[Burden of mortality due to diabetes mellitus in Latin America 2000-2011: the case of Argentina, Chile, Colombia, and Mexico.]

Mortality attributable to type 2 diabetes mellitus in Latin America and the Caribbean: a comparative risk assessment analysis

INTRODUCTION

We quantified the proportion and the absolute number of deaths attributable to type 2 diabetes mellitus (T2DM) in Latin America and the Caribbean (LAC) using an estimation approach.

RESEARCH DESIGN AND METHODS

We combined T2DM prevalence estimates from the NCD Risk Factor Collaboration, relative risks between T2DM and all-cause mortality from a meta-analysis of cohorts in LAC, and death rates from the Global Burden of Disease Study 2019. We estimated population-attributable fractions (PAFs) and computed the absolute number of attributable deaths in 1990 and 2019 by multiplying the PAFs by the total deaths in each country, year, sex, and 5-year age group.

RESULTS

Between 1985 and 2014 in LAC, the proportion of all-cause mortality attributable to T2DM increased from 12.2% to 16.9% in men and from 14.5% to 19.3% in women. In 2019, the absolute number of deaths attributable to T2DM was 349 787 in men and 330 414 in women. The highest death rates (deaths per 100 000 people) in 2019 were in Saint Kitts and Nevis (325 in men, 229 in women), Guyana (313 in men, 272 in women), and Haiti (269 in men, 265 in women).

CONCLUSIONS

A substantial burden of all deaths is attributed to T2DM in LAC. To decrease the mortality attributable to T2DM in LAC, policies are needed to strengthen early diagnosis and management, along with the prevention of complications.

Changes in diabetes mortality rate in Costa Rica 2007-2017

AIM

Diabetes mellitus is a major health problem in Costa Rica. Its prevalence is increasing and represents a significant burden.

OBJECTIVES

To determine specific diabetes mortality rates (SDMR) in Costa Rica from 2007 to 2017 and explore it's potential causes.

METHODS

Death certificates (classification CIE-10) were obtained from the Instituto Nacional de Estadística y Censos. All-cause mortality, SDMR, ischemic heart disease (IHD), cerebrovascular disease (CVD), and peripheral vascular disease mortality were assessed per year, sex, age and province. We evaluated relationships between SDMR and Index of Human Development (IHUD), performed a multivariate regression negative binomial model analysis and compared SDMR with goals of metabolic control in the primary care setting.

RESULTS

All-cause mortality and SDMR increased while IHD and CVD mortality rates remained invariable. SDMR was higher in females and in provinces with predominant rural areas. The years of observation, sex, age and province were significant predictors of death at a 5% level in people with diabetes. Reports from primary care setting showed inadequeate public health care coverage and insuficient metabolic control.

CONCLUSIONS

SDMR increased in elderly patients with specific complications. Age, place of residence and sex predicted SDMR. Unsatisfactory diabetes medical coverage and poorly diabetes management likely explain our findings.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

PURPOSE OF REVIEW

Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes.

RECENT FINDINGS

The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.

Exploratory spatial analysis of diabetes mortality and its relationship with the socioeconomic conditions of Colombian municipalities

Type 2 diabetes mellitus prevalence has increased worldwide, especially in low- and middle-income countries. This study aimed to evaluate in the Colombian context whether the geographic variations of mortality due to type 2 diabetes mellitus are random or statistically significant and to measure the effect of the socioeconomic conditions of municipalities on these variations. An ecological study of trends for regions and subregions was undertaken considering two periods (2003-2009 and 2010-2016). The study population consisted of adults of 20 to 79 years old residing in each of Colombia's municipalities during the period 2003-2016. Smoothed and standardized mortality rates were obtained by fitting a hierarchical Bayesian model, which considers the spatial structure of the data. Four socioeconomic variables related to municipal deprivation and development were included into the model to obtain their relative risk (RR) and 95% credible intervals. Mortality due to type 2 diabetes mellitus decrease between 2003 and 2016 in Colombia, both nationally and regionally. In addition, there was a clear positive association between mortality due to diabetes mellitus and the level of municipal development; the wealthiest and most developed municipalities had higher mortality risks.

