Glycemic Control and Prevention of Diabetic Complications in Low- and Middle-Income Countries: An Expert Opinion

Abstract

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.

Risk Factors of Microvascular Complications Among Type 2 Diabetic Patients Using Cox Proportional Hazards Models: A Cohort Study in Tabuk Saudi Arabia

“…In a single-centre study, glycated haemoglobin variability was independently associated with the development of nephropathy. 14 , 49 The results of this single-centre study lend further support to this finding reported in Saudi Arabian residents. In addition, high BMI was significantly associated with diabetic nephropathy.…”

“…12,13 The incidence of microvascular complications caused by T2D is increasing, primarily in low-and middle-income countries. 14 In Saudi Arabia, the incidence of T2D microvascular complications among people aged 18 years and older is approximately 10%-40%, which increases over time. An increase in the incidence of T2D microvascular complications in Saudi Arabia could be attributed largely to the modifiable behavioural risk factors, such as sedentary lifestyle, excess weight, unhealthy diet, and smoking tobacco products.…”

Prevalence and correlates of vibration perception threshold based diabetic peripheral neuropathy in Gujarati urban population: A cross sectional study

“…So, it must be offered to diabetics to monitor this complication. As per expert opinion,[ 22 ] simple measures like early screening, health education and primary prevention are at modest cost as compared with hospitalization and managing complications. This study also suggests future directions in regard to study in prediabetics, use of neuropathy scale, and interventional studies taking these results as a baseline work.…”

Predictors of poor glycemic control among type 2 diabetes mellitus patients treated with antidiabetic medications

“…[ 2 ] The poor glycemic control rate was higher in developing countries comparing with USA and European countries (63.0% vs 47.8% vs 46.4%%). [ 27 ] In underdeveloped country, the diagnosis of T2DM was made when patients present with retinopathy, nephropathy and other complications, resulting in a consequent loss of treatment efficacy. [ 28 ] In our study, most of patients were short duration with less than 10 years while most of them are with complications.…”