Ninety Percent of Diabetes Patients in Low- and Middle-Income Countries Lack Comprehensive Care

Uncontrolled diabetes increases the risk of a variety of complications, including stroke, neuropathy, cardiovascular disease, and vision problems. A new study finds that millions of people across the world are more apt to face these issues due to a lack of treatment.

Researchers from the University of Michigan and Brigham and Women’s Hospital teamed up with global groups to look at the state of diabetes care on a global scale, finding that only one in ten diabetes patients in low- and middle-income countries is getting adequate comprehensive care for the condition. The results were published in Lancet Healthy Longevity.

David Flood, lead author and a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation, says, “Diabetes continues to explode everywhere, in every country, and 80% of people with it live in these low- and middle-income countries. It confers a high risk of complications such as heart attacks, blindness and strokes. We can prevent these complications with comprehensive diabetes treatment, and we need to make sure people around the world can access treatment.”

The study authors note that comprehensive care for diabetes includes affordable medication for managing blood sugar, blood pressure, and cholesterol levels; counseling on exercise and weight; and dietary guidance. All of these help reduce the risk of serious complications for the 463 million diabetes patients across the globe.

Unfortunately, many don’t realize they have the condition. Even if they do, it can be very difficult to access the care they need.

Researchers analyzed diabetes in 55 low- and middle-income countries through survey data, examinations, and tests performed on more than 680,000 people between the ages of 25 and 64 in recent years. Overall, more than 37,000 had diabetes. More than half of them had not been diagnosed but had the key biomarker of elevated blood sugar.

Researchers found 90% of the total number of patients weren’t getting access to everything they needed.

About half were not taking drugs to lower their blood sugar, 59% were not taking blood pressure medications, and nearly 94% were not on anything to control their cholesterol. When it comes to guidance on diet and exercise, more than two-thirds had no access.

While the figures were better for those with a formal diagnosis, there were still plenty lacking treatment. In this group, 85% were taking blood sugar medication, 57% were on blood pressure drugs, 74% had received dietary counseling, and just under 66% had undergone exercise and weight counseling. Cholesterol treatment remained very low, with just 9% on medication. In addition, among formally diagnosed patients, less than one in five had comprehensive care.

Lack of adequate care was the highest in lower-income countries. There were also strong trends in certain regions.

The study says, “Countries in higher-income groups generally had higher coverage across all treatments. For example, coverage of glucose-lowering medication was 40·3% in low-income countries, 45·1% in lower-middle-income countries, and 64·1% in upper-middle-income countries.”

The study also found coverage was typically the highest in Latin America and the Caribbean and lowest in Oceania and sub-Saharan Africa.

The authors stress that it’s important for the medical community to take steps to address these gaps.

The study says, “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.”

The World Health Organization says cases of diabetes have increased significantly since 1980, when there were just 108 million cases, compared with the 463 million found in this survey. The growth has been sharpest in low- and middle-income countries.