David Flood1, Jacqueline A Seiglie2, Matthew Dunn3, Scott Tschida4, Michaela Theilmann5, Maja E Marcus6, Garry Brian7, Bolormaa Norov8, Mary T Mayige9, Mongal Singh Gurung10, Krishna K Aryal11, Demetre Labadarios12, Maria Dorobantu13, Bahendeka K Silver14, Pascal Bovet15, Jutta M Adelin Jorgensen16, David Guwatudde17, Corine Houehanou18, Glennis Andall-Brereton19, Sarah Quesnel-Crooks20, Lela Sturua21, Farshad Farzadfar22, Sahar Saeedi Moghaddam23, Rifat Atun24, Sebastian Vollmer6, Till W Bärnighausen25, Justine I Davies26, Deborah J Wexler2, Pascal Geldsetzer27, Peter Rohloff28, Manuel Ramírez-Zea29, Michele Heisler30, Jennifer Manne-Goehler31. 1. Division of Hospital Medicine, Department of Internal Medicine, National Clinician Scholars Program, University of Michigan, Ann Arbor, MI, USA; Center for Indigenous Health Research, Wuqu' Kawoq; Tecpán, Guatemala; Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala. 2. Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA. 3. School of Public Health, University of Michigan, Ann Arbor, Michigan, USA. 4. Center for Indigenous Health Research, Wuqu' Kawoq; Tecpán, Guatemala. 5. Institute of Global Health, Heidelberg University, Heidelberg, Germany. 6. Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany. 7. The Fred Hollows Foundation New Zealand, Auckland, New Zealand. 8. National Center for Public Health, Ulaanbaatar, Mongolia. 9. National Institute for Medical Research, Dar es Salaam, Tanzania. 10. Health Research and Epidemiology Unit, Ministry of Health, Bhutan. 11. Monitoring Evaluation and Operational Research Project, Abt Associates, Kathmandu, Nepal. 12. Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. 13. University of Medicine and Pharmacy, Carol Davila, Bucharest, Romania. 14. St. Francis Hospital, Nsambya, Kampala, Uganda. 15. Ministry of Health, Victoria, Republic of Seychelles; University Center for Primary Care and Public Health, Lausanne, Switzerland. 16. Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 17. Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda. 18. Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Benin. 19. Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago. 20. Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia. 21. Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia; Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia. 22. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 23. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. 24. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA. 25. Institute of Global Health, Heidelberg University, Heidelberg, Germany; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA; Africa Health Research Institute, Somkhele, South Africa. 26. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town. 27. Institute of Global Health, Heidelberg University, Heidelberg, Germany; Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, USA. 28. Center for Indigenous Health Research, Wuqu' Kawoq; Tecpán, Guatemala; Division of Global Health Equity, Brigham and Women's Hospital; Boston MA, USA. 29. Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala. 30. Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA. 31. Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Approximately 80% of the 463 million adults worldwide with diabetes live in low- and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the limited nationally representative data on the current patterns of treatment coverage. The objectives of this study are (1) to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment and (2) to describe country-level and individual-level characteristics that are associated with treatment. METHODS: We conducted a cross-sectional analysis of pooled, individual data from 55 nationally representative surveys in LMICs. Our primary outcome of self-reported diabetes treatment coverage was based upon population-level monitoring indicators recommended in the 2020 World Health Organization Package of Essential Noncommunicable Disease Interventions. We assessed coverage of three pharmacological and three non-pharmacological treatments among people with diabetes. At the country level, we estimated the proportion of individuals reporting coverage by per-capita gross national income and geographic region. At the individual level, we used logistic regression models to assess coverage along several key individual characteristics including sex, age, BMI, wealth quintile, and educational attainment. In the primary analysis, we scaled sample weights such that countries were weighted equally. FINDINGS: The final pooled sample from the 55 LMICs included 680,102 total individuals and 37,094 individuals with diabetes. Using equal weights for each country, diabetes prevalence was 9.0% (95% confidence interval [CI], 8.7-9.4), with 43.9% (95% CI, 41.9-45.9) reporting a prior diabetes diagnosis. Overall, 4.6% (95% CI, 3.9-5.4) of individuals with diabetes self-reported meeting need for all treatments recommended for them. Coverage of glucose-lowering medication was 50.5% (95% CI, 48.6-52.5); antihypertensive medication, 41.3% (95% CI, 39.3-43.3); cholesterol-lowering medication, 6.3% (95% CI, 5.5-7.2); diet counseling, 32.2% (95% CI, 30.7-33.7); exercise counseling, 28.2% (95% CI, 26.6-29.8); and weight-loss counseling, 31.5% (95% CI, 29.3-33.7). Countries at higher income levels tended to have greater coverage. Female sex and higher age, BMI, educational attainment, and household wealth were also associated with greater coverage. INTERPRETATION: Fewer than one in ten people with diabetes in LMICs receive coverage of guideline-based comprehensive diabetes treatment. Scaling-up the capacity of health systems to deliver treatment not only to lower glucose but also to address cardiovascular disease risk factors such as hypertension and high cholesterol are urgent global diabetes priorities.
