How well do health systems manage diabetes in lower-income countries?
Across >800,000 adults in 28 LMICs, diabetes prevalence was 8.8% and total unmet need along the care cascade reached 77%, with only ~23% achieving control.
Source
Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys
Study at a glance
- Design
- Cross-sectional — Pooled nationally representative surveys; diabetes care-cascade analysis
- N
- N=800000 · Over 800,000 adults across 28 LMICs
- Population
- Adults in 28 low- and middle-income countries (2008–2016 surveys)
- Outcome
- Diabetes prevalence and cascade stages (tested/diagnosed/treated/controlled)
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What they did
They pooled nationally representative surveys (2008–2016), defined diabetes by glucose/HbA1c/medication, and constructed a cascade from testing through control (HbA1c <8.0% or equivalent).
What they found
Undiagnosed diabetes 4.8%; large losses at detection (63.4%); control only 22.8% overall and 16–25% across World Bank income groups; unmet need 77%.
The limits
What it doesn't show
Cross-sectional cascades cannot track individual longitudinal care quality or prove which health-system reforms work.
Key terms
- LMIC
- Low- and middle-income country.
- Care cascade
- Sequence from testing → diagnosis → treatment → control.
- Unmet need
- Share not reaching successful control across cascade losses.
- HbA1c
- Glycated hemoglobin marker of average glycemia.
- Diabetes control
- Treated diabetes meeting the study’s glycemic threshold.
- Detection loss
- People with diabetes who were never tested/detected.
Flashcards
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Countries included:
Common questions
How many countries/adults?
28 LMICs; >800,000 adults.
Diabetes prevalence?
8.8% (undiagnosed 4.8%).
Unmet need?
77.0%.
Control rate?
22.8% overall; 16–25% by income group.
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