• In the United States alone, nearly 90% of adult diabetics – more than 16 million adults aged 35 and older – have blood sugar, blood pressure, and cholesterol that are not treated effectively, meaning they do not meet widely accepted targets for healthy levels of blood sugar, blood pressure, and cholesterol.
• In Mexico, 99% of adult diabetics are not meeting those targets.
• Up to 62% of diabetic men in Thailand are undiagnosed or untreated for diabetes. This translates to more than 663,000 people in that country.
A new study, published in the Bulletin of the World Health Organization's March edition, has found that millions of people worldwide may be at risk of early death from diabetes and related cardiovascular illnesses because of poor diagnosis and ineffective treatment.
The objective of the study was to examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socio-economic factors.
Researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, who examined diabetes diagnosis, treatment, and management in the US, Thailand, Mexico, Colombia, England, Iran, and Scotland have come to the conclusion that "too many people are not being properly diagnosed with diabetes and related cardiovascular risk factors. Those who are diagnosed aren't being effectively treated. This is a huge missed opportunity to lower the burden of disease in both rich and poor countries."
The percentage of diabetics in the seven countries studied who are reaching International Diabetes Federation treatment goals for blood glucose, blood pressure, and serum cholesterol is very low, ranging from 1% to 12%. The researchers conclude there are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia.
In an attempt to determine the cause of the low rates of diagnosis and effective treatment, researchers examined a range of factors and were surprised to find that “no large socio-economic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management.”
"We were very surprised to see that wealth did not have a big impact on diagnosis and treatment," said Dr. Emmanuela Gakidou, the paper's lead author and an Associate Professor of Global Health at IHME. "And in the three countries where we had health insurance data, we thought it was noteworthy that health insurance actually played a much bigger role than wealth, especially in the US."
In the US, people who had insurance were twice as likely to be diagnosed and effectively treated for diabetes as those who did not have insurance.
The researchers said the findings underscore the need for countries to tackle the growing problem of non-communicable diseases (NCDs) like diabetes, hypertension and cardiovascular diseases in part by gathering better data.
"We don't have enough data from actual physical exams to accurately document the trend in most countries," said Dr. Rafael Lozano, a co-author on the paper and a Professor of Global Health at IHME. "We looked at surveys from nearly 200 countries and only could find data on blood glucose, cholesterol, or blood pressure in seven. We hope that in the build-up to the UN Summit on NCDs this September, countries will make a commitment to more surveys that take blood samples from a representative percentage of the population."
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IHME researchers gathered data and performed their analysis in collaboration with researchers at the University of California, San Francisco, School of Medicine; the Harvard Global Equity Initiative; the National Institute of Public Health in Mexico; and Ramathibodi Hospital in Thailand.
For more information, please visit the IHME website
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