Diabetes vastly undertreated globally with just 10% in poorer countries receiving right care

Most people with diabetes around the world do not receive the right treatment and care standards tend to be lower in poorer countries, scientists have found.

Just 10 per cent of those with diabetes living in low- and middle-income countries received the type of care proven to reduce problems related to the lifelong condition, according to a new study in The Lancet medical journal.

Scientists analysed data from around the globe that showed there was generally a positive correlation between the quality of diabetes care and a country’s average income.

An overwhelming majority of people with diabetes are concentrated in poorer countries where treatment rarely meets the standard set out by the World Health Organisation (WHO).

The WHO recommends patients receive counselling on diet, exercise and weight along with low-cost medicines to mitigate the health risks of the condition. Undertreated patients are at higher risk of heart attacks, strokes, amputations, blindness and other potentially disabling or fatal consequences.

Globally, nearly half of the people who researchers found to have diabetes had not been formally diagnosed, meaning they were unknowingly at risk of the debilitating effects.

Even among people who had received a diagnosis, treatment was not of an adequate standard. Most patients had received medicine to lower blood sugar levels but fewer than one in 10 had been prescribed something to control their cholesterol, despite the WHO advice, which considers strong links between diabetes and high cholesterol levels.

Countries in the Oceania region, where wealthy Australia and New Zealand are surrounded by poor island nations, had the highest prevalence of diabetes, both diagnosed and undiagnosed, but the lowest level of appropriate care.

“Diabetes continues to explode everywhere, in every country, and 80 per cent of people with it live in these low- and middle-income countries,” said Dr David Flood, the study’s lead author and a national clinician scholar at the University of Michigan Institute for Healthcare Policy and Innovation.

“It confers a high risk of complications including heart attacks, blindness and strokes. We can prevent these complications with comprehensive diabetes treatment, and we need to make sure people around the world can access treatment.”

Dr Flood said exceptions had been found where low-income countries had higher quality diabetes care than expected, citing Costa Rica as an example.

Prevalence of diabetes in Latin America and the Caribbean (LAC) was second only to Oceania, but patients received much higher levels of care. Many LAC countries have also implemented policies such as sugar taxes in an effort to reduce the number of people developing the condition.

Focusing on what countries with outsized achievements in diabetes care are doing well could provide valuable insights for improving care elsewhere, Dr Flood said.

A country like Costa Rica could even inform care in high-income countries such as the United States, where the quality of treatment is inconsistent.

Cost is not thought to be a barrier to good diabetes care. Medication is available at low prices and treatment hinges on the changes people can make to their lifestyle, such as adopting a healthier diet and taking more exercise. Studies have shown the medication to be cost-effective, as prescription at an early stage can make savings on other types of care later.

The authors of the study said they have provided their findings to the WHO, which aims to improve access to diabetes care through an initiative known as the Global Diabetes Compact, launched in April to coincide with the 100th anniversary of the discovery of insulin.

The WHO estimates that about one in 11 adults worldwide has diabetes, with the total number having more than quadrupled since the 1980s. In 2019, diabetes was the direct cause of 1.5 million deaths around the world.