Nearly half a billion people on the planet have diabetes, but most of them are not receiving the kind of care that could make their lives healthier, longer, and more productive. This comes from a new global study that looked at data from people with the disease.
Many don’t even know they have the condition.
Only 1 in 10 people with diabetes in the 55 low- and middle-income countries surveyed are receiving the type of comprehensive care that has been shown to reduce diabetes-related problems. This is evident from the new evidence published in the Lancet Healthy Longevity.
This comprehensive care package – inexpensive drugs to lower blood sugar, blood pressure and cholesterol levels; Advice on diet, exercise, and weight can help reduce the health risks of under-treated diabetes. These risks include future heart attacks, strokes, nerve damage, blindness, amputations, and other debilitating or fatal conditions.
The new study, conducted by doctors at the University of Michigan and Brigham and Women’s Hospital with a global team of partners, uses data from standardized household studies to enable apple-to-apple comparison across countries and regions.
The authors analyzed data from surveys, research and tests of more than 680,000 people between the ages of 25 and 64 that were carried out around the world in the past few years. More than 37,000 of them had diabetes; more than half of them had not yet been officially diagnosed but had an important biomarker of high blood sugar.
Researchers made their findings available to the World Health Organization, which is making efforts to improve the delivery of evidence-based diabetes care around the world through an initiative known as the WHO Global Diabetes Compact. The forms of diabetes-related care used in the study are all included in the WHO 2020 package for interventions in non-communicable diseases.
“Diabetes continues to explode everywhere, in every country, and 80% of people with diabetes live in these low- and middle-income countries,” said David Flood, lead author and National Clinician Scholar at the UM Institute for Health Policy and Innovation. “It carries a high risk of complications like heart attacks, blindness and strokes. We can prevent these complications with comprehensive diabetes management and we need to ensure that people around the world have access to treatment. “
Flood worked with senior author Jennifer Manne-Goehler of Brigham and Women’s Hospital and the Medical Practice Evaluation Center of Massachusetts General Hospital to lead the analysis of detailed global data.
In addition to the key finding that 90% of people with diabetes studied did not have access to all six components of effective diabetes care, the study also found large gaps in specific care.
For example, while about half of people with diabetes were taking a drug to lower their blood sugar and 41% were taking a drug to lower their blood pressure, only 6.3% were taking cholesterol-lowering drugs.
These results show that proven treatment needs to be expanded not only to lower glucose but also to address risk factors for cardiovascular disease such as high blood pressure and high cholesterol in people with diabetes.
Less than a third have had access to diet and exercise advice that can help people with diabetes adopt habits that can further control their health risks.
Even when the authors focused on those people who had already been formally diagnosed with diabetes, they found that 85% were taking a blood sugar lowering drug, 57% were taking a blood pressure drug, but only 9% were taking something to control them Cholesterol. Almost 74% had received nutrition-related advice, and just under 66% had received exercise and weight advice.
Overall, fewer than one in five people with previously diagnosed diabetes received the full package of evidence-based care.
Relationship to national income and personal characteristics
In general, the study finds that the lower the median income of the country and region in which they lived, the less likely people are to receive evidence-based diabetes care. This is based on a model that the authors created using economic and demographic data about the countries they live in were included in the study.
The nations in the Oceania-Pacific region had the highest prevalence of diabetes – both diagnosed and undiagnosed – but the lowest rates of diabetes-related care.
There were exceptions, however, where low-income countries had an above-expected rate of good diabetes care, says Flood, using the example of Costa Rica. In general, the Latin America and the Caribbean region ranked second after Oceania in terms of diabetes prevalence, but had a much higher level of care.
Focusing on which countries are doing well with oversized successes in diabetes care could provide valuable insights for improving care elsewhere, the authors say. This even includes informing care providers in high-income countries like the United States, which do not consistently provide evidence-based care to people with diabetes.
The study also sheds light on the differences between countries and regions in the percentage of diagnosed diabetes cases. Improving reliable access to diabetes diagnostic technology is important in directing more people to preventive care and counseling.
Women, people with higher levels of education and personal wealth, and people who are older or had high body mass indexes were more likely to receive evidence-based diabetes care. Diabetes in people with “normal” BMI is not uncommon in low- and middle-income countries, suggesting that more focus needs to be placed on these people, the authors say.
The fact that diabetes-related drugs are available at very low cost, and that individuals can reduce their risk through lifestyle changes, means that cost shouldn’t be a huge barrier, says Flood. In fact, studies have shown that the drugs are inexpensive, which means that the cost of using them early and consistently is outweighed by the savings in other types of subsequent care.
In addition to Flood, a clinical lecturer in hospital medicine at Michigan Medicine, UM’s academic medical center, the study team includes two other UM employees: Michele Heisler, professor of internal medicine and health behavior and education, and a member of IHPI and Matthew Dunn, a PhD student at the UM School of Public Health. The study was funded by the National Clinician Scholars Program at IHPI, as well as the National Institute for Diabetes and Digestive and Kidney Diseases, Harvard Catalyst, and the National Center for the Advancement of Translational Sciences.