A substantial proportion of individuals with diabetes remain undiagnosed and untreated in both developed and developing countries, according to a study by IHME researchers and collaborators. The study, Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys, shows that millions of people worldwide may be at risk of early death from diabetes and related cardiovascular illnesses. The work was done in collaboration with researchers from the University of California, San Francisco, the Harvard Global Equity Initiative, the National Institute of Public Health in Mexico, and Ramathibodi Hospital in Thailand.

Research findings

Of the seven countries studied (Colombia, England, Iran, Mexico, Scotland, Thailand, and the United States), Mexico had the highest prevalence of diagnosed diabetes, with 24% of males and 21% of females over the age of 35 with the disease. England and Scotland have the lowest prevalence rates. Prevalence is higher among men in Colombia, England, Mexico, and the US, and among women in Iran and Thailand. Diagnosis rates were higher for women than for men. In all countries, only a small percentage of people with diabetes met the International Diabetes Federation’s treatment targets. The US had the highest rates, while England and Scotland had the lowest. 
The prevalence of arterial hypertension in people with diabetes was high in all surveys, and the rate of diagnosis was distinctly higher in England, Scotland, and the United States than in Colombia, Iran, Thailand, or Mexico. Treatment rates for arterial hypertension followed a similar pattern and were higher in the more developed countries. The United States was the best performer, with 38% of men and 25% of women with diabetes and hypertension meeting their treatment targets for hypertension. 
The prevalence of high cholesterol among individuals with diabetes was above 55% in all surveys except in Mexico, where it was only about 35%. Countries had a lower proportion of people with diabetes being treated for high cholesterol than for high blood pressure or blood glucose, but of those receiving treatment for high cholesterol, higher proportions were meeting treatment targets compared to those receiving treatment for high blood pressure or blood glucose.
Overall, the proportion of individuals with diabetes reaching treatment targets for blood glucose, arterial blood pressure, and serum cholesterol was very low, ranging from 1% of male patients in Mexico to 13% for men in the US. 
Income and education were not significantly related to the rates of diagnosis anywhere except Thailand. However, in the three countries with available data (Colombia, Mexico, and the US), insurance status was a strong predictor of diagnosis and effective management, especially in the US. In the US, insured individuals were almost twice as likely to be effectively managed as those without insurance.

Analytical approach 

Researchers used nationally representative health examination surveys from seven countries to obtain data on diagnosis, treatment, and control of high blood glucose, arterial hypertension, and high cholesterol in individuals with diabetes. They used logistic regression to explore the socioeconomic determinants of diagnosis and effective case management. 

Research objective 

More than 280 million people worldwide have diabetes. Of these, the majority live in the developing world, and the burden of diabetes will only continue to grow, with the number of adults with diabetes in developing countries projected to rise by more than two-thirds between 2010 and 2030. This study was conducted to examine the effectiveness of the health system response to the challenge of diabetes across different settings and to explore the inequalities in diabetes care that are attributable to socioeconomic factors. This research is part of ongoing work by IHME to understand how well health systems are performing so that decision-makers can most effectively target policies and interventions.

Policy implications 

The researchers recommend that governments and multilateral agencies consider the following steps to improve population-level management of diabetes, hypertension, and high cholesterol:

  • Tracking diabetes care at the population level, focusing on actual outcomes, especially in countries with larger numbers of individuals with diabetes that lack nationally representative studies.
  • Prioritizing the development and implementation of national guidelines, and expanding the management of hypertension and high cholesterol in individuals with diabetes, especially in developing countries.
  • Supporting innovations in the technology of diabetes management and in improving financial access to care. 

Gakidou E, Mallinger L, Abbott-Klafter J, Guerrero R, Villalpando S, Ridaura RL, Aekplakorn W, Naghavi M, Lim S, Lozano R, Murray CJL. Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bulletin of the World Health Organization. 2011; 89:172-183.