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DIABETES MANAGEMENT (EASTERN WORLD (Issues of the Developing World…

- - - - Diabetes is a lifelong and progressive illness which requires continued care at the expense of country and patient.
        
        The negative impact of diabetes on economic growth of individuals which is quickly growing in incidence impacts economic growth of individuals and thus nations.
        :!:
        
        :!: Requires reform to treat patients :!:
        
        Clinical inertia is already a main failing point of successful diabetes management and low healthcare funding makes progressive treatment not feasible for patients in transitioning economy
        
        Clinical Inertia remains a large issue in the western world considering established guidelines, awareness and excessive healthcare funding.
  - - - Only 33 of 75 studied countries had identifiable national guidelines
        :red_flag:
        
        23 suggested management of hypogylcemia :red_flag:
        
        This is counter-intuitive as someone who has spent long periods of time in hypoglycemia or hyperglycemia will have higher HbA1c yet not all countries with national guidelines suggest management of hypoglycemia. [5]
        :red_flag:
        
        Agreed on
        
        25 countries recommend insulin therapy to maintain low HbA1c levels for T1 diabetics
        :warning:
        
        60% recommended insulin therapy and a second option for T1 diabetes treatment
      - Rely Heavily on
      - Only 67% of 75 countries recommended non interventional treatments by lifestyle changes
        :warning:
- - - - Fundamental Guidelines
        
        Maintaining a Hemoglobin A1C level of <7.5%
        
        HbA1c levels >8% increase risk of developing diabetes related complications
        
        International guidelines provide too many alternative options which can cause a doctor with less experience to provide an ineffective or non-optimal treatment options
        :warning:
        
        Difficulty of setting clear guidelines
        
        Interventional treatment
        
        Glucose monitoring with effective treatment plan is mandatory for diabetes care.
        
        Insulin Therapy
        
        Metformin
        
        Anti-diabetes medication
        
        Continuous glucose monitoring systems
        
        Blood Monitoring systems
        Finger Pricking
        
        Reduce time spend in hypoglycemia
        
        Non interventional treatment
        
        Healthful eating
        
        Systematic Physical Activity
        
        Avoid alcohol and tobacco use
        
        Stress Reduction
  - - - USA and Great Britain scored worse than Sweden by >1% on mean HbA1c levels :warning:
        
        USA averages 8.6%
      - Nordic countries scored lower HbA1c levels with tight center variation which indicate the success of nationwide programs to improve diabetic care :check:
        
        This is achieved by publicly disclosing performance of diabetic care centers which are monitored in participation with the centers themselves for systematic improvement. :check:
      - 64,666 T1 diabetes subjects under the age of 18 studied
      - Mean HbA1c levels in 8 European Countries.
        Lower is better. Goal is to reach below 7.5%
      - Wider center variation of glucose control has correlation to the freedom to choose health providers from a blend of caregivers.
        :warning:
        
        Accounts for Austria's and Germany's wide center variation of HbA1c levels in T1 Diabetics. This can also be seen in the United States Healthcare system though it is limited especially when accounting federal medical insurance availability.
- - - - 4) Huizinga MM, Rothman RL. Addressing the diabetes pandemic: a comprehensive approach. Indian J Med Res. 2006;124:481–4.
        
        5) George Grunberger, Timothy Bailey, Pauline M. Camacho, Daniel Einhorn, Alan J. Garber, Yehuda Handelsman, R. Mack Harrell, Howard M. Lando, Bill Law Jr., Jonathan D. Leffert, and Eric A. Orzeck (2015) Proceedings From The American Association Of Clinical Endocrinologists And American College Of Endocrinology Consensus Conference On Glucose Monitoring. Endocrine Practice: May 2015, Vol. 21, No. 5, pp. 522-533.