Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study

Abstract

We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35-70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 6 3.0 years. RESULTS

Epidemiology of type 2 diabetes in the Middle East and North Africa: Challenges and call for action

“…In addition to the apparently higher mortality in middle-income countries and low-income countries, the largest proportion of diabetes-related deaths occur among individuals under 60 years of age, with loss of productive years, adding to the socioeconomic burden of diabetes[ 2 ]. The finding of lower mortality for the HIC is consistent with recent world data[ 76 , 77 ].…”

“…Having diabetes essentially increases the risk of having a major adverse vascular event defined as nonfatal myocardial infarction, stroke, heart failure, and/or cardiovascular death by 2-3-fold after adjusting for age, sex, and smoking status[ 72 , 76 , 78 ]. We could not find any large cohort studies nor national data on the above hard outcomes even from countries with a high prevalence of T2D who have a national diabetes registry and/or have a relatively well-funded health care system[ 79 ].…”

“…The heterogeneity of the MENA population, the presence or absence of risk factors, and the inconsistent definition of outcomes makes comparisons between individual regions challenging. However, a recent study of 143567 adults with diabetes aged 35-70 years from 21 countries around the world, including 5 countries from the MENA (Saudi Arabia, UAE, Iran, Palestine, and Pakistan) and followed for 9 years found an absolute incidence of major CVD among people with diabetes of 8.3; 9.2; and 10.3 per 1000 person-years in HIC, middle-income countries, and low-income countries, respectively, as compared to 3.4; 4.9; and 5.3 per 1000 person-years in people without diabetes, respectively[ 76 ].…”

Fundus Photography as the Base of Three-Tier Diabetic Retinopathy Care System to Its Wider Roles: Learning from a Case Experience

“…It is just recently reported that the CVD rates, CVD mortality, and all-cause mortality are markedly higher among those with diabetes in lowincome countries than others. 16 Apart from controlling and monitoring blood glucose, the management of diabetes includes the management of its risk factors, including obesity and comorbidities, especially hypertension, and the prevention of the complication of CVD. 17 The inclusion of the use of inhaled steroids and bronchodilators in chronic respiratory disease and identification of presenting features of cancer along with other interventions indicated in the WHO PEN in the curriculum can complete the areas of training of traditional diabetes educator as that of educator for the four major NCD for primary care and education of the patients.…”

Long Non-Coding RNAs (lncRNAs) in Cardiovascular Disease Complication of Type 2 Diabetes

“…The increasing prevalence of diabetes worldwide is a burden, as most T2D patients will develop macrovascular and microvascular complications, which lead to various severe health problems and mortality [2][3][4]. Despite advances and improvements in the treatment options for T2D, the majority of deaths in T2D patients are due to cardiovascular diseases (CVD) [5][6][7][8]. People with diabetes have a CVD mortality risk 3-to 4-fold higher than those without diabetes [6,9].…”