Screen Shot 2019-03-06 at 23.28.04CITATION: 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


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.

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