Diabetes remains major health challenge in the Pacific

A recent study has identified methodological errors in the surveys conducted through the World Health
Organization’s (WHO) STEPwise approach to non-communicable disease (NCD) surveillance (STEPS) in
some Pacific Island countries. The study is published in the Journal of Diabetes and summarised in this
Devpolicy post.
The error stemmed from a change in the technology for blood glucose testing for type 2 diabetes. In early
STEPS surveys conducted in Fiji, Samoa and Tonga between 2002 and 2004, glucose meters reported
glucose levels in whole blood. In later surveys conducted between 2011 and 2013, the glucose meters
reported glucose levels in plasma. However, the researchers found that when WHO analysed the later
surveys, the incorrect whole blood glucose cut-off (6.1 mmol/L) was used instead of the correct plasma
glucose cut-off (7.0 mmol/L). When the data were re-analysed using the correct cut-off point, the rates of
diabetes were lower than previously reported.
This means that results from STEPS surveys carried out in 2011 (Fiji), 2012 (Tonga) and 2013 (Samoa),
showing that type 2 diabetes rates had doubled, are not accurate. Instead it appears that when compared
with STEPS surveys conducted in these countries 10 years earlier, diabetes prevalence had actually
decreased by 0.4% in Fiji and 3.4% in Tonga, and increased by 2.8% in Samoa. The researchers warn this
methodological error may also have implications for STEPS results in other countries, both in the Pacific and
globally. It appears only two additional Pacific countries – i.e., Niue and Vanuatu – may be affected by this
methodological error. WHO is yet to issue an official response to the research findings at this stage.
Nonetheless, these revised statistics do not change the fact that diabetes is still a major problem in the
Pacific. The revised rates of diabetes in these three countries are still very significant – 15.6% in Fiji; 19% in
Tonga; and 24.3% in Samoa. These figures are three to five times higher than in neighbouring Australia,
where approximately 5% of people have diabetes, and much greater than the estimated global prevalence of
10%.