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Disease characteristics and treatment of patients with diabetes mellitus attending government health services in Indonesia, Peru, Romania and South Africa
Author(s) -
Soetedjo Nanny N. M.,
McAllister Susan M.,
UgarteGil Cesar,
Firanescu Adela G.,
Ronacher Katharina,
Alisjahbana Bachti,
Costache Anca L.,
Zubiate Carlos,
Malherbe Stephanus T.,
Koesoemadinata Raspati C.,
Laurence Yoko V.,
Pearson Fiona,
KerryBarnard Sarah,
Ruslami Rovina,
Moore David A. J.,
Ioana Mihai,
Kleynhans Leanie,
Permana Hikmat,
Hill Philip C.,
Mota Maria,
Walzl Gerhard,
Dockrell Hazel M.,
Critchley Julia A.,
Crevel Reinout
Publication year - 2018
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13137
Subject(s) - medicine , diabetes mellitus , metformin , obesity , proteinuria , disease , public health , insulin , endocrinology , nursing , kidney
Objective To describe the characteristics and management of Diabetes mellitus ( DM ) patients from low‐ and middle‐income countries ( LMIC ). Methods We systematically characterised consecutive DM patients attending public health services in urban settings in Indonesia, Peru, Romania and South Africa, collecting data on DM treatment history, complications, drug treatment, obesity, HbA1c and cardiovascular risk profile; and assessing treatment gaps against relevant national guidelines. Results Patients (median 59 years, 62.9% female) mostly had type 2 diabetes (96%), half for >5 years (48.6%). Obesity (45.5%) and central obesity (females 84.8%; males 62.7%) were common. The median HbA1c was 8.7% (72 mmol/mol), ranging from 7.7% (61 mmol/mol; Peru) to 10.4% (90 mmol/mol; South Africa). Antidiabetes treatment included metformin (62.6%), insulin (37.8%), and other oral glucose‐lowering drugs (34.8%). Disease complications included eyesight problems (50.4%), EGFR <60 ml/min (18.9%), heart disease (16.5%) and proteinuria (14.7%). Many had an elevated cardiovascular risk with elevated blood pressure (36%), LDL (71.0%) and smoking (13%), but few were taking antihypertensive drugs (47.1%), statins (28.5%) and aspirin (30.0%) when indicated. Few patients on insulin (8.0%), statins (8.4%) and antihypertensives (39.5%) reached treatment targets according to national guidelines. There were large differences between countries in terms of disease profile and medication use. Conclusion DM patients in government clinics in four LMIC with considerable growth of DM have insufficient glycaemic control, frequent macrovascular and other complications, and insufficient preventive measures for cardiovascular disease. These findings underline the need to identify treatment barriers and secure optimal DM care in such settings.