A Selective Analysis of Access to Diabetes Diagnostics in Low to Medium-Income Countries 

Healthcare
Written By Girls Who Impact .

Authors: Avery Ma, Weiwei Liang

Highlights:

  • Over 422 million individuals globally are affected by Diabetes, with a rapid increase in low and middle-income countries such as India, Brazil, and Indonesia.

  • By 2045, the number of diabetic patients in India is estimated to reach 134 million, indicating a continuous rise in prevalence rates. Factors such as diabetes not appearing as an obvious imminent disease, along with the lack of access to proper diagnostics and treatments, contribute to the rising numbers. 

  • A cross-sectional study revealed that 19.3% of diabetes patients in India receive care from doctors specializing in Diabetology/Endocrinology, while 41.5% are treated by doctors with MD or DNB in medicine. Around 30.7% of diabetes patients in India receive care from healthcare providers with nontraditional degrees, such as Ayurvedic or Homeopathic qualifications, which may have contributed to delayed effective treatment.

 

Introduction of Type 1 and Type 2 Diabetes

Over the last decade, the prevalence of Diabetes has risen to more than 422 million people globally, and prevalence in low and middle-income countries (LMICs) is growing more rapidly than in high-income countries (WHO). Diabetes is a chronic disease often associated with the excessive consumption of sugary foods, a phenomenon rooted in the rapid entry of sugars from these foods into the bloodstream, where they accumulate and contribute to the blood sugar level. The biological perspective of Diabetes sheds light on the connection between high-sugar food intake and elevated blood sugar levels and is a common worry of many who are trying to have a healthy and sustainable diet. 


Blood sugar, also known as glucose, is the primary energy source for many organisms including humans. However, when the level of blood sugar exceeds a certain threshold and remains in the blood for a prolonged period of time, it places a significant burden on our pancreas to release insulin in amounts equivalent to the sugar intake to break it down. Eventually, this can lead to some serious health issues, such as Type 2 Diabetes and cardiovascular diseases. Insulin acts as a mediator in the sugar digestive process, effectively transporting energy in the human body while regulating sugar levels in the blood. Each time insulin facilitates the transportation of sugar from the bloodstream into cells, the concentration of sugar in the blood vessels diminishes. The subsequent chain reaction creates a linear response: after the drop in glucose in the bloodstream, the pancreas releases less insulin, forming a negative feedback loop. Similarly, when there is excessive sugar in the bloodstream, the pancreas releases more insulin. Over time, the cells require more insulin to absorb the same amount of glucose, ultimately leading to inefficient insulin use. 

 

Differences Between Type 1 and Type 2 Diabetes

There are two types of diabetes: Type 1 and Type 2. The primary cause of type 1 diabetes is attributed to the immune system rather than genetic factors (JDFR). Its most significant trigger factor lies in autoimmune reactions, where the body is unable to recognize itself and attacks its own tissues (CDC), resulting in insufficient or complete lack of insulin production. On the other hand, for type 2 diabetes, the main issue is that the body either doesn't produce enough insulin or cannot utilize it effectively. According to the CDC, it is not clear exactly what causes insulin resistance in patients with type 2 diabetes. However, common elements including being overweight and inactive are key contributing factors (Mayo Clinic). 

To distinguish the two forms of diabetes more precisely: Type 1 diabetes involves the pancreas not producing insulin needed to break down sugar, whereas in Type 2 diabetes, the pancreas produces an insufficient amount of insulin or the body cannot use the insulin effectively. There can be various factors contributing to the body's development of insulin resistance, such as obesity, genetic predisposition, and lifestyle choices. Insulin resistance means that your body stops responding to insulin, even when it is available (UVA Health). Based on research done by the CDC, only 5-10% of people diagnosed with diabetes have Type 1, indicating that the largest group of patients worldwide has Type 2 diabetes. 

