Managing Diabetes in Low Income Countries

Abstract

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Time to First Optimal Glycemic Control and its Predictors Among Type 1 Diabetic Children<15 Years in Bahir Dar City Public Referral Hospitals, North West Ethiopia: A Retrospective Follow Up Study

“…The overall rst optimal glycemic control rate was 8.2(95%CI: 7.2-9.7) per 100 person/month observation.The nding related to overall incidence rate to achieve glycemic target in this study is less than other studies conducted in Kenya (28%),Jordan (20.9%), Saudi Arabia (39.1%), and California( 33%) (39,40,50,51) but greater than a study done in Tanzania(2.6%)(26).This discrepancy can be due to differences in population characteristics, sample size, study methodology and overall health care system including resource allocation (10,16,17,23,24,52).…”

“…A varieties of factors that predict glucose control in children with T1DM have documented (7,(18)(19)(20)(21)(22).High proportion of patients with uncontrolled glycemic level were due to sociodemographic factors, concomitant disease, personal and other clinical factors (16,17,23); health care system with limited resources, lack of trained health personnel and in ability of the patient or family to use and afford treatment expenditures (10,24). Uncontrolled glycemic situation results complication which can hurt many parts of the body including growth failure later in time (3,(22)(23)(24).…”

“…A varieties of factors that predict glucose control in children with T1DM have documented (7,(18)(19)(20)(21)(22).High proportion of patients with uncontrolled glycemic level were due to sociodemographic factors, concomitant disease, personal and other clinical factors (16,17,23); health care system with limited resources, lack of trained health personnel and in ability of the patient or family to use and afford treatment expenditures (10,24). Uncontrolled glycemic situation results complication which can hurt many parts of the body including growth failure later in time (3,(22)(23)(24). As a result, both acute and chronic complications were reported in different studies (24).Adverse effects like lipodystrophy is one of the clinical complication which may occur related to insulin injection and leads to insulin absorption problems, which ultimately can hinder rst optimal glycemic control (25,26).The most common complication prior in three months were hypoglycemia(21-42%) followed by 31.5%-39% of diabetic keto acidosis(DKA),10.5%-32.9% of nephropathy,13.6%of neuropathy,10.5% of convulsion,10.3% of retinopathy (27)(28)(29).…”

“…Uncontrolled glycemic situation results complication which can hurt many parts of the body including growth failure later in time (3,(22)(23)(24). As a result, both acute and chronic complications were reported in different studies (24).Adverse effects like lipodystrophy is one of the clinical complication which may occur related to insulin injection and leads to insulin absorption problems, which ultimately can hinder rst optimal glycemic control (25,26).The most common complication prior in three months were hypoglycemia(21-42%) followed by 31.5%-39% of diabetic keto acidosis(DKA),10.5%-32.9% of nephropathy,13.6%of neuropathy,10.5% of convulsion,10.3% of retinopathy (27)(28)(29). Sustained abnormal blood sugar uctuation for periods of greater than two months can also contribute to high burden of the disease, hospitalization and negative consequences of disease out comes (30,32).…”

The importance of continuing adequate lifestyle including exercise, daily activity and low carbohydrate diet (LCD) for type 2 diabetes mellitus (T2DM)

“…1 It may give burden to each patient, society and country. 2 The prevalence and incidence of DM and noncommunicable diseases (NCDs) have been elevated remarkably in developing and developed countries worldwide. 3 As to treatment for DM, some options have been present, including several kinds of oral hypoglycemic agents (OHAs) and other injectable diabetic agents.…”