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21-05-2021 | Healthcare systems | News

Large diabetes care gaps identified in low- and middle-income countries

Author: Eleanor McDermid


medwireNews: Fewer than one in 10 people with type 2 diabetes in low- and middle-income countries receive treatment in line with World Health Organization recommendations, shows a global analysis.

Overall, just 4.6% of people received all recommended diabetes-related treatments pertinent to their clinical characteristics, from a possible six: glucose-lowering medication; antihypertensive treatment; lipid-lowering medication; and diet, exercise, and weight-loss counseling.

“Our findings suggest that improving access to comprehensive treatment not only to lower glucose but also to address cardiovascular disease risk factors such as hypertension and elevated cholesterol are global diabetes priorities,” write the researchers in The Lancet Healthy Longevity.

Their analysis involved 680,102 people whose individual data were drawn from nationally representative surveys conducted in 55 low- or middle-income countries between 2009 and 2017.

Of these people 9% had diabetes based on glycemic markers, which the researchers say “is the most valid method to compare performance of health systems in delivering diabetes treatment with the overall population in need, which was our study’s main objective.”

Indeed, just 43.9% of people with type 2 diabetes based on glycemic markers reported having received a diabetes diagnosis.

Among people who required the specific treatments, 50.5% were receiving glucose-lowering medications, 41.3% antihypertensives, and just 6.3% a lipid-lowering medication. In addition, 32.2% of people who required it had received diet counseling, with 28.2% and 31.5% reporting receipt of exercise and weight-loss counseling, respectively.

Receipt of diabetes treatments was more common among people with a stated diagnosis than those without, ranging from 9.2% for lipid-lowering medication to 85.0% for glucose-lowering medication. But use of lipid-lowering medication was not more frequent in the subset of people with a 10-year cardiovascular disease risk of at least 20%.

Guideline-recommended care was overall more common in higher-income countries, although David Flood (University of Michigan, Ann Arbor, USA) and study co-authors did identify some lower-income countries that bucked this trend.

“Costa Rica emerged as an example of one such well performing country, a result that has been attributed to the country’s commitment to universal health coverage,” they write. “Other countries that outperformed predicted coverage based on per-capita income included Bangladesh, Cambodia, Eritrea, Guyana, Iran, and Saint Vincent and the Grenadines.

Women were more likely to receive recommended treatments than men, which the team states “is consistent with the broad global literature detailing lower use of primary health care services among men in low-resource settings.”

More highly educated people tended to receive better treatment, as did older people and those with a higher BMI, which the researchers suggest may be due to a healthcare provider focus on traditional risk factors.

“These findings are crucial given that there is a high proportion of individuals with diabetes in [low- and middle-income countries] who are normal weight according to clinically defined BMI categories, and adequate diabetes treatment in a young person might confer health and economic benefits throughout the lifespan,” they stress.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

Lancet Healthy Longev 2021; doi:10.1016/S2666-7568(21)00089-1


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