The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults.
The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults.
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DOI：
10.1016/s2666-7568(21)00089-1
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发表时间：
2021-06
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影响因子：
--
通讯作者：
Manne-Goehler J
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文献类型：
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作者：
Flood D;Seiglie JA;Dunn M;Tschida S;Theilmann M;Marcus ME;Brian G;Norov B;Mayige MT;Singh Gurung M;Aryal KK;Labadarios D;Dorobantu M;Silver BK;Bovet P;Adelin Jorgensen JM;Guwatudde D;Houehanou C;Andall-Brereton G;Quesnel-Crooks S;Sturua L;Farzadfar F;Saeedi Moghaddam S;Atun R;Vollmer S;Bärnighausen TW;Davies JI;Wexler DJ;Geldsetzer P;Rohloff P;Ramírez-Zea M;Heisler M;Manne-Goehler J
全球 4.63 亿成人糖尿病患者中，约 80% 生活在低收入和中等收入国家 (LMIC)。设计循证政策以改善中低收入国家糖尿病结局的一个主要障碍是关于当前治疗覆盖模式的全国代表性数据有限。本研究的目的是 (1) 估计中低收入国家中接受推荐的药物和非药物糖尿病治疗的成人糖尿病患者的比例，以及 (2) 描述与治疗相关的国家层面和个人层面的特征。我们对中低收入国家 55 项具有全国代表性的调查的汇总个人数据进行了横断面分析。我们自我报告的糖尿病治疗覆盖率的主要结果是基于 2020 年世界卫生组织基本非传染性疾病干预措施中建议的人口水平监测指标。我们评估了糖尿病患者中三种药物治疗和三种非药物治疗的覆盖率。在国家层面，我们按人均国民总收入和地理区域估算了报告覆盖率的个人比例。在个人层面，我们使用逻辑回归模型来评估几个关键个人特征的覆盖范围，包括性别、年龄、体重指数、财富五分位数和教育程度。在初步分析中，我们调整了样本权重，使各国的权重相等。 55 个中低收入国家的最终汇总样本包括 680,102 名个体和 37,094 名糖尿病患者。使用每个国家相同的权重，糖尿病患病率为 9.0%（95% 置信区间 [CI]，8.7–9.4），其中 43.9%（95% CI，41.9–45.9）报告既往糖尿病诊断。总体而言，4.6%（95% CI，3.9-5.4）的糖尿病患者自我报告满足为他们推荐的所有治疗的需要。降糖药物的覆盖率为 50.5%（95% CI，48.6–52.5）；抗高血压药物，41.3%（95% CI，39.3–43.3）；降胆固醇药物，6.3%（95% CI，5.5–7.2）；饮食咨询，32.2%（95% CI，30.7–33.7）；运动咨询，28.2%（95% CI，26.6–29.8）；减肥咨询，31.5%（95% CI，29.3-33.7）。收入水平较高的国家往往覆盖范围更大。女性性别和较高的年龄、体重指数、教育程度和家庭财富也与更大的覆盖率相关。在中低收入国家中，不到十分之一的糖尿病患者接受基于指南的综合糖尿病治疗。加强卫生系统提供治疗的能力，不仅可以降低血糖，还可以解决高血压和高胆固醇等心血管疾病危险因素，是全球糖尿病的紧迫优先事项。
Approximately 80% of the 463 million adults worldwide with diabetes live in low- and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the limited nationally representative data on the current patterns of treatment coverage. The objectives of this study are (1) to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment and (2) to describe country-level and individual-level characteristics that are associated with treatment. We conducted a cross-sectional analysis of pooled, individual data from 55 nationally representative surveys in LMICs. Our primary outcome of self-reported diabetes treatment coverage was based upon population-level monitoring indicators recommended in the 2020 World Health Organization Package of Essential Noncommunicable Disease Interventions. We assessed coverage of three pharmacological and three non-pharmacological treatments among people with diabetes. At the country level, we estimated the proportion of individuals reporting coverage by per-capita gross national income and geographic region. At the individual level, we used logistic regression models to assess coverage along several key individual characteristics including sex, age, BMI, wealth quintile, and educational attainment. In the primary analysis, we scaled sample weights such that countries were weighted equally. The final pooled sample from the 55 LMICs included 680,102 total individuals and 37,094 individuals with diabetes. Using equal weights for each country, diabetes prevalence was 9.0% (95% confidence interval [CI], 8.7–9.4), with 43.9% (95% CI, 41.9–45.9) reporting a prior diabetes diagnosis. Overall, 4.6% (95% CI, 3.9–5.4) of individuals with diabetes self-reported meeting need for all treatments recommended for them. Coverage of glucose-lowering medication was 50.5% (95% CI, 48.6–52.5); antihypertensive medication, 41.3% (95% CI, 39.3–43.3); cholesterol-lowering medication, 6.3% (95% CI, 5.5–7.2); diet counseling, 32.2% (95% CI, 30.7–33.7); exercise counseling, 28.2% (95% CI, 26.6–29.8); and weight-loss counseling, 31.5% (95% CI, 29.3–33.7). Countries at higher income levels tended to have greater coverage. Female sex and higher age, BMI, educational attainment, and household wealth were also associated with greater coverage. Fewer than one in ten people with diabetes in LMICs receive coverage of guideline-based comprehensive diabetes treatment. Scaling-up the capacity of health systems to deliver treatment not only to lower glucose but also to address cardiovascular disease risk factors such as hypertension and high cholesterol are urgent global diabetes priorities.
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影响因子：
15.8
作者：
Ng M;Fullman N;Dieleman JL;Flaxman AD;Murray CJ;Lim SS
通讯作者：
Lim SS
DOI：
10.1016/s0140-6736(18)31668-4
发表时间：
2018-11-17
期刊：
Lancet (London, England)
影响因子：
--
作者：
Kruk ME;Gage AD;Joseph NT;Danaei G;García-Saisó S;Salomon JA
通讯作者：
Salomon JA
影响因子：
16.2
作者：
Schmidt MI;Bracco P;Canhada S;Guimarães JMN;Barreto SM;Chor D;Griep R;Yudkin JS;Duncan BB
通讯作者：
Duncan BB
DOI：
10.1016/s2214-109x(18)30386-3
发表时间：
2018-11
期刊：
The Lancet. Global health
影响因子：
--
作者：
Kruk ME;Gage AD;Arsenault C;Jordan K;Leslie HH;Roder-DeWan S;Adeyi O;Barker P;Daelmans B;Doubova SV;English M;García-Elorrio E;Guanais F;Gureje O;Hirschhorn LR;Jiang L;Kelley E;Lemango ET;Liljestrand J;Malata A;Marchant T;Matsoso MP;Meara JG;Mohanan M;Ndiaye Y;Norheim OF;Reddy KS;Rowe AK;Salomon JA;Thapa G;Twum-Danso NAY;Pate M
通讯作者：
Pate M
DOI：
10.1016/s2213-8587(15)00129-1
发表时间：
2015-08
期刊：
The lancet. Diabetes & endocrinology
影响因子：
--
作者：
NCD Risk Factor Collaboration (NCD-RisC)
通讯作者：
NCD Risk Factor Collaboration (NCD-RisC)