Massive diabetes care gaps recognized in low- and middle-income nations


medwireNews: Less than one in ten people with type 2 diabetes in low- and middle-income countries are treated according to the recommendations of the World Health Organization, a global analysis shows.

Overall, only 4.6% of people received all of the recommended diabetes-related treatments relevant to their clinical features out of six possible: glucose-lowering drugs; antihypertensive treatment; lipid lowering drugs; and diet, exercise, and weight loss advice.

“Our results suggest that improving access to comprehensive treatment not only to lower glucose but also to treat risk factors for cardiovascular disease such as high blood pressure and high cholesterol are global priorities for diabetes,” the researchers write in The Lancet Healthy Longevity.

Their analysis included 680,102 people whose individual data came from nationally representative surveys carried out in 55 low- and middle-income countries between 2009 and 2017.

Of these people, 9% had diabetes based on glycemic markers. The researchers say this is the most appropriate way to compare health systems performance in providing diabetes treatment with the general population in need, which was the main objective of our study.

In fact, only 43.9% of people with type 2 diabetes said they had a diagnosis of diabetes based on glycemic markers.

Among the people who needed the specific treatments, 50.5% received glucose-lowering drugs, 41.3% received antihypertensive drugs, and only 6.3% received lipid-lowering drugs. In addition, 32.2% of those who needed it had received nutritional advice, with 28.2% and 31.5% saying they had received exercise and weight loss advice, respectively.

Receipt of diabetes treatments was more common in people with a stated diagnosis than in people without a diagnosis, ranging from 9.2% for lipid-lowering drugs to 85.0% for glucose-lowering drugs. However, the use of lipid lowering drugs was not more common in those with a 10-year risk of cardiovascular disease 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 co-authors of the study identified some lower-income countries that bucked this trend.

“Costa Rica has emerged as an example of such a capable country, a result of the country’s commitment to universal health coverage,” they write. “Other countries that exceeded projected coverage based on per capita income were Bangladesh, Cambodia, Eritrea, Guyana, Iran, and St. Vincent and the Grenadines.

Women were more likely to receive recommended treatments than men, which the team said was “consistent with the broad global literature describing lower use of primary health care among men in resource-poor settings.”

Highly educated people tended to receive better treatment, as did the elderly and those with higher BMI, which the researchers believe may be due to a health care provider focusing on traditional risk factors.

“These results are critical as a high proportion of people with diabetes are in [low- and middle-income countries] Anyone who is of normal weight according to clinically defined BMI categories and who carries out appropriate diabetes treatment in young people can bring health and economic benefits throughout their lifespan, ”they emphasize.

medwireNews is an independent medical news service from 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