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11-16-2016 | Article

Editorial board comment

Author:
Sanjay Kalra MBBS, MD, DM

Comment on: Diabetes exacts heavy price in middle-income countries

Mexico is a middle-income country in economic transition. This “transitional” status is visible in its health burden as well. Modern Mexico grapples with both communicable and non-communicable disease, and both acute and chronic illness. This creates a unique health burden which is shared by other countries with similar features.

One condition which straddles this spectrum of morbidity is diabetes. In developing countries, diabetes is not only a chronic syndrome; it is an acute illness as well. Diabetic ketoacidosis, hyperosmolar coma, acute infections, and complications requiring immediate resolution (such as frozen shoulder or painful neuropathy) are common. Equally prevalent are chronic micro and macro vascular complications such as nephropathy and cardiovascular disease. Suboptimal health care seeking behavior, and inadequate access or availability of health services add to the challenges. Thus epidemiological data from developed nations may not necessarily be appropriate for developing societies.

Alegre Diaz and colleagues make an important contribution to global diabetes care by publishing a large prospective study detailing diabetes-related mortality in Mexico City. Their data show significant contributions of chronic microvascular (renal disease), macrovascular (cardiac disease), acute complications (acute diabetic crisis) and acute comorbidities (infection) to deaths associated with diabetes. The data from this study can be used by other countries with demographic and health care systems similar to those of Mexico.

The scale of diabetes-associated mortality is humungous. In Alegre-Diaz and team’s study, one third of all deaths of adults aged 35 to 74 years were linked to diabetes. Much of this mortality could have been avoided, if better glycemic control, with wider use of biguanides and vasoprotective medicines had been achieved. It is noteworthy that these data pertain to the capital city, where medical care would probably be better than that in outlying districts.

The study makes important points, which have global relevance. Diabetes is an important contributor to mortality. This is mediated through both acute and chronic conditions. Uncontrolled glycemia, concomitant obesity, and inadequate use of vasoprotective drugs (antithrombotic and lipid-lowering medication) contribute to this avoidable burden, and must be addressed.

Equal emphasis must be placed on prevention and timely management of acute diabetic crises and infections. Good glycemic control, regular glucose monitoring, and immunization where appropriate, should be instituted. Best practices from Mexico, including health insurance, taxation of sugary drinks and high calorie foods may be replicated in other parts of the world.

From an Indian news point, the results of the Mexican study underscore the reality: diabetes is too important to be ignored: it must be tackled immediately.