Diabetes
How well do health systems manage diabetes in lower-income countries?
Open access · cc by · source: Europe PMC
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.
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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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How well do health systems manage diabetes in lower-income countries?
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Diabetes prevalence 8.8%; undiagnosed 4.8%.
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%).
Total unmet need 77.0%.
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%).
Key findings
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%.
Methodology
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).
Limitations
Cross-sectional cascades cannot track individual longitudinal care quality or prove which health-system reforms work.
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