Management of Type 2 Diabetes in Developing Countries: Balancing Optimal Glycaemic Control and Outcomes with Affordability and Accessibility to Treatment

Abstract

Why carry out this study? Diabetes mellitus is becoming a global epidemic but it disproportionally affects poorer developing countries. Newer agents, although increasingly recognized by some international guidelines, are not always widely accessible and affordable, unlike long-standing drugs such as sulfonylureas (SUs) This review considers existing antidiabetic drugs and makes a case for appropriateness of SUs, especially newer generation SUs What was learned from the study? The newer drugs like DPP4 inhibitors, SGLT2 inhibitors and GLP-1 receptor agonists, while showing benefits, may not be affordable and accessible for many individuals in developing countries The newer generation SUs like gliclazide and glimepiride are time-tested, effective, safe and should continue to be used especially in resource-restricted settings

Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review

“…The effect of the social determinants of health on diabetes management is evidenced also in low-income settings in high-income countries, for instance, in the United States where inequities in health are seriously marked due to unequal distribution of the resources [92,93]. However, strategies to overcome inequities in health may be different according to the perspective of low-or middle-income countries [94,95]. Solid evidence shows that a patient-centred care could be useful to integrate family, patients' beliefs and patients' circumstances into diabetes care [96,97].…”

Current data on the effectiveness of gliclazide and molecular mechanisms of action of the drug

“…Достижение и поддержание целевого уровня гликемии является важным принципом профилактики осложнений СД2 [10]. В частности, ранний интенсивный гликемический контроль с целью достижения уровня гликированного гемоглобина (HbA 1c ) 7,0% и менее не только уменьшает частоту возникновения почечных осложнений, но и безопасен с точки зрения сердечнососудистых исходов [11].…”

“…Недавно выявленный обменный белок, непосредственно активируемый циклическим аденозинмонофосфатом (цАМФ) 2 (Epac2), был идентифицирован как новая клеточная мишень для некоторых представителей класса ПСМ [17] В нескольких крупных исследованиях была установлена связь между приемом ПСМ и эффективным снижением уровня HbA 1c , а также улучшением отдаленных результатов [11,24,25]. В систематическом обзоре и метаанализе эффективности монотерапия ПСМ приводила к снижению HbA 1c на 1,51% по сравнению с плацебо.…”

Rhinocerebral mucormycosis to the rise? The impact of the worldwide diabetes epidemic

“…It is associated to numerous complications and comorbidities such as neutrophil dysfunction and impaired humoral immunity that predispose to fungal infections 2 .…”