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Diabetes uncontrolled in seven countries
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Millions of people worldwide may be at risk for early mortality from diabetes and related cardiovascular illnesses because of poor diagnosis and ineffective treatment, researchers at the Institute for Health Metrics and Evaluation at University of Washington found.
The study examined the diagnosis, treatment and management of diabetes in the United States, Colombia, England, Iran, Mexico, Scotland and Thailand.
In the United States alone, nearly 90% of adults with diabetes — more than 16 million adults aged 35 years and older — have blood glucose, blood pressure and cholesterol that do not meet widely accepted targets for healthy levels, according to the results. In Mexico, 99% of adults with diabetes do not meet the aforementioned targets.
The study is published in the Bulletin of the World Health Organization’s March edition.
Low diagnosis, treatment
“Too many people are not being properly diagnosed with diabetes and related CV risk factors. Those who are diagnosed aren’t being effectively treated,” Stephen Lim, MD, a study co-author and associate professor of global health at the Institute of Health Metrics and Evaluation (IHME), said in a press release. “This is a huge missed opportunity to lower the burden of disease in both rich and poor countries.”
According to the results, undiagnosis and untreatment is present in a substantial proportion of individuals with diabetes in developed and developing countries, ranging from 24% of women in Scotland and the US to 62% of men in Thailand. The researchers found that up to 62% of men with diabetes in Thailand are undiagnosed or untreated for diabetes, which translates to more than 663,000 people. Diagnosis rates tended to be higher for women compared with men; the largest difference was seen in Colombia, where 15% more women with diabetes are diagnosed vs. men.
Analysis yielded a low percentage of people with diabetes in the seven countries studied who are reaching International Diabetes Federation treatment goals for blood glucose, BP and cholesterol: 1% to 12%. In Scotland, researchers noted difficulty in finding women with diabetes who met accepted targets for managing these risks.
Effect of wealth
“We were very surprised to see that wealth did not have a big impact on diagnosis and treatment,” Emmanuela Gakidou, MSc, PhD, associate professor of global health at IHME, said in the release. “And in the three countries where we had health insurance data, we thought it was noteworthy that health insurance actually played a much bigger role than wealth, especially in the United States.”
In the United States, people who had insurance were twice as likely to be diagnosed and effectively treated for diabetes as those who did not have insurance.
Although the researchers noted no large socioeconomic inequalities, they said a strong predictor of diagnosis and management of diabetes was financial access to care.
Documenting trends
The researchers said these findings underscore the need for countries to tackle the growing problem of noncommunicable diseases, in part by gathering better data.
“We don’t have enough data from actual physical exams to accurately document the trend in most countries,” Rafael Lozano, MSc, MD, professor of global health at IHME, said in the release. “We looked at surveys from nearly 200 countries and only could find data on blood glucose, cholesterol or BP in seven.”
The researchers concluded that there are a number of “missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolemia.”
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