Nanny N M Soetedjo1, Susan M McAllister2, Cesar Ugarte-Gil3, Adela G Firanescu4, Katharina Ronacher5,6, Bachti Alisjahbana1,7, Anca L Costache8,9,10, Carlos Zubiate11, Stephanus T Malherbe5, Raspati C Koesoemadinata7,12, Yoko V Laurence13, Fiona Pearson14, Sarah Kerry-Barnard14, Rovina Ruslami7,12, David A J Moore3,13, Mihai Ioana9,10, Leanie Kleynhans5, Hikmat Permana1, Philip C Hill2, Maria Mota4, Gerhard Walzl5, Hazel M Dockrell15, Julia A Critchley14, Reinout van Crevel8. 1. Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. 2. Centre for International Health, University of Otago, Dunedin, New Zealand. 3. Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru. 4. Clinic of Diabetes Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, University of Medicine and Pharmacy of Craiova, Craiova, Romania. 5. South African Medical Research Council Centre for TB Research, Stellenbosch University, Stellenbosch, South Africa. 6. Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia. 7. TB-HIV Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. 8. Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands. 9. Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania. 10. Regional Centre for Human Genetics, Dolj, Emergency Clinical County Hospital, Craiova, Romania. 11. Servicio de Endocrinologia, Hospital Maria Auxiliadora, Lima, Peru. 12. Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. 13. Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK. 14. Population Health Research Institute, St George's University of London, London, UK. 15. Department of Immunology & Infection, London School of Hygiene & Tropical Medicine, London, UK.
Abstract
OBJECTIVE: To describe the characteristics and management of Diabetes mellitus (DM) patients from low- and middle-income countries (LMIC). METHODS: We systematically characterised consecutive DM patients attending public health services in urban settings in Indonesia, Peru, Romania and South Africa, collecting data on DM treatment history, complications, drug treatment, obesity, HbA1c and cardiovascular risk profile; and assessing treatment gaps against relevant national guidelines. RESULTS: Patients (median 59 years, 62.9% female) mostly had type 2 diabetes (96%), half for >5 years (48.6%). Obesity (45.5%) and central obesity (females 84.8%; males 62.7%) were common. The median HbA1c was 8.7% (72 mmol/mol), ranging from 7.7% (61 mmol/mol; Peru) to 10.4% (90 mmol/mol; South Africa). Antidiabetes treatment included metformin (62.6%), insulin (37.8%), and other oral glucose-lowering drugs (34.8%). Disease complications included eyesight problems (50.4%), EGFR <60 ml/min (18.9%), heart disease (16.5%) and proteinuria (14.7%). Many had an elevated cardiovascular risk with elevated blood pressure (36%), LDL (71.0%) and smoking (13%), but few were taking antihypertensive drugs (47.1%), statins (28.5%) and aspirin (30.0%) when indicated. Few patients on insulin (8.0%), statins (8.4%) and antihypertensives (39.5%) reached treatment targets according to national guidelines. There were large differences between countries in terms of disease profile and medication use. CONCLUSION: DM patients in government clinics in four LMIC with considerable growth of DM have insufficient glycaemic control, frequent macrovascular and other complications, and insufficient preventive measures for cardiovascular disease. These findings underline the need to identify treatment barriers and secure optimal DM care in such settings.
OBJECTIVE: To describe the characteristics and management of Diabetes mellitus (DM) patients from low- and middle-income countries (LMIC). METHODS: We systematically characterised consecutive DMpatients attending public health services in urban settings in Indonesia, Peru, Romania and South Africa, collecting data on DM treatment history, complications, drug treatment, obesity, HbA1c and cardiovascular risk profile; and assessing treatment gaps against relevant national guidelines. RESULTS:Patients (median 59 years, 62.9% female) mostly had type 2 diabetes (96%), half for >5 years (48.6%). Obesity (45.5%) and central obesity (females 84.8%; males 62.7%) were common. The median HbA1c was 8.7% (72 mmol/mol), ranging from 7.7% (61 mmol/mol; Peru) to 10.4% (90 mmol/mol; South Africa). Antidiabetes treatment included metformin (62.6%), insulin (37.8%), and other oral glucose-lowering drugs (34.8%). Disease complications included eyesight problems (50.4%), EGFR <60 ml/min (18.9%), heart disease (16.5%) and proteinuria (14.7%). Many had an elevated cardiovascular risk with elevated blood pressure (36%), LDL (71.0%) and smoking (13%), but few were taking antihypertensive drugs (47.1%), statins (28.5%) and aspirin (30.0%) when indicated. Few patients on insulin (8.0%), statins (8.4%) and antihypertensives (39.5%) reached treatment targets according to national guidelines. There were large differences between countries in terms of disease profile and medication use. CONCLUSION:DMpatients in government clinics in four LMIC with considerable growth of DM have insufficient glycaemic control, frequent macrovascular and other complications, and insufficient preventive measures for cardiovascular disease. These findings underline the need to identify treatment barriers and secure optimal DM care in such settings.
Authors: R C Koesoemadinata; S M McAllister; N N M Soetedjo; P Santoso; R Ruslami; H Damayanti; N Rahmadika; B Alisjahbana; R van Crevel; P C Hill Journal: Public Health Action Date: 2021-12-21
Authors: Shukri F Mohamed; Olalekan A Uthman; Martin K Mutua; G Asiki; Mustapha S Abba; Paramjit Gill Journal: BMJ Open Date: 2021-12-13 Impact factor: 3.006