Glycemic Control and Prevention of Diabetic Complications in Low- and Middle-Income Countries: An Expert Opinion
| Autor: | Kamlesh Khunti, León Litwak, Freddy Goldberg-Eliaschewitz, Shih-Te Tu, Pablo Aschner, Khadija Hafidh, Guillermo Gonzalez-Galvez, Ambika Gopalakrishnan Unnikrishnan, Khier Djaballah, Dilek Gogas Yavuz, Gagik Radikovich Galstyan |
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| Přispěvatelé: | Aschner, Pablo, Galstyan, Gagik, Yavuz, Dilek G., Litwak, Leon, Gonzalez-Galvez, Guillermo, Goldberg-Eliaschewitz, Freddy, Hafidh, Khadija, Djaballah, Khier, Tu, Shih-Te, Unnikrishnan, Ambika G., Khunti, Kamlesh |
| Rok vydání: | 2021 |
| Předmět: |
Pediatrics
medicine.medical_specialty Endocrinology Diabetes and Metabolism medicine.medical_treatment 030209 endocrinology & metabolism Type 2 diabetes 030204 cardiovascular system & hematology Hypoglycemia 03 medical and health sciences Diabetes mellitus Glycemic control 0302 clinical medicine Diabetes complications Internal Medicine medicine Obesity Original Research Nutrition Glycemic Health services development Low- and middle-income countries and middle-income countries business.industry Incidence (epidemiology) Insulin Retrospective cohort study medicine.disease Health policy Low Human resources Health promotion business |
| Zdroj: | Diabetes Therapy |
| ISSN: | 1869-6961 1869-6953 |
| DOI: | 10.1007/s13300-021-00997-0 |
| Popis: | Introduction Trends on glycemic control and diabetes complications are known for high-income countries, but comprehensive data from low- and middle-income countries (LMIC) are lacking. Methods This is an expert opinion based on two retrospective studies. Here we examine the recent subset analysis of relevant data from the IDMPS Wave 7 (International Diabetes Management-Practices Study, 2015-2016) and the GOAL study conducted in multiple LMICs. Results Wave 7 sub-analysis was performed in 6113 people with type 2 diabetes from 24 LMIC. Poorly controlled diabetes (hemogloblin A1c [HbA1c] >= 7%) was found in 58.6, 73.0 and 78.3% of participants with diabetes duration of < 5, 5-12 and > 12 years, respectively (in association with a high prevalence of macro- and microvascular complications). Moreover, 37.7% of participants with diabetes duration of 5-12 years were treated only with oral antihyperglycemic drugs. The GOAL study investigated the efficacy of insulin in 2704 poorly controlled participants (mean HbA1c 9.7%; diabetes duration 10.1 +/- 6.7 years; 10 LMIC). A significant 2% reduction in mean HbA1c levels was observed after 12 months of treatment. Only 7.2% of participants experienced a symptomatic episode of hypoglycemia (nocturnal or severe hypoglycemia events were infrequent). Conclusion The rate of well-controlled participants (HbA1c < 7.0%) in the Wave 7 sub-analysis was lower than that observed in the USA (NHANES survey) or in European countries (GUIDANCE study), and the incidence of microvascular complications was higher. The GOAL study showed that insulin treatment improves glycemic control and reduces this gap. The Expert Panel recommends intensifying diabetes treatment as soon as possible, as well as patients' education and other preventive measures, initiatives which require modest costs compared to hospitalization and treatment of diabetes complications. |
| Databáze: | OpenAIRE |
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