BACKGROUND: Approximately 80% of the 463 million adults worldwide with diabetes live in low- and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the limited nationally representative data on the current patterns of treatment coverage. The objectives of this study are (1) to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment and (2) to describe country-level and individual-level characteristics that are associated with treatment. METHODS: We conducted a cross-sectional analysis of pooled, individual data from 55 nationally representative surveys in LMICs. Our primary outcome of self-reported diabetes treatment coverage was based upon population-level monitoring indicators recommended in the 2020 World Health Organization Package of Essential Noncommunicable Disease Interventions. We assessed coverage of three pharmacological and three non-pharmacological treatments among people with diabetes. At the country level, we estimated the proportion of individuals reporting coverage by per-capita gross national income and geographic region. At the individual level, we used logistic regression models to assess coverage along several key individual characteristics including sex, age, BMI, wealth quintile, and educational attainment. In the primary analysis, we scaled sample weights such that countries were weighted equally. FINDINGS: The final pooled sample from the 55 LMICs included 680,102 total individuals and 37,094 individuals with diabetes. Using equal weights for each country, diabetes prevalence was 9.0% (95% confidence interval [CI], 8.7-9.4), with 43.9% (95% CI, 41.9-45.9) reporting a prior diabetes diagnosis. Overall, 4.6% (95% CI, 3.9-5.4) of individuals with diabetes self-reported meeting need for all treatments recommended for them. Coverage of glucose-lowering medication was 50.5% (95% CI, 48.6-52.5); antihypertensive medication, 41.3% (95% CI, 39.3-43.3); cholesterol-lowering medication, 6.3% (95% CI, 5.5-7.2); diet counseling, 32.2% (95% CI, 30.7-33.7); exercise counseling, 28.2% (95% CI, 26.6-29.8); and weight-loss counseling, 31.5% (95% CI, 29.3-33.7). Countries at higher income levels tended to have greater coverage. Female sex and higher age, BMI, educational attainment, and household wealth were also associated with greater coverage. INTERPRETATION: Fewer than one in ten people with diabetes in LMICs receive coverage of guideline-based comprehensive diabetes treatment. Scaling-up the capacity of health systems to deliver treatment not only to lower glucose but also to address cardiovascular disease risk factors such as hypertension and high cholesterol are urgent global diabetes priorities.
