 h sitting on a weekday. Mean adapted Patient Health Questionnaire 9 score was 4.61, with 34% of participants having mild depressive symptoms and 11% having moderate‐severe depressive symptoms. Conclusions: Our SNAPE survey tool results present a high‐risk, disadvantaged Indigenous population with Type 2 diabetes. More resources will be needed to sustainably implement interventions with the goal of improving health behaviours and subsequent long‐term health. What's new?: Health behaviours of Indigenous Australians with diabetes are not recorded methodically.We systematically documented the self‐reported health behaviours of Indigenous Australians with Type 2 diabetes using a novel survey tool [Smoking, Nutrition, Alcohol consumption, Physical Activity, Emotional well‐being (SNAPE)].In a remote setting, we found low fruit and vegetable intake, and high rates of depressive symptoms, smoking among men and risky alcohol consumption among drinkers.We recommend systematic health behaviour monitoring of Indigenous Australians with diabetes using SNAPE or similar survey tools in appropriate clinical settings to support targeted interventions to improve health behaviours associated with diabetes and its complications. [ABSTRACT FROM AUTHOR]