Vast Under-Treatment of Diabetes Seen in Global Study

Only 1 in 10 people with diabetes in low- and middle-income countries are getting evidence-based, low-cost comprehensive care.

11:11 AM

Author | Kara Gavin

blue pill with globes inside of it piled up
Getty Images

Artículo en español.

Many don't even know they have the condition.

Only 1 in 10 people with diabetes in the 55 low- and middle-income countries studied receive the type of comprehensive care that's been proven to reduce diabetes-related problems, according to the new findings published in Lancet Healthy Longevity.

That comprehensive package of care – low-cost medicines to reduce blood sugar, blood pressure and cholesterol levels; and counseling on diet, exercise and weight – can help lower the health risks of under-treated diabetes. Those risks include future heart attacks, strokes, nerve damage, blindness, amputations and other disabling or fatal conditions.

The new study, led by physicians at the University of Michigan and Brigham and Women's Hospital with a global team of partners, draws on data from standardized household studies, to allow for apples-to-apples comparisons between countries and regions.

The authors analyzed data from surveys, examinations and tests of more than 680,000 people between the ages of 25 and 64 worldwide conducted in recent years. More than 37,000 of them had diabetes; more than half of them hadn't been formally diagnosed yet, but had a key biomarker of elevated blood sugar.

The researchers have provided their findings to the World Health Organization, which is developing efforts to scale up delivery of evidence-based diabetes care globally as part of an initiative known as the Global Diabetes Compact. The forms of diabetes-related care used in the study are all included in the 2020 WHO Package of Essential Noncommunicable Disease Interventions.

Like Podcasts? Add the Michigan Medicine News Break on iTunes, Google Podcast or anywhere you listen to podcasts.

"Diabetes continues to explode everywhere, in every country, and 80% of people with it live in these low- and middle-income countries," says David Flood, M.D., M.Sc., lead author and a National Clinician Scholar at the U-M Institute for Healthcare Policy and Innovation. "It confers a high risk of complications such as including 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."

Flood worked with senior author Jennifer Manne-Goehler, M.D., Sc.D., of Brigham and Women's Hospital and the Medical Practice Evaluation Center at Massachusetts General Hospital, to lead the analysis of detailed global data.

Key findings

In addition to the main finding that 90% of the people with diabetes studied weren't getting access to all six components of effective diabetes care, the study also finds major gaps in specific care.

For instance, while about half of all people with diabetes were taking a drug to lower their blood sugar, and 41% were taking a drug to lower their blood pressure, only 6.3% were receiving cholesterol-lowering medications.

These findings show the need to scale-up proven treatment not only to lower glucose but also to address cardiovascular disease risk factors, such as hypertension and high cholesterol, in people with diabetes.

Less than a third had access to counseling on diet and exercise, which can help guide people with diabetes to adopt habits that can control their health risks further.

Diabetes continues to explode everywhere, in every country, and 80% of people with it live in these low- and middle-income countries. We need to make sure people around the world can access treatment.
David Flood, M.D., M.Sc.

Even when the authors focused on the people who had already received a formal diagnosis of diabetes, they found that 85% were taking a medicine to lower blood sugar, 57% were taking a blood pressure medication, but only 9% were taking something to control their cholesterol. Nearly 74% had received diet-related counseling, and just under 66% had received exercise and weight counseling.

Taken together, less than one in five people with previously diagnosed diabetes were getting the full package of evidence-based care.

Relationship to national income and personal characteristics

In general, the study finds that people were less likely to get evidence-based diabetes care the lower the average income of the country and region they lived in. That's based on a model that the authors created using economic and demographic data about the countries that were included in the study.

The nations in the Oceania region of the Pacific had the highest prevalence of diabetes – both diagnosed and undiagnosed – but the lowest rates of diabetes-related care.

SEE ALSO: We're Watching the World Go Blind

But there were exceptions where low-income countries had higher-than-expected rates of good diabetes care, says Flood, citing the example of Costa Rica. And in general, the Latin America and Caribbean region was second only to Oceania in diabetes prevalence, but had much higher levels of care.

Focusing on what countries with outsize achievements in diabetes care are doing well could provide valuable insights for improving care elsewhere, the authors say. That even includes informing care in high-income countries like the United States, which does not consistently deliver evidence-based care to people with diabetes.

MORE FROM THE LAB: Subscribe to our weekly newsletter

The study also shines a light on the variation between countries and regions in the percentage of cases of diabetes that have been diagnosed. Improve reliable access to diabetes diagnostic technologies is important in leading more people to obtain preventive care and counseling.

Women, people with higher levels of education and higher personal wealth, and people who are older or had high body mass index were more likely to be receiving evidence-based diabetes care. Diabetes in people with "normal" BMI is not uncommon in low- and middle-income countries, suggesting more need to focus on these individuals, the authors say.

SEE ALSO: Does High Blood Sugar Worsen COVID-19 Outcomes?

The fact that diabetes-related medications are available at very low cost, and that individuals can reduce their risk through lifestyle changes, mean that cost should not be a major barrier, says Flood. In fact, studies have shown the medications to be cost-effective, meaning that the cost of their early and consistent use is outweighed by the savings on other types of care later.

In addition to Flood, who is a clinical lecturer in hospital medicine at Michigan Medicine, U-M's academic medical center, the study team includes two others from U-M: Michele Heisler, M.D., M.P.A., a professor of internal medicine and member of IHPI, and Matthew Dunn, a student at the U-M School of Public Health. The study was funded by the National Clinician Scholars Program at IHPI, and by the National Institute of Diabetes and Digestive and Kidney Diseases, Harvard Catalyst, and the National Center for Advancing Translational Sciences.

Paper cited: Lancet Healthy Longevity. DOI: 10.1016/S2666-7568(21)00089-1

More Articles About: Industry DX Diabetes Health Care Delivery, Policy and Economics Wellness and Prevention All Research Topics Metabolism, Endocrinology & Diabetes
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]


Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Featured News & Stories cells colorful
Health Lab
Improvements in human genome databases offer a promising future for cancer research
A gene sequencing method called ribosome profiling has expanded our understanding of the human genome by identifying previously unknown protein coding regions. Also known as Ribo-seq, this method allows researchers to get a high-resolution snapshot of protein production in cells.
flies moving sled in snow with person
Health Lab
Gene links exercise endurance, cold tolerance and cellular maintenance in flies
A study in PNAS identifies a protein that, when missing, makes exercising in the cold that much harder—that is, at least in fruit flies.
kids on the floor
Health Lab
Protecting children from poor air quality: 6 things to know
As smoke from Canada's historic wildfires triggers poor air quality alerts across the country, many parents worry about the impact on their child’s health, a national poll suggests. Here, a Michigan Medicine expert provides six ways to help reduce exposure.
bacteria black background yellow cell
Health Lab
The surprising origin of a deadly hospital infection
Surprising findings from a Michigan Medicine study in Nature Medicine suggest that the burden of C. diff infection may be less a matter of hospital transmission and more a result of characteristics associated with the patients themselves.
Health Lab
Genetic mutation linked to adrenal tumor and hypertension
Research from the Department of Molecular & Integrative Physiology at Michigan Medicine identifies a previously unknown genetic mutation that causes the disease called primary aldosteronism in certain populations.
cancer cell
Health Lab
Language barriers in cancer care
Research from experts at Michigan Medicine shows that significant language-based disparities exist in patients’ access to cancer care services, and it’s well before their first appointment with a doctor.