Barriers to the delivery of optimal antidiabetic therapy in the Middle East and Africa

Al-Maatouq, Mohamed A.; Alarouj, Monira; Amod, Aslam; Assaad-Khalil, S.; Assaad, Samir N.; Azar, Sami T.; Esmat, Khaled; Hassoun, Ahmed; Jarrah, Nadim; Zatari, S.

doi:10.1111/ijcp.12342

Cited by 10 publications

(11 citation statements)

References 52 publications

(58 reference statements)

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“…The people of Africa, the Middle East and Russia should be at the forefront of interventions to reduce the burden of NCDs, but a Westernised approach will be insufficient: it is crucially important that these strategies address the distinct cultural and other barriers to diabetes prevention and management that prevail in these nations. 110 A call to action is needed, aimed at governments, international healthcare institutions, local diabetes societies and leading physicians to undertake multiple medical and societal interventions in these countries. These would be the subject of another review, but will certainly include education on improved lifestyles, awareness campaigns on diabetes prevention (including changing the food environment for children and young adults in school or university), legislation on food labelling and reduced availability of sugary foods/ drinks.…”

Section: Call To Actionmentioning

confidence: 99%

Prediabetes management in the Middle East, Africa and Russia: Current status and call for action

Khalil

Abdelaziz

Shammary

et al. 2019

Diabetes and Vascular Disease Research

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Most data on the burden of diabetes and prediabetes are from countries where local infrastructure can support reliable estimates of the burden of non-communicable diseases. Countries in the Middle East and Africa, together with Russia, have a total population of almost 2 billion, but have been relatively overlooked by authors in this field. We reviewed the prevalence and drivers of prediabetes and diabetes across this large region. A large, and variable, burden of dysglycaemia exists, especially in Middle Eastern and North African countries, associated with high levels of obesity and sedentariness, with a generally lower prevalence in most other parts of Africa. The design and size of studies are highly variable, and more research to quantify the scale of the problem is needed. Local barriers to care relating to issues concerned with gender, consanguinity, lack of understanding of diabetes, lack of understanding of obesity as a health issue, and limited resource at a national level for tracking and intervention for diabetes and other non-communicable diseases. Lifestyle interventions with proven local cost-effectiveness, enhanced access to pharmacologic intervention, and societal interventions to promote better diet and more activity will be an important element in strategies to combat these adverse trends.

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Section: Call To Actionmentioning

confidence: 99%

Prediabetes management in the Middle East, Africa and Russia: Current status and call for action

Khalil

Abdelaziz

Shammary

et al. 2019

Diabetes and Vascular Disease Research

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“…Additional regional and cultural barriers exist in developing countries. In the Middle East, Africa, and South-East Asia in particular, there is often a gap between guideline-driven and actual diabetes care practices, and access to healthcare can be limited due to limited insurance coverage, low physician:population ratios, rural and inaccessible communities, and cost [ 17 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

An RCT Investigating Patient-Driven Versus Physician-Driven Titration of BIAsp 30 in Patients with Type 2 Diabetes Uncontrolled Using NPH Insulin

et al. 2017

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IntroductionThe aim of this study was to confirm the efficacy of patient-driven titration of BIAsp 30 in terms of glycemic control, by comparing it to physician-driven titration of BIAsp 30, in patients with type 2 diabetes in North Africa, the Middle East, and Asia.MethodsA 20-week, open-label, randomized, two-armed, parallel-group, multicenter study in Egypt, Indonesia, Morocco, Saudi Arabia, and Vietnam. Patients (n = 155) with type 2 diabetes inadequately controlled using neutral protamine Hagedorn (NPH) insulin were randomized to either patient-driven or physician-driven BIAsp 30 titration.ResultsThe noninferiority of patient-driven compared to physician-driven titration with respect to the reduction in HbA1c was confirmed. The estimated mean change in HbA1c from baseline to week 20 was −1.27% in the patient-driven arm and −1.04% in the physician-driven arm, with an estimated treatment difference of −0.23% (95% confidence interval: −0.54; 0.08). After 20 weeks of treatment, the proportions of patients achieving the target of HbA1c <7.5% were similar between titration arms; the proportions of patients achieving the target of ≤6.5% were also similar. Both titration algorithms were well tolerated, and hypoglycemic episode rates were similar in both arms.ConclusionPatient-driven titration of BIAsp 30 can be as effective and safe as physician-driven titration in non-Western populations. Overall, the switch from NPH insulin to BIAsp 30 was well tolerated in both titration arms and led to improved glycemic control. A limitation of the study was the relatively small number of patients recruited in each country. Clinical trial registration: ClinicalTrials.gov NCT01589653.FundingNovo Nordisk A/S, Denmark.