Authors: Apostolos Tsapas; Ioannis Avgerinos; Thomas Karagiannis; Konstantinos Malandris; Apostolos Manolopoulos; Panagiotis Andreadis; Aris Liakos; David R Matthews; Eleni Bekiari Journal: Ann Intern Med Date: 2020-06-30 Impact factor: 25.391
Authors: Madeline Pesec; Hannah L Ratcliffe; Ami Karlage; Lisa R Hirschhorn; Atul Gawande; Asaf Bitton Journal: Health Aff (Millwood) Date: 2017-03-01 Impact factor: 6.301
Authors: David B Sacks; Mark Arnold; George L Bakris; David E Bruns; Andrea Rita Horvath; M Sue Kirkman; Ake Lernmark; Boyd E Metzger; David M Nathan Journal: Clin Chem Date: 2011-05-26 Impact factor: 8.327
Authors: Jacqueline A Seiglie; Maja-Emilia Marcus; Cara Ebert; Nikolaos Prodromidis; Pascal Geldsetzer; Michaela Theilmann; Kokou Agoudavi; Glennis Andall-Brereton; Krishna K Aryal; Brice Wilfried Bicaba; Pascal Bovet; Garry Brian; Maria Dorobantu; Gladwell Gathecha; Mongal Singh Gurung; David Guwatudde; Mohamed Msaidié; Corine Houehanou; Dismand Houinato; Jutta Mari Adelin Jorgensen; Gibson B Kagaruki; Khem B Karki; Demetre Labadarios; Joao S Martins; Mary T Mayige; Roy Wong-McClure; Joseph Kibachio Mwangi; Omar Mwalim; Bolormaa Norov; Sarah Quesnel-Crooks; Bahendeka K Silver; Lela Sturua; Lindiwe Tsabedze; Chea Stanford Wesseh; Andrew Stokes; Rifat Atun; Justine I Davies; Sebastian Vollmer; Till W Bärnighausen; Lindsay M Jaacks; James B Meigs; Deborah J Wexler; Jennifer Manne-Goehler Journal: Diabetes Care Date: 2020-02-12 Impact factor: 19.112
Authors: Margaret E Kruk; Anna D Gage; Naima T Joseph; Goodarz Danaei; Sebastián García-Saisó; Joshua A Salomon Journal: Lancet Date: 2018-09-05 Impact factor: 79.321
Authors: Maria Inês Schmidt; Paula Bracco; Scheine Canhada; Joanna M N Guimarães; Sandhi Maria Barreto; Dora Chor; Rosane Griep; John S Yudkin; Bruce B Duncan Journal: Diabetes Care Date: 2020-11-10 Impact factor: 19.112
Authors: Marie Ng; Nancy Fullman; Joseph L Dieleman; Abraham D Flaxman; Christopher J L Murray; Stephen S Lim Journal: PLoS Med Date: 2014-09-22 Impact factor: 11.069
Authors: David Flood; Pascal Geldsetzer; Kokou Agoudavi; Krishna K Aryal; Luisa Campos Caldeira Brant; Garry Brian; Maria Dorobantu; Farshad Farzadfar; Oana Gheorghe-Fronea; Mongal Singh Gurung; David Guwatudde; Corine Houehanou; Jutta M Adelin Jorgensen; Dimple Kondal; Demetre Labadarios; Maja E Marcus; Mary Mayige; Mana Moghimi; Bolormaa Norov; Gastón Perman; Sarah Quesnel-Crooks; Mohammad-Mahdi Rashidi; Sahar Saeedi Moghaddam; Jacqueline A Seiglie; Silver K Bahendeka; Eric Steinbrook; Michaela Theilmann; Lisa J Ware; Sebastian Vollmer; Rifat Atun; Justine I Davies; Mohammed K Ali; Peter Rohloff; Jennifer Manne-Goehler Journal: Diabetes Care Date: 2022-09-01 Impact factor: 17.152
Authors: Eyitayo Omolara Owolabi; Daniel Ter Goon; Anthony Idowu Ajayi; Oladele Vincent Adeniyi Journal: PLoS One Date: 2022-07-15 Impact factor: 3.752
Authors: Maja E Marcus; Jennifer Manne-Goehler; Michaela Theilmann; Farshad Farzadfar; Sahar Saeedi Moghaddam; Mohammad Keykhaei; Amirali Hajebi; Scott Tschida; Julia M Lemp; Krishna K Aryal; Matthew Dunn; Corine Houehanou; Silver Bahendeka; Peter Rohloff; Rifat Atun; Till W Bärnighausen; Pascal Geldsetzer; Manuel Ramirez-Zea; Vineet Chopra; Michele Heisler; Justine I Davies; Mark D Huffman; Sebastian Vollmer; David Flood Journal: Lancet Glob Health Date: 2022-03 Impact factor: 26.763
Authors: Owen Nkoka; Peter A M Ntenda; Yohane V A Phiri; Gugulethu N Mabuza; Sihle A Dlamini Journal: BMC Cardiovasc Disord Date: 2022-04-02 Impact factor: 2.298
Authors: Akram Hernández-Vásquez; Antonio Barrenechea-Pulache; Andres Portocarrero-Bonifaz; Carlos Rojas-Roque; Jesús Eduardo Gamboa-Unsihuay Journal: Prev Med Rep Date: 2022-07-04
Authors: Maria Lisa Odland; Khadija Gassama; Tahir Bockarie; Haja Wurie; Rashid Ansumana; Miles D Witham; Oyinlola Oyebode; Lisa R Hirschhorn; Justine I Davies Journal: PLoS One Date: 2022-09-09 Impact factor: 3.752