Diabetes in developing countries.

Abstract:

:There has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro- and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D. :发展中国家的2型糖尿病(T2D)患病率迅速上升,在不同的农村与城市生活环境中以及在不同的城市化程度下,其患病率各不相同。与白种人相比,某些民族(如南亚人、其他亚洲人与非洲人)要早10年发生糖尿病,并且发病时的体重指数也较低,主要是腹型肥胖,并且糖尿病前期向糖尿病的转变也加速了。无论是大血管还是微血管并发症的负担都非常巨大,但也因人群而异。在许多发展中国家中经常见到糖尿病患者合并HIV或者肺结核,并且容易相互感染。在不同栖息地生活的大样本人群中筛查糖尿病可能并不划算,但是针对高风险人群进行筛查可能具有一定的意义。诊断测试的成本以及卫生人力资源的匮乏对于患者的诊断与监测来说都是一个巨大的障碍。在大多数发展中国家,预防工作仍处于初级阶段。护理质量大部分都很差;因此,有相当一部分患者都没有达到治疗目标。因为延误了寻求治疗的时间、“宿命态度”、药物与胰岛素的高成本并且不易获得,这种情况进一步在扩大。为了应对这些众多的挑战,迫切需要新的政治承诺和行政法规来促进健康与预防疾病。目前已经在试用一些低成本的创新方法并且取得了令人鼓舞的成果,包括培训与部署非医疗保健专业的辅助人员,使用手机与远程医疗提供简单的健康信息来预防与管理T2D。.

journal_name

J Diabetes

journal_title

Journal of diabetes

authors

Misra A,Gopalan H,Jayawardena R,Hills AP,Soares M,Reza-Albarrán AA,Ramaiya KL

doi

10.1111/1753-0407.12913

subject

Has Abstract

pub_date

2019-07-01 00:00:00

pages

522-539

issue

7

eissn

1753-0393

issn

1753-0407

journal_volume

11

pub_type

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