Sex disparities in the epidemic of type 2 diabetes in Mexico: national and state level results based on the Global Burden of Disease Study, 1990-2017

PURPOSE

To analyze the type 2 diabetes (T2D) health burden in Mexico by sex at the national and state levels from 1990 to 2017.

METHODS

This was a secondary analysis based on data from the Global Burden of Disease Study, 1990-2017. We used the indicators of mortality rates, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs).

RESULTS

At the national level, there was an increase in the standardized mortality rates, YLLs, YLDs and DALYs, especially in the male group. At the state level, the health impacts of T2D varied within the population and did not exhibit any clearly defined geographic pattern. However, the most pronounced increases in the various indicators occurred in the poorer states of the country.

CONCLUSION

T2D continues to have a dominant impact on Mexican public health, with marked disparities between the states. Working to reduce these health inequalities is necessary, and resources must be focused on the priority groups, for example, men, young and middle-aged adults, and individuals living in the states with the highest index of marginalization.

Needed Improvements in Diabetes Prevention and Management in Brazil

INTRODUCTION

Diabetes mellitus is one of the most common chronic diseases worldwide and its prevalence continues to increase. Adherence to good health behaviors provides better control of the disease. This study analyzed trends in the prevalence of diabetes among Brazilian adults between 2006 and 2016 and compared the frequency of key health behaviors between people with and without diabetes.

METHODS

We analyzed data from 572,437 Brazilian adults interviewed between 2006 and 2016 by using the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel). We used regression models to investigate significant trends in the prevalence of diabetes and differences in adherence to health behaviors between people with and without diabetes.

RESULTS

The prevalence of diabetes increased significantly from 5.5% to 8.9% (P <.001), being higher among women, older adults, and those with less than a high school education. The greatest increase was observed among these groups with higher prevalence. People with diabetes had a lower frequency of risk behaviors and a higher frequency of protective behaviors when compared to people without diabetes. The greatest differences were observed in the consumption of soft drinks and sugar-sweetened beverages (9.5% vs 25.0%) and alcoholic beverages (9.0% vs 17.9%), and the smallest differences were related to regular consumption of fruits and vegetables (40.7% vs 34.0%) and meats with excess fat (24.3% vs 32.2%). People with diabetes reported less leisure-time physical activity (PRa, 0.92 [P < .001]) and less transport-related physical activity (PRa, 0.84 [P <.001]) than those without diabetes.

CONCLUSION

Diabetes prevalence increased between 2006 and 2016. People with diabetes had better dietary habits than those without diabetes, but still had risk behaviors such as insufficient physical activity.

Changes in life expectancy due to avoidable and non-avoidable deaths in Argentina, Chile, Colombia and Mexico, 2000-2011

The objective of this study was to analyze the level and trend of avoidable deaths and non-avoidable deaths and their contribution to the change in life expectancy in Latin America by studying the situations in Argentina, Chile, Colombia and Mexico between the years 2000 and 2011, stratified by sex and 5-year age groups. The information source used in this study was the mortality vital statistics, and the population data were obtained from censuses or estimates. The proposal by Nolte & McKee (2012) was used to calculate the standardized mortality rates and the influence from avoidable and non-avoidable causes in the change in life expectancy between 0 and 74 years. In Argentina, Chile and Colombia, all the rates declined between the years 2000 and 2011, whereas in Mexico, the avoidable deaths and non-avoidable deaths rates increased slightly for men and decreased for women. In all the countries, the non-avoidable death rates were higher than the avoidable death rates, and the rates were higher for men. The largest contributions to changes in life expectancy were explained by the non-avoidable deaths for men in all countries and for women in Argentina; in contrast, in Chile, Colombia and Mexico, the gains in years of life expectancy for women were mainly a result of avoidable causes. The results suggest there have been reductions in mortality from these causes that have resulted in gains in years of life expectancy in the region. Despite these achievements, differences between countries, sex and age groups are still present, without any noticeable progress in the reduction of these inequalities until now.

