Diabetes in developing countries

Abstract

Highlights• Diabetes in developing countries is increasing and often undiagnosed. In South Asians, diabetes and related metabolic abnormalities develop at a younger age and at a lower body mass index and waist circumference than in Whites. • Overall glycemic control and management of diabetes is suboptimal, driven by multiple factors (eg, unawareness, cost of drugs and insulin etc.), and the load of complications is high. • To stem this epidemic, strong actions for prevention and management are required using innovative and low-cost approaches. AbstractThere has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro-and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.

Dietary Habits of Saharawi Type II Diabetic Women Living in Algerian Refugee Camps: Relationship with Nutritional Status and Glycemic Profile

“…Moreover, 75.4% of subjects were insulin-resistant, a situation presumably the consequence of obesity itself, but also of inadequate diabetes care and a dietary pattern characterized by little variability and poor nutritional quality. As in other developing countries [2], the Saharawi refugee camps also have a poor supply of glucose-lowering drugs and insulin, as well as materials, reagents, and tools for diabetes diagnosis and monitoring. In our sample, almost all of the diabetic women were treated with metformin, glibenclamide, or a combination of the two.…”

“…Body height was measured to the nearest 0.1 cm using a vertical stadiometer. BMI was calculated as weight (kg)/height (m) 2 and overweight and obesity were classified following the NIH guidelines [17]. Waist (WC) and hip circumferences (HC) were measured with a non-stretch tape to the nearest 0.5 cm at the midpoint between the last rib and the iliac crest and around the widest portion of the buttocks, respectively.…”

“…Many factors, including the changing pattern of food consumption, urbanization, physical inactivity, and perinatal under-nutrition, have led to a rapid increase in the prevalence of type II diabetes mellitus in developing countries over the last decade [2]. However, the quality of diabetes care in many developing countries has not increased as quickly, and currently still remains poor [3,4].…”

“…Moreover, if it is true that diet plays an important role in the management of diabetes [5,6], it is also true that, in some developing countries, due to war, political issues, poverty, and adverse environmental conditions, there may be barriers to accessing food, particularly food of high nutritional quality. The situation is exacerbated among refugees, who, in addition to these problems, also face the stress of changing living and dietary habits [2].…”

Climate Change Vulnerability Assessment in the High Mountain Region of Nepal: A Case Study of Lamjung District

“…The analysis of temperature shows a trend of warming by 0.4°C-0.6°C per decade [33,40]. Climate change had been observe more severely in Hindu Kush Himalayan region including Nepal [41][42][43]. Different sectors such as socio-economic, biodiversity, livelihood, water resources and energy are already experiencing negative impact of climate change in the country [44][45][46].…”