The Xavante, one of the indigenous communities most vulnerable to SARS-CoV-2 in Brazil, is suffering from an epidemic of diabetes, a “silent” disease considered a risk factor for severe COVID-19.
A group of researchers affiliated with the School of Medicine of the Federal University of São Paulo (EPM-UNIFESP) and the Ribeirão Preto School of Medicine at the University of São Paulo (FMRP-USP) examined the retinas of 157 people before the COVID-19 pandemic and found a prevalence of type 2 diabetes and eye disorders caused by the disease.
The study was supported by the São Paulo Research Foundation – FAPESP (https: //bv.fapesp.br /in/help /28693), and the results are published (https: //www.scienceirect.with/science/article /abs /pii /S0168822720306331) in Diabetes Research and Clinical Practice, the official journal of the International Diabetes Federation.
“Ninety-five of the 157 Xavantes we examined [60.5%] have been diagnosed with diabetes “, Fernando Korn Malerbi (https: //bv.fapesp.br /in/searcher/47115 /fernando-korn-malerbi), postdoctoral researcher in the ophthalmology department of EPM-UNIFESP and first author of the article published on the study.
According to Malerbi, diabetes can cause eye problems such as retinopathy. Diabetic retinopathy develops when high blood sugar levels damage the blood vessels in the retina, causing vision loss if left untreated.
To diagnose cases of diabetic retinopathy and other possible eye disorders, the researchers examined members of the Xavante community on the Volta Grande and São Marcos reserves in the state of Mato Grosso in the Central West region of Brazil. They used a smartphone-controlled retinal photography system developed by Phelcom Technologies (https: //phelcom.with.br /in/business/) via a project (https: //bv.fapesp.br /in/help /105359) supported by the FAPESP Innovative Research in Small Business program (PIPE (https: //bv.fapesp.br /in/3 /)).
Called the Eyer, the portable retinal machine is an optical device that produces precise images of the retina to detect disease in the fundus of the eye (fundus) at a cost much lower than conventional methods. In addition, it has the advantage of being usable for remote diagnosis by an ophthalmologist via telemedicine.
The optical device is connected to a smartphone. It turns on and images the retina, and a specially written software application sends the images over the Internet to Eyer Cloud, which stores and manages patient files.
In the absence of Wi-Fi or a 3G or 4G network, images are stored in the smartphone and sent to the cloud when a high-speed Internet connection becomes available (find out more at: agencia.fapesp.br/30784 ( https: //agency.fapesp.br /portable-device-can-be-used-to-diagnose-eye-disease-remotely /30784 /)).
Malerbi personally examined the Xavante volunteers and promptly gave them his diagnosis. “When retinal lesions suggesting a risk of blindness were observed via the portable retinal machine, we informed the subjects via an interpreter and referred them to the local indigenous health service for follow-up and treatment,” he said. .
Of the 95 people with diabetes who underwent the full eye imaging protocol, 23 (24.2%) had undegradable images due to media opacities caused by cataracts that precluded assessment of retinopathy in at minus one eye.
The images of the remaining 72 subjects (75.8%) were good enough for diabetic retinopathy to be detected. The researchers found that 16 had the disease and that it was severe enough to threaten eyesight in seven.
“We have proven that screening for diabetic retinopathy with a portable retinograph is feasible and economically viable because the technology is inexpensive and can be used in remote communities such as Indian reservations, where the population is generally dispersed in several villages.” , said Malerbi.
Deterioration of health
A previous study of eye problems in the Xavante reported a prevalence of diabetic retinopathy of 19.3% in the same locations. The higher level of prevalence found in this latest study may be due to the higher quality of the retinal camera images compared to the indirect ophthalmoscopy method used in the previous study.
Another hypothesis is that the health of this indigenous population – one of the largest in Brazil, comprising some 17,000 Indians living on nine reserves – deteriorated in the intervening years, the researchers estimated.
A previous study showed that 66.1% of 932 members of the Xavante community had metabolic syndrome, defined as a condition in which risk factors for cardiovascular disease and diabetes mellitus occur in the same individual.
For the researchers, the situation reflected the evolution of the health profile and the diet over the last decades, in particular the consumption of industrialized foods and a sedentary lifestyle (for more information: agencia.fapesp.br/22624 (https : //agency.fapesp.br /two-thirds of an indigenous community have metabolic syndrome and are obese /22624 /)).
“The Xavantes were traditionally hunter-gatherers, but have become more sedentary. They have also changed their diets in recent decades, consuming new foods that are high in sugar,” said Malerbi.
In addition to the Xavante, the researchers also examined the retinas of 33 Bororo – another community threatened by both COVID-19 and the bushfires that have destroyed much of the Pantanal this year. Seven Bororo were diabetics. One of them was diagnosed with severe diabetic retinopathy and referred to a health service for treatment.
About the São Paulo Research Foundation (FAPESP)
The São Paulo Research Foundation (FAPESP) is a public institution whose mission is to support scientific research in all fields of knowledge by awarding scholarships, scholarships and grants to researchers linked to educational institutions and Research Institute of the State of São Paulo, Brazil. FAPESP is aware that the best research can only be achieved by working with the best international researchers. Therefore, he has established partnerships with funding agencies, higher education, private companies and research organizations in other countries known for the quality of their research and has encouraged the scientists funded by his grants to develop more their international collaboration. You can find out more about FAPESP at http: // www.fapesp.br /in and visit the FAPESP press agency at http: // www.agency.fapesp.br /in keep abreast of the latest scientific advances that FAPESP is helping to achieve through its many programs, awards and research centers. You can also subscribe to the FAPESP press agency at http: // agencia.fapesp.br /subscribe.
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