Genotypic and Phenotypic Factors Influencing Drug Response in Mexican Patients With Type 2 Diabetes Mellitus

The treatment of Type 2 Diabetes Mellitus (T2DM) consists primarily of oral antidiabetic drugs (OADs) that stimulate insulin secretion, such as sulfonylureas (SUs) and reduce hepatic glucose production (e.g., biguanides), among others. The marked inter-individual differences among T2DM patients’ response to these drugs have become an issue on prescribing and dosing efficiently. In this study, fourteen polymorphisms selected from Genome-wide association studies (GWAS) were screened in 495 T2DM Mexican patients previously treated with OADs to find the relationship between the presence of these polymorphisms and response to the OADs. Then, a novel association screening method, based on global probabilities, was used to globally characterize important relationships between the drug response to OADs and genetic and clinical parameters, including polymorphisms, patient information, and type of treatment. Two polymorphisms, ABCC8-Ala1369Ser and KCNJ11-Glu23Lys, showed a significant impact on response to SUs. Heterozygous ABCC8-Ala1369Ser variant (A/C) carriers exhibited a higher response to SUs compared to homozygous ABCC8-Ala1369Ser variant (A/A) carriers (p-value = 0.029) and to homozygous wild-type genotypes (C/C) (p-value = 0.012). The homozygous KCNJ11-Glu23Lys variant (C/C) and wild-type (T/T) genotypes had a lower response to SUs compared to heterozygous (C/T) carriers (p-value = 0.039). The screening of OADs response related genetic and clinical factors could help improve the prescribing and dosing of OADs for T2DM patients and thus contribute to the design of personalized treatments.

Prescription patterns and costs of antidiabetic medications in a large group of patients

AIMS

To determine the prescription patterns of antidiabetic medications and the variables associated with their use in a Colombian population.

METHODS

A cross-sectional study using a systematized database of approximately 3.5 million affiliates of the Colombian Health System. Patients of both genders and all ages treated uninterruptedly with antidiabetic medications for three months (June-August 2015) were included. A database was designed that included sociodemographic, pharmacological, comedication, and cost variables.

RESULTS

A total of 47,532 patients were identified; the mean age was 65.5 years, and 56.3% were women. Among the patients, 56.2% (n=26,691) received medication as monotherapy. The most prescribed medications were metformin, 81.3% (n=38,664), insulins, 33.3% (n=15,848), and sulfonylureas, 21.8% (n=10,370). Among the patients, 92.8% received comedications, including antihypertensives (79.7%), hypolipemiants (65.5%), antiplatelet drugs (56.3%), analgesics (33.9%), antiulcerants (33.1%), and thyroid hormone (17.3%). The cost per 1000 inhabitants/day was $1.21 USD for metformin, $3.89 USD for insulins, and $0.02 USD for glibenclamide.

CONCLUSIONS

Generally, rational prescription habits predominated, however in some cases an overuse of comedications (such as antiulcer drugs) and a large group of patients with high cost formulations were observed. Subsequent effectiveness and cost-benefit analyzes are required.

An Epidemiologic Analysis of Diabetes in Colombia

BACKGROUND

The burden of diabetes is a global problem, wherein the significant growth of diabetes in Colombia reflects a complex pathophysiology and epidemiology found in many other South American nations.

OBJECTIVES

The aim of this study was to analyze epidemiologic data from Colombia and the South American region in general to identify certain disease drivers and target them for intervention to curb the increasing prevalence of diabetes.

METHODS

A detailed search was conducted using MEDLINE, SciELO, HINARI, LILACS, IMBIOMED, and Latindex databases, in addition to clinical practice guidelines, books, manuals, and other files containing relevant and verified information on diabetes in Colombia.

