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

Détails

Ressource 1Télécharger: BIB_D4F480258824.pdf (939.93 [Ko])
Etat: Public
Version: Final published version
Licence: CC BY 4.0
ID Serval
serval:BIB_D4F480258824
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys.
Périodique
PLoS medicine
Auteur(s)
Manne-Goehler J., Geldsetzer P., Agoudavi K., Andall-Brereton G., Aryal K.K., Bicaba B.W., Bovet P., Brian G., Dorobantu M., Gathecha G., Singh Gurung M., Guwatudde D., Msaidie M., Houehanou C., Houinato D., Jorgensen JMA, Kagaruki G.B., Karki K.B., Labadarios D., Martins J.S., Mayige M.T., McClure R.W., Mwalim O., Mwangi J.K., Norov B., Quesnel-Crooks S., Silver B.K., Sturua L., Tsabedze L., Wesseh C.S., Stokes A., Marcus M., Ebert C., Davies J.I., Vollmer S., Atun R., Bärnighausen T.W., Jaacks L.M.
ISSN
1549-1676 (Electronic)
ISSN-L
1549-1277
Statut éditorial
Publié
Date de publication
03/2019
Peer-reviewed
Oui
Volume
16
Numéro
3
Pages
e1002751
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Résumé
The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach.
We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. 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 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys.
The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.
Mots-clé
Adolescent, Adult, Cross-Sectional Studies, Delivery of Health Care/economics, Delivery of Health Care/trends, Diabetes Mellitus/economics, Diabetes Mellitus/epidemiology, Diabetes Mellitus/therapy, Female, Health Services Needs and Demand/economics, Health Services Needs and Demand/trends, Health Surveys/economics, Health Surveys/trends, Humans, Income/trends, Male, Middle Aged, Poverty/economics, Poverty/trends, Young Adult
Pubmed
Web of science
Open Access
Oui
Création de la notice
12/03/2019 10:32
Dernière modification de la notice
26/10/2019 6:09
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