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“…8,14 Hypoglycaemia Socio-economic, cultural and educational barriers may contribute to poor control of diabetes. 15 However, fear of hypoglycaemia is a major barrier for those with type 1 diabetes striving to achieve good control as well as for people with type 2 diabetes on insulin and/or sulphonylureas. 16 The impact of hypoglycaemia can range from being a nuisance to being immediately life-threatening; hypoglycaemia can be unpleasant, a cause of embarrassment and disabling; it can promote discrimination at work or school and loss of a driving licence.…”

Section: Limitations Of Hba1c and Glucose Variabilitymentioning

confidence: 99%

“…13 Severe hypoglycaemia can cause neurological disability, seizures, coma and injury, and has been associated with increased mortality. [13][14][15][16][17][18] Recurrent hypoglycaemia is a particularly vicious problem as it may lead to hypoglycaemia unawareness, with loss of early warning signs of hypoglycaemia and increased risk of further and potentially more profound and dangerous hypoglycaemic episodes. 14 In the DCCT, intensive vs. standard glycaemic control was associated with a 3.3-fold increase in the rate of severe hypoglycaemia, with a clear association between hypoglycaemia and achieved HbA 1c .…”

Section: Limitations Of Hba1c and Glucose Variabilitymentioning

confidence: 99%

Glycaemic control, glucose variability and the Triangle of Diabetes Care

Rayman

2016

Br J Diabetes

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The discovery of insulin turned a diagnosis of type 1 diabetes from a terminal condition to one that can be managed in a way that allows a full and fulfilling life. Optimal management of glycaemia plays a key role within the long-term management of diabetes. Indeed, the Diabetes Control and Complications Trial and the UK Prospective Diabetes Study established beyond doubt that intensive management of blood glucose (HbA1c) reduced the risk of long-term (especially microvascular) complications of the disease in type 1 and type 2 diabetes, respectively. Long-term observational follow up years or decades beyond these trials revealed a longer-term macrovascular benefit from these interventions. There is more to glycaemic control than the prevailing level of HbA1c, however. Variability of blood glucose within and between days promotes hypoglycaemic and hyperglycaemic episodes that may increase the risk of diabetes complications or adverse clinical outcomes and which certainly impair patients' quality of life and confidence in managing their insulin regimen. The Triangle of Diabetes Care has emerged as a useful concept here, bringing together the need to improve glucose levels, but also to avoid hypoglycaemia and to reduce glucose variability. Continuous glucose monitoring is a particularly valuable tool for addressing glycaemic variability, but patients and healthcare professionals can be swamped by the large amount of data that it generates. Advanced glucose profiling provides a means of producing a straightforward, visual representation of daily glucose profiles over a number of days that can help to pinpoint the changes in the insulin regimen needed to optimise blood glucose control.Br J Diabetes 2016;16(Suppl1):S3-S6

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Barriers to the delivery of optimal antidiabetic therapy in the Middle East and Africa

Abstract: Important barriers to the delivery of optimal diabetes care exist in the Middle East and Africa.

Cited by 10 publications

References 52 publications

Prediabetes management in the Middle East, Africa and Russia: Current status and call for action

Prediabetes management in the Middle East, Africa and Russia: Current status and call for action

An RCT Investigating Patient-Driven Versus Physician-Driven Titration of BIAsp 30 in Patients with Type 2 Diabetes Uncontrolled Using NPH Insulin

Glycaemic control, glucose variability and the Triangle of Diabetes Care

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