FINDINGS

According to the International Diabetes Federation and the World Health Organization, the prevalence of diabetes in Colombia is 7.1% and 8.5%, respectively. In contrast, a national survey in Colombia shows a prevalence ranging from 1.84% to 11.2%, depending on how the diagnosis is made, the criteria used, and the age range studied. The prevalence exclusively in rural areas ranges from 1.4% to 7.9% and in urban areas from 1% to 46%. The estimated mean overall (direct and indirect) cost attributed to type 2 diabetes is 5.7 billion Colombian pesos (US $2.7 million). Diabetes is the fifth leading cause of death in Colombia with a rate of 15 deaths per 100,000 individuals.

CONCLUSIONS

Based on a clustering of factors, 4 relevant disease drivers emerge that may account for the epidemiology of diabetes in Colombia: demographic transition, nutritional transition, forced displacement/internal migration and urban development, and promotion of physical activity.

Projecting diabetes prevalence among Mexicans aged 50 years and older: the Future Elderly Model-Mexico (FEM-Mexico)

OBJECTIVE

Diabetes has been growing as a major health problem and a significant burden on the population and on health systems of developing countries like Mexico that are also ageing fast. The goal of the study was to estimate the future prevalence of diabetes among Mexico's older adults to assess the current and future health and economic burden of diabetes.

DESIGN

A simulation study using longitudinal data from three waves (2001, 2003 and 2012) of the Mexican Health and Aging Study and adapting the Future Elderly Model to simulate four scenarios of hypothetical interventions that would reduce diabetes incidence and to project the future diabetes prevalence rates among populations 50 years and older.

PARTICIPANTS

Data from 14 662 participants with information on self-reported diabetes, demographic characteristics, health and mortality.

OUTCOME MEASURES

We obtained, for each scenario of diabetes incidence reduction, the following summary measures for the population aged 50 and older from 2012 to 2050: prevalence of diabetes, total population with diabetes, number of medical visits.

RESULTS

In 2012, there were approximately 20.7 million persons aged 50 and older in Mexico; 19.3% had been diagnosed with diabetes and the 2001-2003 diabetes incidence was 4.3%. The no-intervention scenario shows that the prevalence of diabetes is projected to increase from 19.3% in 2012 to 34.0% in 2050. Under the 30% incidence reduction scenario, the prevalence of diabetes will be 28.6% in 2050. Comparing the no-intervention scenario with the 30% and 60% diabetes incidence reduction scenarios, we estimate a total of 816 320 and 1.6 million annual averted cases of diabetes, respectively, for the year 2020.

DISCUSSION

Our study underscores the importance of diabetes as a disease by itself and also the potential healthcare demands and social burden of this disease and the need for policy interventions to reduce diabetes prevalence.

Análisis de la tendencia temporal de la mortalidad por diabetes mellitus en Argentina, 1990-2013

Objetivos

El objetivo de este trabajo es describir la tendencia temporal de la mortalidad por Diabetes Mellitus (DM) en la Argentina en el período comprendido entre 1990 y 2013, por edad y sexo.

Métodos

Se calcularon las tasas brutas, específicas por edad y ajustadas por edad de mortalidad por DM en la Argentina para el período 1990-2013. Los datos de mortalidad se obtuvieron del Informe Estadístico de Defunción de la Dirección de Estadísticas e Información de Salud. Se realizó un análisis de la tendencia mediante modelos de regresión joinpoint.

Resultados

El análisis de la tendencia de las tasas brutas y ajustadas por edad de mortalidad por DM muestra un modelo estadísticamente significativo en el que se produce un incremento en la mortalidad entre 1990 y 2001, momento a partir del cual puede observarse un descenso. Asimismo, para las tasas ajustadas por edad se encuentra una tendencia significativa de descenso de la mortalidad para mujeres (AAPC: -1,10, IC 95%: -1,70; -0,50). Las tasas de mortalidad específicas por edad se multiplican cada 10 años de edad. Todos los grupos de edad mayores de 50 años muestran una tendencia creciente entre 1990 y 2001.

Conclusiones

La mortalidad por DM afecta principalmente a personas mayores de 50 años y a hombres. Es significativa la tendencia decreciente en las tasas ajustadas de mortalidad por DM para mujeres. Se subraya la importancia de desarrollar políticas de prevención y de detección temprana, como así también la codificación de la muerte por múltiples causas.