Extensive treatment of diabetes seen in a worldwide study

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According to a new global study of data from people with this disease, about half a billion people on the planet have diabetes, but most do not receive the kind of care that can make their lives healthier, longer and more productive. .

Many don’t even know they have them.

According to new findings published in, only 1 in 10 people with diabetes in the 55 low- and middle-income countries studied receive the type of comprehensive care that reduces diabetes-related problems. Lancet Healthy Longevity.

This complete package of care: low-cost drugs to lower blood sugar, and blood pressure ; and advice on diet, exercise and weight, can help reduce weight of poorly treated diabetes. These risks include future heart attacks, strokes, nerve damage, blindness, amputations, and other deadly or disabling conditions.

The new study, led by physicians at the University of Michigan and Brigham and Women’s Hospital with a global team of partners, draws on standardized home study data to allow comparisons between apples and countries between countries and regions.

The authors analyzed data from surveys, examinations and tests of more than 680,000 people between the ages of 25 and 64 worldwide conducted in recent years. More than 37,000 of them had diabetes; more than half of them had not yet been formally diagnosed, but they had a key biomarker of high blood sugar.

Researchers have provided their findings to the World Health Organization, which is working to increase the distribution of evidence-based diabetes care worldwide as part of an initiative known as the World Health Organization. Global Compact against Diabetes. The forms of diabetes-related care used in the study are included in WHO 2020 package of essential interventions on non-communicable diseases.

“Diabetes continues to explode everywhere, in all countries, and 80% of people living in these low- and middle-income countries,” says David Flood, MD, M.Sc., lead author and national scholar of clinicians from the UM Institute for Healthcare Policy and Innovation. “It confers a high risk of complications such as heart attacks, blindness and stroke. We can prevent these complications with comprehensive diabetes treatment and we need to make sure that people around the world can access the treatment.”

Flood worked with senior author Jennifer Manne-Goehler, MD, Sc.D., of Brigham and Women’s Hospital and the Massachusetts General Hospital Medical Practice Evaluation Center, to lead the analysis of detailed global data.

Main conclusions

In addition to the main finding that 90% of people with diabetes studied did not have access to the six components of effective diabetes care, the study also finds significant 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 receiving medications to lower their cholesterol.

These results show the need to extend proven treatment not only to lower glucose, but also to address risk factors for cardiovascular disease, such as hypertension and high cholesterol, in people with diabetes.

Less than a third had access to diet and exercise advice, which can help guide people with diabetes to adopt habits that can further control their health risks.

Even when the authors focused on people who had already received a formal diagnosis of diabetes, they found that 85% were taking a medication to decrease it. , 57% were taking blood pressure medications, but only 9% were taking something to control cholesterol. Almost 74% had received diet-related advice and just under 66% had received advice on exercise and weight.

Overall, less than one in five people with previously diagnosed diabetes received the full evidence-based care package.

Relationship with national income and personal characteristics

Overall, the study found that people were less likely to receive evidence-based diabetes care, the lower the average income in the country and region where they lived. This is based on a model that the authors created using economic and demographic data on the countries that were included in the study.

The nations of the Pacific region of Oceania had the highest prevalence of diabetes — both diagnosed and undiagnosed — but diabetes-related assistance rates were the lowest.

But there were exceptions where low-income countries had higher-than-expected diabetes care rates, says Flood, who cites the example of Costa Rica. And overall, the Latin American and Caribbean region ranked second in Oceania in diabetes prevalence, but had much higher levels of care.

Focusing on what countries with great success in diabetes care are doing well could provide valuable information to improve care elsewhere, the authors say. It even includes information on care in high-income countries like the United States, which does not offer evidence-based care consistently to people with diabetes.

The study also highlights the variation between countries and regions in the percentage of cases of diabetes diagnosed. Improving reliable access to diabetes diagnostic technologies is important to drive more people to get preventive care and counseling.

Women, people with higher levels of education and higher personal wealth, and older people or those with a high body mass index were more likely to receive evidence-based care for diabetes. Diabetes in people with a “normal” BMI is not uncommon in people with a low and low index , suggest a greater need to focus on these people, the authors say.

The fact that Related drugs are available at a very low cost and people can reduce their risk through lifestyle changes, which means cost should not be a major barrier, Flood says. In fact, studies have shown that drugs are cost-effective, meaning that the cost of their early and consistent use is offset by savings in other types of care later.


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More information:
David Flood et al, The state of diabetes treatment coverage in 55 low- and middle-income countries: a cross-sectional study of nationally and nationally representative data in 680,102 adults, The Lancet Healthy Longevity (2021). DOI: 10.1016 / S2666-7568 (21) 00089-1

Citation: Large Insufficient Treatment of Diabetes Seen in a Global Study (2021, May 22) Retrieved May 22, 2021 at https://medicalxpress.com/news/2021-05-vast-under-treatment-diabetes-global .html

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