 

Diabetes diagnosis in low to medium-income countries (LMICs)

Discussing access to diabetes diagnosis in low to medium-income countries around the world is paramount due to the escalating disease burden in these regions. The prevalence of diabetes is surging annually, posing an increasingly serious public health challenge. Projections indicate a substantial rise in diabetes cases in countries such as India, Brazil, and Indonesia. By the year 2025, the number of diabetic patients residing in LMICs in comparison to the total population of diabetic patients is expected to reach 75% compared to 62% in 1995. This stark increase of 13% underscores the urgent need to address diabetes diagnosis in order to apply diabetes management in LMICs. Furthermore, approximately 80% of the 463 million adults worldwide with diabetes live in LMICs, focusing on access to diabetes diagnosis in those countries is essential for effectively managing this global epidemic and improving health outcomes in vulnerable populations.

India is one of the main countries with a continuously rising rate of Diabetes 

According to data from the WHO,  it is estimated that 77 million individuals aged 18 years and above are affected by Type 2 diabetes, and nearly 25 million are prediabetic in India. This means that India has a large population of individuals who have a higher risk of developing diabetes in the future.

Data collected by the WHO indicates that the actual number of individuals affected by diabetes far exceeds 77 million. This discrepancy is due to several factors, including the absence of 2024 data, which is not expected to show a decline in numbers. Additionally, diagnosed cases only include patients who have the resources to visit a physician for a diagnosis. In low- and middle-income countries (LMICs), obtaining a diagnosis for a disease that is not immediate and seemingly life-threatening is often not a high priority. Instead, individuals prioritize making money and providing for their families and themselves. Among the 25 million patients diagnosed with prediabetes, there are two possible outcomes: receiving intervening treatment to prevent the progression of prediabetes into diabetes, or receiving insufficient attention, leading to the continued malignant progression of the condition.

Based on the NIH, it is estimated that by 2045, the number of diabetic patients in India will increase to 134 million, indicating a continuous increase in the prevalence rate of diabetes. There is reason to assume that a certain portion of this linear growth in cases may be due to diagnosed individuals who are prediabetic do not take the disease seriously, due to other more imminent issues such as working to provide for their families. This often results in the progression of diabetes over time. According to the National Library of Medicine, it is estimated that about 5-10% of adults with prediabetes develop diabetes each year. Therefore, if the prediabetes rate in India remains constant, the conversion rate from prediabetes to diabetes for these 25 million patients should be between 1.25 million and 2.5 million per year. This indicates that there are at least 1.25 million new potential diabetes patients in India each year, assuming the prediabetes rate stays the same. Additionally, there are patients who are directly diagnosed with diabetes each year, further contributing to the overall number of diabetes cases. 

Taking a closer look based on a cross-sectional study conducted in India on the care and diagnosis of diabetes, the data reveals that 19.3% of the study participants received care from doctors specializing in Diabetology/Endocrinology, while 41.5% received diabetes care from doctors holding either an MD or DNB in medicine. On the other hand, 30.7% of participants have received care from healthcare providers with nontraditional degrees, such as Ayurvedic or Homeopathic qualifications. Interestingly, 8.3% of the study participants were unaware of the qualifications of their treating personnel. Further in this study, it was found that a statistically significant association (P < 0.0001) was found between the qualification of the treating doctor and the initiation of antidiabetic medications within 3 months of diagnosis, which deviates from standard guidelines. This suggests that doctors with different qualifications initiate antidiabetic medications within three months of diagnosis at different rates, contrary to recommended guidelines of individualized treatment plans, gradual introduction of medications, and regular follow-up to optimize diabetes management and minimize risks. This suggests that there is a poor standardization of treatment plans among various medical personnel, indicating a limitation and lack of specialization in diabetes care among healthcare professionals as diabetes patients may be diagnosed and managed by non-traditional medical specialists. The lack of standardization could strongly contribute to delayed or ineffective treatment for some individuals, contributing to the rising prevalence of diabetic patients.

In conclusion, it is evident that diabetes not only poses a global health crisis but especially presents significant challenges in terms of management and prevention in low to medium-income countries. This discourse examines India's profile as a country with a high number of diabetic individuals, analyzing the trajectory of diabetes, diagnostic protocols, and emerging data on prevention strategies and control measures. It is evident that prevention vigilance, meticulous patient monitoring and treatment, increased patient awareness, and improved medical proficiency are critical factors in containing the escalating incidence of diabetes in India and other low- and middle-income countries (LMICs). These countries specifically need programs that enable accessible diagnosis and treatment, a platform that is currently lacking but urgently needed.

 
Girls Who Impact .
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