Management of diabetes in resource-poor settings

Grant, Paul

doi:10.7861/clinmedicine.13-1-27

Cited by 45 publications

(48 citation statements)

References 22 publications

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“…85 Unfortunately, diabetes management in low-income and middle-income countries rarely meets evidence-based standards. 86 Very often the public’s awareness of both diseases is low, diagnostic services and trained specialists are scarce, and diabetes treatments are restricted because of the low supply and high cost of drugs. 86,87 In many low-income and middle-income countries, diabetes monitoring and treatment are only partly covered by health insurance or government support.…”

Section: Implications For Health Service Delivery and Health Economicsmentioning

confidence: 99%

Clinical management of concurrent diabetes and tuberculosis and the implications for patient services

Riza

Pearson

Ugarte-Gil

et al. 2014

The Lancet Diabetes & Endocrinology

179

147

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Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes.

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Section: Implications For Health Service Delivery and Health Economicsmentioning

confidence: 99%

Clinical management of concurrent diabetes and tuberculosis and the implications for patient services

Riza

Pearson

Ugarte-Gil

et al. 2014

The Lancet Diabetes & Endocrinology

179

147

View full text Add to dashboard Cite

show abstract

“…It is also believed that the 'directly observed treatment, short course' system will be adopted in some of the African countries [19]. This system has been very successful in managing TB treatment in resource-poor settings.…”

Section: Expert Commentary and Five-year Viewmentioning

confidence: 99%

“…Another infectious disease associated with diabetes in Africa is TB [19]. This is regarded as being the outcome of the large spread of HIV/AIDS, which has precipitated in a rise in TB in immune-suppressed individuals.…”

Section: Hiv/aids and Tb In Childrenmentioning

confidence: 99%

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Future challenges for pediatric diabetes management in developing countries: lessons from Africa

Steyn

Mchiza

Kengne

2014

Expert Review of Endocrinology & Metabolism

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In this review, we describe the epidemiology of diabetes mellitus in children and adolescents in Africa, noting that there is a paucity of data with regard to the burden of disease, prevalence of undiagnosed diabetes, healthcare and acute and chronic complications. Furthermore, access to care remains an issue of great concern. Our view is that in the next 5 years, more research will be undertaken on the burden of the disease and on interventions to provide better access to care. While the majority of African countries still have a low incidence of diabetes in children, it is predicted that the incidence will increase and it is therefore essential that governments develop sustainable policies to deal with such increases.

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“…Lack of access to specialist healthcare, insufficient clinical evaluation, delayed diagnosis, clinical inertia and suboptimal self-care are some of the challenges with regards to diabetes management in Asia (Cramer, 2004;Ko et al, 2010;Mu et al, 2012). Low levels of health literacy due to poor general education and insufficient health education in these countries further add burden to already under-resourced healthcare systems, which are unlikely to cope with the escalating costs of end-stage disease with rising prevalence of diabetes in Asia (Grant, 2013;Ringborg et al, 2009).…”

Section: Introductionmentioning

confidence: 96%