Impact of a diabetes care capacity building program in Pacific Island countries

Abstract

Diabetes has reached epidemic proportions globally and imposed an unsustainable financial burden on national health systems; undermines productivity through lost employment; and threatens household income through health care expenditure. Evidence shows that much of the human and social impact caused by diabetes could be averted through cost effective interventions and certain clinical processes and practices can delay the onset of diabetes and its complications. However, there is little peer-reviewed evidence of the health, economic and societal burden of diabetes in Pacific Island countries (PICs) and how such diabetes care intervention can be implemented successfully and sustainably in these small under-resourced island nations. In order to improve the quality of diabetes care and contribute to the pool of knowledge about the burden of diabetes as well as the effectiveness of intervention, an overarching diabetes capacity building program under which this research study was undertaken was conducted in the Solomon Islands, Nauru and Vanuatu. The overall aims and specific objectives of the research component of this program included in this thesis are outlined below. Aims and objectives Overall, this thesis aimed to i) measure the health, economic and societal burden of diabetes (first phase of research) and ii) examine the outcomes and impacts associated with a diabetes capacity building program in the Solomon Islands, Nauru and Vanuatu (second phase of research). 6 The specific objectives of the first phase of research were to: i) review the available evidence about the health, social and economic impact of diabetes in PICs (research study 1) including the Solomon Islands, Nauru and Vanuatu; ii) determine the prevalence of diabetes complications and associated risk factors, and percentages achieving agreed clinical targets among people with diabetes (research study 2); iii) identify the precipitating events and factors preceding diabetes related amputations among people with diabetes (research study 3); and iv) examine the costs associated with diabetes to governments, people with diabetes and their carers, and its impact on quality of life (research study 4). The specific objectives of the second phase of research were to: i) compare the metabolic control and complications in people with diabetes at baseline and following an intervention (research study 5); and ii) assess the policy and infrastructure outcomes and impacts associated with a diabetes capacity building program in three PICs: the Solomon Islands, Nauru and Vanuatu (research study 6). Methods This thesis consisted of six research studies and each study was designed to stand alone. These studies, when taken together, addressed the overall research aims and specific objectives of this thesis. A combination of different research methods was used, with each method selected based on its appropriateness for addressing specific objectives of each research study. Overall, this thesis included the collection of cross-sectional descriptive data (first phase of research – research studies 1-4) and prospective follow-up/evaluation data (second phase of research – research studies 5-6).