Diabetes in developing countries

被引:165
作者
Misra, Anoop [1 ,2 ,3 ]
Gopalan, Hema [1 ]
Jayawardena, Ranil [4 ]
Hills, Andrew P. [5 ]
Soares, Mario [6 ]
Reza-Albarran, Alfredo A. [7 ]
Ramaiya, Kaushik L. [8 ]
机构
[1] Natl Diabet Obes & Cholesterol Fdn, Safdarjung Dev Area, New Delhi, India
[2] Diabet Fdn India, New Delhi, India
[3] Fortis C DOC Ctr Excellence Diabet Metab Dis & En, New Delhi, India
[4] Univ Colombo, Fac Med, Colombo, Sri Lanka
[5] Univ Tasmania, Coll Hlth & Med, Sch Hlth Sci, Launceston, Tas, Australia
[6] Curtin Univ, Sch Publ Hlth, Perth, WA, Australia
[7] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Endocrinol & Metab Dept, Mexico City, DF, Mexico
[8] Shree Hindu Mandal Hosp, Dar Es Salaam, Tanzania
关键词
developing countries; diabetes; India; management of diabetes; prediabetes; prevention; CARDIOVASCULAR RISK-FACTORS; SUB-SAHARAN AFRICA; IMPAIRED GLUCOSE-TOLERANCE; LIFE-STYLE INTERVENTIONS; CROSS-SECTIONAL SURVEY; FATTY LIVER-DISEASE; ASIAN INDIANS; PHYSICAL-ACTIVITY; METABOLIC SYNDROME; MIDDLE-INCOME;
D O I
10.1111/1753-0407.12913
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:522 / 539
页数:18
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