Growing Global Burden of Diabetes Exacerbated by Massive Inequalities

Despite growing awareness and ongoing multinational efforts, diabetes remains epidemic, with prevalence increasing exponentially and worldwide, according to a new series published in 2016. outweighs most diseases. lancet and The Lancet Diabetes and Endocrinology magazine. Worse, the systemic racism experienced by ethnic minorities and the geographic inequalities experienced by low- and middle-income countries (LMICs) contribute to diabetic disease, illness and mortality worldwide. is rapidly increasing.

A new startling estimate has been announced lancet In parallel with the GBD 2021 Diabetes Collaborators series, by 2050 more than 1.3 billion people will have diabetes, one of the leading causes of death and disability worldwide, in the absence of effective mitigation strategies. I predict that I will live.

No country is expected to experience a decline in age-standardized diabetes prevalence over the next 30 years, and many countries in the worst-affected regions of Oceania, North Africa and the Middle East are expected to have diabetes levels above 20%. It is expected and Guyana in the Caribbean.

The new collection of series papers also highlights how the growing global burden of diabetes is exacerbated by massive inequalities in diabetes prevalence, morbidity and mortality. It is estimated that by 2045, more than three-quarters of her diabetic adults will be living in her LMIC, and one in ten of them will have access to comprehensive guideline-based diabetes care. expected to be less than

Similarly, in high-income countries (HICs) such as the United States, diabetes prevalence among ethnic minorities (such as American Indians, Alaska Natives, Blacks, Hispanics, and Asians) is lower than that of the white population due to systemic racism. It is almost 1.5 times higher than the .

The series explores how people in marginalized communities around the world have less access to essential medicines such as insulin and new treatments, poorer glycemic control, lower quality of life, and shorter life expectancy. It became clear that there is The COVID-19 pandemic has increased diabetes inequality globally. people with diabetes They are 50% more likely to develop a serious infection and twice as likely to die compared to people without diabetes, especially those from ethnic minorities.

Against this background, the authors The Lancet – The Lancet Diabetes and Endocrinology A series on global inequalities in diabetes focuses on real-world interventions that have shown potential to reduce inequitable diabetes care and outcomes among racially and geographically marginalized groups and communities. We are looking for higher quality real world research.

Diabetes remains one of the greatest public health threats of our time, rising exponentially in all countries, age groups and genders over the next 30 years, posing serious challenges to healthcare systems around the world. ”

Dr. Shivani Agarwal, Series Leader, Fleischer Institute for Diabetes and Metabolism, Montefiore Health System, Albert Einstein College of Medicine, USA

She continued, “Achieving the United Nations Sustainable Development Goal of reducing non-communicable diseases by 30% within seven years and curbing the increasingly negative health impacts of marginalized populations will require diabetes. It is essential to focus on and understand the inequalities in “This series provides an important opportunity for concerted and pragmatic action to transform approaches to diabetes care and outcomes for marginalized populations around the world.”

Structural and social factors play a major role in shaping diabetes outcomes and care

In this series, the large-scale and deep-seated effects of structural racism and geographic inequality contribute to the unequal impact of the social determinants of health (the social and economic conditions in which people live and work) globally. We review diabetes prevalence, care, and how it impacts diabetes outcomes. course of life. The negative impacts of public attitudes and policies, economic development, access to quality care, management innovation and socio-cultural norms are felt widely by marginalized populations and future generations.

“Racist policies, such as residential segregation, affect where people live, access to adequate and healthy food and health services,” explains co-author Leonard Egede, professor of medicine at the University of Wisconsin, USA. do. “This widening spiral of diabetes inequality results in wide disparities in care and clinical outcomes for people of historically disenfranchised races and ethnicities, including Blacks, Hispanics and Indigenous peoples.”

