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Diabetes Risk and Provision of Diabetes Prevention Activities in 44 Low-Income and Middle-Income Countries: A Cross-Sectional Analysis of Nationally Representative, Individual-Level Survey Data Publisher Pubmed



Rahim NE1 ; Flood D2 ; Marcus ME3 ; Theilmann M4, 5 ; Aung TN1 ; Agoudavi K6 ; Aryal KK7 ; Bahendeka S8 ; Bicaba B9 ; Bovet P10, 11 ; Diallo AO12 ; Farzadfar F13 ; Guwatudde D14 ; Houehanou C15 Show All Authors
Authors
  1. Rahim NE1
  2. Flood D2
  3. Marcus ME3
  4. Theilmann M4, 5
  5. Aung TN1
  6. Agoudavi K6
  7. Aryal KK7
  8. Bahendeka S8
  9. Bicaba B9
  10. Bovet P10, 11
  11. Diallo AO12
  12. Farzadfar F13
  13. Guwatudde D14
  14. Houehanou C15
  15. Houinato D15
  16. Hwalla N16
  17. Jorgensen J17
  18. Kagaruki GB18
  19. Mayige M18
  20. Wongmcclure R19
  21. Larijani B20
  22. Saeedi Moghaddam S20, 21
  23. Mwalim O22
  24. Mwangi KJ23, 24
  25. Sarkar S25
  26. Sibai AM26
  27. Sturua L27
  28. Wesseh C28
  29. Geldsetzer P29, 30
  30. Atun R31, 32
  31. Vollmer S33
  32. Barnighausen T4, 32, 34
  33. Davies J35, 36, 37
  34. Ali MK38, 39
  35. Seiglie JA40, 41
  36. Mannegoehler J1, 3
Show Affiliations
Authors Affiliations
  1. 1. Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
  2. 2. Department of Medicine, University of Michigan, Ann Arbor, MI, United States
  3. 3. Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
  4. 4. Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
  5. 5. Behavioral Science for Disease Prevention and Health Care, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
  6. 6. Togo Ministry of Health, Lome, Togo
  7. 7. Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  8. 8. Diabetes and Endocrinology, Saint Francis Hospital Nsambya, Kampala, Uganda
  9. 9. National Institute of Public Health, Ouagadougou, Burkina Faso
  10. 10. University Center for General Medicine and Public Health (Unisante), Lausanne, Switzerland
  11. 11. Ministry of Health, Victoria, Seychelles
  12. 12. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
  13. 13. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  14. 14. Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
  15. 15. Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
  16. 16. Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
  17. 17. Institute of Global Health, Department of Public Health and Epidemiology, Copenhagen University, Copenhagen, Denmark
  18. 18. National Institute for Medical Research, Dar es Salaam, Tanzania
  19. 19. Costa Rican Social Security Fund, San Jose, Costa Rica
  20. 20. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  21. 21. Kiel Institute for the World Economy, Kiel, Germany
  22. 22. Ministry of Health, Zanzibar City, Tanzania
  23. 23. Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
  24. 24. World Health Organization Country Office, Pretoria, South Africa
  25. 25. Division of Endocrinology, Diabetes, and Metabolism, John Hopkins University, Baltimore, MD, United States
  26. 26. Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  27. 27. Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
  28. 28. Ministry of Health, Monrovia, Liberia
  29. 29. Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA, United States
  30. 30. Chan Zuckerberg Biohub—San Francisco, San Francisco, CA, United States
  31. 31. Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, United States
  32. 32. Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, United States
  33. 33. Department of Economics and Centre for Modern Indian Studies, University of Gottingen, Gottingen, Germany
  34. 34. Africa Health Research Institute, Somkhele, South Africa
  35. 35. MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
  36. 36. Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  37. 37. Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
  38. 38. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
  39. 39. Department of Family and Prevention Medicine, School of Medicine, Emory University, Atlanta, GA, United States
  40. 40. Diabetes Unit, Massachusetts General Hospital, Boston, MA, United States
  41. 41. Department of Medicine, Harvard Medical School, Boston, MA, United States

Source: The Lancet Global Health Published:2023


Abstract

Background: The global burden of diabetes is rising rapidly, yet there is little evidence on individual-level diabetes prevention activities undertaken by health systems in low-income and middle-income countries (LMICs). Here we describe the population at high risk of developing diabetes, estimate diabetes prevention activities, and explore sociodemographic variation in these activities across LMICs. Methods: We performed a pooled, cross-sectional analysis of individual-level data from nationally representative, population-based surveys conducted in 44 LMICs between October, 2009, and May, 2019. Our sample included all participants older than 25 years who did not have diabetes and were not pregnant. We defined the population at high risk of diabetes on the basis of either the presence of impaired fasting glucose (or prediabetes in countries with a haemoglobin A1c available) or overweight or obesity, consistent with the WHO Package of Essential Noncommunicable Disease Guidelines for type 2 diabetes management. We estimated the proportion of survey participants that were at high risk of developing diabetes based on this definition. We also estimated the proportion of the population at high risk that reported each of four fundamental diabetes prevention activities: physical activity counselling, weight loss counselling, dietary counselling, and blood glucose screening, overall and stratified by World Bank income group. Finally, we used multivariable Poisson regression models to evaluate associations between sociodemographic characteristics and these activities. Findings: The final pooled sample included 145 739 adults (86 269 [59·2%] of whom were female and 59 468 [40·4%] of whom were male) across 44 LMICs, of whom 59 308 (40·6% [95% CI 38·5–42·8]) were considered at high risk of diabetes (20·6% [19·8–21·5] in low-income countries, 38·0% [37·2–38·9] in lower-middle-income countries, and 57·5% [54·3–60·6] in upper-middle-income countries). Overall, the reach of diabetes prevention activities was low at 40·0% (38·6–41·4) for physical activity counselling, 37·1% (35·9–38·4) for weight loss counselling, 42·7% (41·6–43·7) for dietary counselling, and 37·1% (34·7–39·6) for blood glucose screening. Diabetes prevention varied widely by national-level wealth: 68·1% (64·6–71·4) of people at high risk of diabetes in low-income countries reported none of these activities, whereas 49·0% (47·4–50·7) at high risk in upper-middle-income countries reported at least three activities. Educational attainment was associated with diabetes prevention, with estimated increases in the predicted probability of receipt ranging between 6·5 (3·6–9·4) percentage points for dietary fruit and vegetable counselling and 21·3 (19·5–23·2) percentage points for blood glucose screening, among people with some secondary schooling compared with people with no formal education. Interpretation: A large proportion of individuals across LMICs are at high risk of diabetes but less than half reported receiving fundamental prevention activities overall, with the lowest receipt of these activities among people in low-income countries and with no formal education. These findings offer foundational evidence to inform future global targets for diabetes prevention and to strengthen policies and programmes to prevent continued increases in diabetes worldwide. Funding: Harvard T H Chan School of Public Health McLennan Fund: Dean's Challenge Grant Program and the EU's Research and Innovation programme Horizon 2020. © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
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