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Background: The small Pacific Island nation like Tonga has faced a crisis for decades due to premature loss of lives and disabilities due to diabetes. However, there is limited peer-reviewed literatures on the rates of diabetes complications and capacity for providing quality diabetes care in Tonga. The lack of adequate information in local context triggers significant challenges to make informed decision, proper planning, and effective implementation to improve diabetes care.

Aim: This study aims to determine the prevalence of diabetes complications and associated risk factors among people with diabetes, and the capacity for managing diabetes as an initial step towards strengthening diabetes care at the primary health care setting in Tonga.

Methods: This cross-sectional study was conducted on a sample of 207 people with diabetes from the primary health care centre in Tonga. People with diabetes were screened by qualified health professional using a standardised protocol, and the capacity of diabetes care was assessed by a standardised assessment form.

Results: Of the 207 people with diabetes aged between 20 and 80 years screened for diabetes related complications, 135 (74%) had family history of diabetes, 57 (28%) female subjects had history of gestational diabetes, and 28 (14%) subjects were current smokers. The prevalence of overweight was 51%, obese was 38% and hypertension was 44%. The percentage of subjects with high cholesterol was 42%. HbA1c was measured and subjects with good, poor, and very poor blood glucose control were 15%, 49% and 36% respectively. The percentage of people with diabetes who had retinopathy was 18% and who were at risk of developing diabetic foot ulcer was 14%. This study also found that people with diabetes did not attend regular follow-up visits at the health care centre and the capacity to provide quality diabetes care services is limited.

Conclusion: This study highlighted the urgent need to improve the quality and accessibility of diabetes care to reduce diabetes complications. The findings also provided a timely reminder to government and development partners to invest additional resources to effectively manage diabetes at the primary health care level. Tonga will require to strengthen a resilient health system to improve screening for early detecting of diabetes complications and enhance management services at the primary health care setting.