In Australia, for example, longstanding systemic racism and inequality have caused Aboriginal and Torres Strait Islander populations to have three times the prevalence of type 2 diabetes as the general population, and the prevalence of juvenile-onset type 2 diabetes is among the highest in the world. belong to the highest category. “Intergenerational trauma can affect not only mental health and well-being, but also the home environment in which people live, increasing their risk of diabetes,” co-author of the Menzies Health Study in Australia. explains graduate professor Louise Maple-Brown. “Food insecurity and overcrowded housing in remote areas also significantly impede diabetes self-management and care.”

Structural racism and the structural conditions of where people live and work have pervasive negative impacts on diabetes outcomes across generations and around the world. “In sub-Saharan Africa, declining health care costs, lack of human resources, food insecurity and limited access to essential medicines have led to worsening outcomes, while lack of public awareness and specific diabetes policies has led to , there are limited efforts to drive change at the population level,” says co-author Alesha Wade, associate professor at the University of the Witwatersrand in South Africa. “It is critical that the impact of social and economic factors on diabetes be recognized, understood, and incorporated into efforts to curb the global diabetes crisis.”

A series of articles published in The Lancet Diabetes and Endocrinology These findings are even more important, highlighting the wide disparities in diabetes burden and management that exist within and between races and ethnic groups in the United States. For example, blacks born in Africa or the Caribbean are 25% less likely to develop diabetes than blacks born in the United States. Also, Asian, black and Hispanic individuals and low-income individuals are less likely than white and wealthy individuals to treat diabetes with GLP1 receptor agonists.

“Current racial and ethnic categories are insufficient to explain the nuances of lived experience or fully reveal inequalities embedded in social structures, including health care,” said co-authors. Says Dr. Saria Hassan of Emory University School of Medicine in the United States. “Furthermore, focusing only on adults misses the extent of the accelerating epidemic. childhood type 2 diabetes And adolescents add to the burden of disease, exacerbating inequality across America. ”

Addressing diabetes inequality requires a broader strategy

Based on 2020 recommendations lancet Diabetes Commission to work with WHO’s 2021 Global Diabetes Compact and United Nations Sustainable Development Goals to address racial inequalities in diabetes care and engage most affected communities in intervention development and implementation It outlines an action plan to address racial inequalities in diabetes care and improve outcomes by developing and incorporating multiple policies. A multi-layered strategy to address the structural and social determinants of health that underlie global inequalities.

The authors provide an international example of how to address diabetes inequities in the real world by changing ecosystems (societal- and policy-level factors), building capacity, and improving clinical practice environments. I am emphasizing.

Access to insulin is a critical part of the ecosystem for millions of diabetics who are unable to obtain or purchase the supplies they need to self-manage their diabetes. One of the interventions in sub-Saharan Africa developed in collaboration with governments, industry and patient groups is Diabetes CarePak’s “co-packaging” solution to increase access to safe insulin and supplies. A monthly supply of test strips, alcohol swabs, needles and syringes, and a blood glucose meter led to more frequent blood glucose monitoring and an average 2.8% decrease in hemoglobin A1C over his two months. This reduction rate is comparable to that of drug use.

IMPACT (Individualized Administration of Patient-Centered Goals), another promising program to build capacity across the United States, harnesses the power of locally recruited community health workers to provide advocacy, social support, and support. It has been shown to provide health guidance and improve chronic disease management. For the average Medicaid payer, $2.47 is returned for every dollar invested, shortening hospital stays while delivering a good return on investment.

These international examples demonstrate that approaches that address not only structural inequalities, but individuals within the larger social context have the greatest potential for sustainable and equitable change in diabetes worldwide. indicates that ”

Dr. Ashby Walker, University of Florida, USA, Chair of the American Diabetes Association National Health Disparities Commission

Ultimately, this series addresses the need for more impactful, high-quality, real-world research to ensure that all people with diabetes get the care they need, when and where they need it. shall be firmly established. “While research has focused on explaining these inequalities, it is important to develop and test interventions to address them. We have to stop celebrating the problem and start solving it,” says Dr. Agarwal. “We hope that this series will spur increased research funding to identify and develop more effective measures to address disparities in diabetes treatment and outcomes, and promote sustainable policies at the population level. If we don’t take action, we are undermining our present and our health. Future generations are at stake.”