Diabetes greatly undertreated globally, survey shows

• A study of diabetes treatment in 55 low and middle income countries found that many of the participants with diabetes were unaware that they had the condition.
• Overall, less than 5% were getting adequate drug treatments and lifestyle advice.
• The researchers pooled data from nationally representative surveys that asked people what treatments they were taking to reduce blood sugar, blood pressure, and cholesterol levels and what advice they had received about diet, exercise, and weight.
• Diabetes medications are cheap and proven to reduce both the risk of diabetes-associated complications and the long-term costs of care.

The International Diabetes Federation notes that of the estimated 463 million adults in the world who have diabetes, almost 80% live in low and middle income countries.

Diabetes increases a person’s risk of a range of disabling and potentially fatal complications, including heart attack, stroke, blindness, and damage to the kidneys and nerves.

Drug treatments for the condition are cheap and proven to reduce morbidity and mortality.

However, the ability of health services in low and middle income countries to diagnose the condition and deliver these treatments is often limited. This inevitably leads to unnecessary suffering and many avoidable deaths.

Doctors at the University of Michigan in Ann Arbor and Brigham and Women’s Hospital in Boston, MA, recently led a study to estimate the scale of the problem.

The researchers drew on data from standardized household surveys in low and middle income countries that included information on blood test results for diabetes and self-reported treatments.

They discovered that only 4.6% of people with diabetes were receiving the whole package of care that the World Health Organization (WHO) recommends for treating the condition in primary care.

While 50.5% and 41.3% of the respondents were taking drugs to lower their blood sugar and blood pressure, respectively, only 6.3% were on cholesterol-lowering medication.

Overall, 32.2% of respondents said that they had received advice on diet. Just 31.5% had received advice on weight loss, and 28.2% on exercise.

“Diabetes continues to explode everywhere, in every country, and 80% of people with it live in these low and middle income countries,” says lead author David Flood, M.D., M.Sc., who is a national clinician scholar at the University of Michigan Institute for Healthcare Policy & Innovation.

“It confers a high risk of complications, including heart attacks, blindness, and strokes,” he adds. “We can prevent these complications with comprehensive diabetes treatment, and we need to make sure people around the world can access treatment.”

The research has been published in The Lancet Health Longevity.

Lack of treatment for high cholesterol

The household surveys provided data for a total of 680,102 adults in 55 low and middle income countries.

Blood tests indicated that 37,094 of these individuals had diabetes. However, only 43.9% of them said that they had received a diagnosis.

Even among those with a formal diagnosis, there was room for improvement in terms of drug treatments. While 85% and 57% of those who knew that they had diabetes were taking drugs to lower their blood sugar levels and blood pressure, respectively, only 9% were taking a statin to lower their cholesterol.

The researchers write:

“Our findings suggest that delivering treatment not only to lower glucose but also to manage [cardiovascular disease] risk factors, such as hypertension and elevated cholesterol, among people with diabetes are urgent global priorities.”

Countries with higher incomes tended to have better coverage across all the diabetes treatments.

Coverage was generally highest in Latin America and the Caribbean and lowest in Oceania (Pacific islands) and sub-Saharan Africa.

The researchers have passed their findings to the WHO, which launched the Global Diabetes Compact on April 14, 2021, to step up efforts to prevent and treat diabetes worldwide.

Two-way links with COVID-19

People with diabetes and obesity are more likely to develop severe COVID-19 infections, and researchers also believe that COVID-19 may trigger diabetes.

Jennifer Manne-Goehler, M.D., Sc.D., one of the authors of the new paper, told MNT that the pandemic has increased the urgency to improve diabetes services in resource-limited contexts.

Dr. Manne-Goehler is an infectious diseases physician at Brigham and Women’s Hospital and a clinical fellow at Harvard Medical School, both in Boston, MA.

She and her colleagues have found that diabetes is associated with “poor early outcomes” for people hospitalized with COVID-19.

“The COVID-19 pandemic has really highlighted how important the intersection between diabetes and infectious conditions is and the far-reaching implications of ensuring everyone with diabetes has access to much needed services,” she said.

Limitations of the research

The study authors highlight several limitations in their paper, including inconsistencies across the different surveys in terms of the year they took place, the diagnostic tests that were used, and the age profile of the participants.

These differences and others may account for some of the observed variation in treatment coverage among countries.

The researchers also report that they were unable to get enough data about the availability of counseling to quit smoking.

They write that this is a limitation because smoking is a major contributor to the risk of cardiovascular disease among people with diabetes.

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