An inter-humanitarian agency study of diabetes care and surveillance in humanitarian settings

Kehlenbrink, Sylvia; Mahboob, Omar; Al-Zubi, Sara; Boulle, Philippa; Perone, Sigiriya Aebischer; Alani, Ahmad Hecham; Kiapi, Lilian; Miller, Laura; Hering, Heiko; Woodman, Michael; Donelan, Karen; Kayden, Stephanie; Porneala, Bianca; Rosner, Bernard; Meigs, James B.

doi:10.1016/s2213-8587(22)00036-5

Cited by 9 publications

(8 citation statements)

References 4 publications

(6 reference statements)

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“…Looking at the cascade of care in NCD management more broadly, several recurring research and information gaps are noted. There is generally poor collection of standard data regarding disease states and recognised risk factors, there is a paucity of evidence to guide interventions, and there are infrastructure and supply problems even for those conditions in which treatments are available [ 16 , 17 , 31 , 104 ]. Many of these factors are applicable to overweight and obesity.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of the burden of, access to services for and perceptions of patients with overweight and obesity, in humanitarian crisis settings

Shortland

McGranahan

Stewart³

et al. 2023

PLoS ONE

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Introduction Excess body weight causes 4 million deaths annually across the world. The number of people affected by humanitarian crises stands at a record high level with 1 in 95 people being forcibly displaced. These epidemics overlap. Addressing obesity is a post-acute phase activity in non-communicable disease management in humanitarian settings. Information is needed to inform guidelines and timing of interventions. The objective of this review was to explore the prevalence of overweight and obesity in populations directly affected by humanitarian crises; the cascade of care in these populations and perceptions of patients with overweight and obesity. Methods Literature searches were carried out in five databases. Grey literature was identified. The population of interest was non-pregnant, civilian adults who had experience of humanitarian crises (armed conflict, complex emergencies and natural disasters). All study types published from January 1st, 2011, were included. Screening, data extraction and quality appraisal were carried out in duplicate. A narrative synthesis is presented. Results Fifty-six reports from forty-five studies were included. Prevalence estimates varied widely across the studies and by subgroups. Estimates of overweight and obesity combined ranged from 6.4% to 82.8%. Studies were heterogenous. Global distribution was skewed. Increasing adiposity was seen over time, in older adults and in women. Only six studies were at low risk of bias. Body mass index was the predominant measure used. There were no studies reporting cascade of care. No qualitative studies were identified. Conclusion Overweight and obesity varied in crisis affected populations but were rarely absent. Improved reporting of existing data could provide more accurate estimates. Worsening obesity may be prevented by acting earlier in long-term crises and targeting risk groups. The use of waist circumference would provide useful additional information. Gaps remain in understanding the existing cascade of care. Cultural norms around diet and ideal body size vary.

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Section: Discussionmentioning

confidence: 99%

A systematic review of the burden of, access to services for and perceptions of patients with overweight and obesity, in humanitarian crisis settings

Shortland

McGranahan

Stewart³

et al. 2023

PLoS ONE

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“…У деяких південно-східних містах України, таких як Маріуполь, люди зіткнулися з критичною нестачею продовольства, води й інсуліну, що посилювалася блокадою гуманітарних конвоїв. У розпал гуманітарної кризи пацієнти із ЦД у цих регіонах відчувають зменшення ресурсів системи охорони здоров'я з безпрецедентною швидкістю [18].…”

Section: менеджмент пацієнтів із цукровим діабетом 1-го і 2-го типів ...unclassified

Management of type 1 type 2 diabetes mellitus in conditions of armed conflict

Mykytyuk

Караченцев

2022

Mìžnarodnij endokrinologìčnij žurnal

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Humanitarian crises caused by armed conflict are constantly growing and present a serious global problem for health systems. The war in Ukraine produced about 4.8 million Ukrainians seeking temporary protection abroad, and about 10 million received the status of an internally displaced person. The situation in Ukraine has been described as potentially the largest migration crisis in Europe in the last century. As humanitarian crises become widespread and prolonged, chronic diseases such as diabetes mellitus (DM) are becoming increasingly important. Food security, limited access to medical facilities and medicines, and economic difficulties are just some of the many difficulties faced by patients with DM in armed conflict. The experience of the functioning of the health care system in conditions of armed conflict, on the example of other countries, shows that in the short term, the priority should be to ensure the continuity of insulin therapy and access to basic oral sugar-lowering agents and educational programs for patients on self-control of the disease with an emphasis on recognizing the symptoms of hypoglycemia, diabetic ketoacidosis, and dehydration; in the long term — ensuring access to high-quality medical care and medicines, training of local and international providers of medical services for the diagnosis and treatment of DM and its acute complications and the development of clinical guidance on the management of patients in these conditions. Humanitarian crises in the world have become more protracted, and therefore health workers must go beyond direct basic primary care and address the long-term health consequences of those affected. Further research is needed to be aimed at improving the quality of medical care for patients with DM in the context of the humanitarian crisis caused by the armed conflict, there is a need to develop simplified, cost-effective models of monitoring the condition of patients, the quality of medical care and the availability of medicines to patients in this category.

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“…In humanitarian settings, low professional knowledge and uncoordinated clinical practices are accompanied by limited data and disease surveillance. In 2018, the Humanitarian NCD Interagency Study in Emergencies and Disasters (UNITED) found that less than 50% of 83 surveyed humanitarian sites distinguished between T1D and T2D, and less than 30% reported on GV complications [103], further supporting the necessity of strengthened T1D knowledge translation in humanitarian settings.…”

Section: Invest In and Provide T1d Relevant Capacity Building Knowled...mentioning

confidence: 99%

“…Diabetes is also a heterogeneous disease with large variations in beta cell dysfunction and insulin resistance, which can lead to conflation between T1D and T2D diagnoses [107]. In humanitarian settings, sites also often only collect aggregate data on the number of diabetes consultations, rather than the number of patients with T1D or T2D, which can lead to the generalization of all diabetes to T2D [103]. Both circumstances can lead to the misclassification of T1D as T2D, meaning that articles excluded due to a focus on T2D would have been missed in the research process.…”

Section: Limitationsmentioning

confidence: 99%

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An inter-humanitarian agency study of diabetes care and surveillance in humanitarian settings

Cited by 9 publications

References 4 publications

A systematic review of the burden of, access to services for and perceptions of patients with overweight and obesity, in humanitarian crisis settings

A systematic review of the burden of, access to services for and perceptions of patients with overweight and obesity, in humanitarian crisis settings

Management of type 1 type 2 diabetes mellitus in conditions of armed conflict

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