Head of Operational Research Unit of Doctors with Africa in Mozambique.
Title: Diabetes and cataract in low- and middle-income countries
Head of Operational Research Unit on behalf of Doctors with Africa in Mozambique since 2015 and coordinator for Sofala provinces from 2017. From 2017 editor of Journal of Clinical and Experimental Endocrinology. He obtained the PhD on Endocrinology, Metabolism and Andrological Sciences in 2013 winning the Thesis Award 2014 at Sapienza University in Rome. He won the “Award for excellence in biomedical research” of Foresta Foundation and from 2014 to 2015 he was research fellow at the Department of Medicine, University of Padua. He has more than fifty publications in international, peer-review journals.
Background: In people with diabetes, cataract is a major cause of visual impairment with a three to four-fold increased risk of cataract in patients with diabetes under the age of 65, and up to a two-fold excess risk in patients above 65. On the one hand, cataract has a particularly devastating consequence in low and middle-income countries where it remains the leading cause of blindness, accounting for 50% of blindness. On the other hand, in low and middle-income countries diabetes has reached epidemic levels but prevention, diagnosis, and treatment are generally inadequate. Methods: We performed a cross-sectional, community-based data from the Study on Global Ageing and Adult Health (SAGE) analyzing (n=42,469 adults aged ≥18 years). Information on self-reported diagnosis of cataract in the past five years was collected. Three definitions for cataract were used: (a) Self-reported diagnosis and/or past 12-month symptoms; (b) Solely self-reported diagnosis; and (c) Surgical treatment for cataract in the past five years. Diabetes was based on self-reported diagnosis. Multivariable logistic regression was conducted to assess the associations. Results: Overall, the prevalence of diabetes was 3.1% (95%CI=2.7%-3.5%) and that of cataract based on the three different definitions was: (a) 13.3% (95%CI=12.4%-14.3%); (b) 4.4% (95%CI=3.9%-4.8%), (c) 1.7% (95%CI=1.5%-2.0%). After adjustment for potential confounders, diabetes was associated with significantly elevated odds for cataract: (a) OR=2.10 (95%CI=1.59-2.76); (b) OR=2.62 (95%CI=2.00-3.42); (c) OR=2.80 (95%CI=1.78-4.40). These associations were particularly pronounced among those aged <50 years. Conclusions: A strong association between diabetes and cataract was observed in in low and middle-income countries and, considering the increasing prevalence of diabetes, it is mandatory to introduce health policies for prevention, early diagnosis, and treatment, as well as its complications such as vision diseases. Since diabetes is a chronic disease requiring therapy compliance and adequate follow up in order to obtain effective long-term control, it will be crucial to organize a multidisciplinary approach which takes into account of all aspects of comorbidity.