International audienceThe prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach

Agoudavi, Kokou

Andall-Brereton, Glennis

Aryal, Krishna

Atun, Rifat

Barnighausen, Till

Bicaba, Brice Wilfried

Bovet, Pascal

Brian, Garry

Davies, Justine

Dorobantu, Maria

Ebert, Cara

Gathecha, Gladwell

Geldsetzer, Pascal

Guwatudde, David

Houehanou, Corine

Houinato, Dismand

Jaacks, Lindsay

Jorgensen, Jutta Mari Adelin

Kagaruki, Gibson

Karki, Khem

Labadarios, Demetre

Manne-Goehler, Jennifer

Marcus, Maja

Martins, Joao

Mayige, Mary

McClure, Roy Wong

Msaidie, Mohamed

Mwalim, Omar

Mwangi, Joseph Kibachio

Norov, Bolormaa

Quesnel-Crooks, Sarah

Silver, Bahendeka

Singh Gurung, Mongal

Stokes, Andrew

Sturua, Lela

Tsabedze, Lindiwe

Vollmer, Sebastian

Wareham, Nicholas

Wesseh, Chea Stanford

PLoS Medicine

English

CITATION: Manne-Goehler, J., et al. 2019. Health system performance for people with diabetes in 28 low- and middle-income countries : a cross-sectional study of nationally representative surveys. PLoS Medicine, 16(3):e1002751, doi:10.1371/journal.pmed.1002751.The original publication is available at https://journals.plos.org/plosmedicineBackground: The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach.
Methods and findings: We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given (“treated”), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. 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%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. 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%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys.
Conclusions: The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.A Boyce 2021-09https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002751Publisher's versio

Andall- Brereton, Glennis

Aryal, Krishna K.

Gurung, Mongal Singh

Kagaruki, Gibson B.

Karki, Khem B.

Martins, Joao S.

Mayige, Mary T.

Silver, Bahendeka K.

Davies, Justine I.

Barnighausen, Till W.

Jaacks, Lindsay M.

Stellenbosch University SUNScholar Repository

Health system performance for people with diabetes in 28 low- and middle-income countries : a cross-sectional study of nationally representative surveys

BACKGROUND: The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach.METHODS AND FINDINGS: We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c &lt; 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. 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%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. 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%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys.CONCLUSIONS: The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.</p

Aryal, Krishna K

Kagaruki, Gibson B

Karki, Khem B

Martins, Joao S

Mayige, Mary T

Silver, Bahendeka K

Davies, Justine I

Bärnighausen, Till W

Jaacks, Lindsay M

University of Birmingham Research Portal

Health system performance for people with diabetes in 28 low- and middle-income countries:a cross-sectional study of nationally representative surveys

The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach.
We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c &lt; 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. 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%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. 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%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys.
The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured

Manne-Goehler, J.

Geldsetzer, P.

Agoudavi, K.

Andall-Brereton, G.

Aryal, K.K.

Bicaba, B.W.

Bovet, P.

Brian, G.

Dorobantu, M.

Gathecha, G.

Singh Gurung, M.

Guwatudde, D.

Msaidie, M.

Houehanou, C.

Houinato, D.

Jorgensen, JMA

Kagaruki, G.B.

Karki, K.B.

Labadarios, D.

Martins, J.S.

Mayige, M.T.

McClure, R.W.

Mwalim, O.

Mwangi, J.K.

Norov, B.

Quesnel-Crooks, S.

Silver, B.K.

Sturua, L.

Tsabedze, L.

Wesseh, C.S.

Stokes, A.

Marcus, M.

Ebert, C.

Davies, J.I.

Vollmer, S.

Atun, R.

Bärnighausen, T.W.

Jaacks, L.M.

Serveur académique lausannois

Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys.

BACKGROUND:The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. METHODS AND FINDINGS:We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. 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%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. 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%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. CONCLUSIONS:The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured

Jennifer Manne-Goehler

Pascal Geldsetzer

Kokou Agoudavi

Glennis Andall-Brereton

Krishna K Aryal

Brice Wilfried Bicaba

Pascal Bovet

Garry Brian

Maria Dorobantu

Gladwell Gathecha

Mongal Singh Gurung

David Guwatudde

Mohamed Msaidie

Corine Houehanou

Dismand Houinato

Jutta Mari Adelin Jorgensen

Gibson B Kagaruki

Khem B Karki

Demetre Labadarios

Joao S Martins

Mary T Mayige

Roy Wong McClure

Omar Mwalim

Joseph Kibachio Mwangi

Bolormaa Norov

Sarah Quesnel-Crooks

Bahendeka K Silver

Lela Sturua

Lindiwe Tsabedze

Chea Stanford Wesseh

Andrew Stokes

Maja Marcus

Cara Ebert

Justine I Davies

Sebastian Vollmer

Rifat Atun

Till W Bärnighausen

Lindsay M Jaacks

Directory of Open Access Journals

Edinburgh Research Explorer

Health system performance for people with diabetes in 28 low- and middle-income countries:A cross-sectional study of nationally representative surveys

Mcclure, Roy Wong

HAL-UNILIM

Health system performance for people with diabetes in 28 low- and middle-income countries: A cross-sectional study of nationally representative surveys

BackgroundThe prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach.Methods and findingsWe pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given (“treated”), and controlled (HbA1c ConclusionsThe study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.</div

Health system performance for people with diabetes in 28 low- and middle-income countries:A cross-sectional study of nationally representative surveys

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