PLoS Medicine: Health system performance for people with diabetes in 28 low- and middle-income countries

3 March, 2019

'There is a large unmet need for diabetes care that reflects the need for a greater investment of health resources to strengthen systems of care for this disease. Given that diabetes is considered a tracer condition for examining health systems, these findings also indicate that many countries face challenges in achieving universal health coverage... To the best of our knowledge, this study provides the first empirical analysis of health system performance for management of diabetes across LMICs in multiple geographic regions.' So conclude the authors of this new paper in PLoS Medicine. 'Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was high, at 77%'

Below are the citation and author summary. Full text here: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1...

CITATION: Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys.

Jennifer Manne-Goehler, Pascal Geldsetzer, 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 Msaidie... Lindsay M. Jaacks

PLoS Medicine - Published: March 1, 2019

https://doi.org/10.1371/journal.pmed.1002751

AUTHOR SUMMARY

Why was this study done?

- Diabetes is a growing problem in low-income and middle-income countries, which already carry about 75% of the global diabetes burden, but there is limited evidence to guide policymaking in these settings.

- Prior studies have analyzed the cascade of care for diabetes in single-country or subnational contexts, but to our knowledge there have been no prior multi-country analyses on this subject.

- This study analyzes nationally representative data regarding health system performance for people who have diabetes, as defined by biological criteria, across a spectrum of levels of economic development.

What did the researchers do and find?

- We harmonized nationally representative population-based survey data from 28 low-income and middle-income countries in 4 geographic regions, and used these data to construct the diabetes care cascade stratified by individual factors and national income.

- In this sample of over 800,000 adults, the overall prevalence of diabetes was 8.8% (95% CI: 8.2%–9.5%), of which 4.8% (95% CI: 4.5%–5.2%) was undiagnosed.

- In this study, we found that health system performance for diabetes showed large losses to care at the stage of detection (63.4% [95% CI: 56.7%–69.6%]) and low rates of diabetes control (22.8% [95% CI: 20.9%–24.9%]).

- Total unmet need for diabetes care (defined as the sum of undetected, detected but undiagnosed, diagnosed but untreated, and treated but not controlled diabetes) was 77.0% (95% CI: 74.9%–78.9%).

- Performance along the care cascade was better in upper-middle-income countries, but across all World Bank income groups, only 16%–25% of those with diabetes achieved diabetes control.

- Increasing age, educational attainment, and overweight or obesity were associated with higher odds of being tested, treated, and achieving control.

What do these findings mean?

- There is a large unmet need for diabetes care that reflects the need for a greater investment of health resources to strengthen systems of care for this disease.

- Given that diabetes is considered a tracer condition for examining health systems, these findings also indicate that many countries face challenges in achieving universal health coverage.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org