HEALTH: Poor struggle to access diabetes care, says study
Amputee because of diabetes
BANGKOK, 2 March 2011 (IRIN) - Ineffective or insufficient diabetes treatment can be fatal for millions worldwide, according to a new study
by the US-based Institute for Health Metrics and Evaluation.
Of the areas evaluated - the United States, Iran, Mexico, Scotland, England, Colombia and Thailand - only in Thailand did the poorest have more trouble accessing diabetes care than the general population.
Thai chronic disease specialists say screenings, high-quality labs and treatment for the risk factors that can lead to diabetes - high blood sugar, blood pressure and cholesterol - are lacking outside big cities.
Lack of awareness
Using data from 2004, the study found more than eight out of 10 Thai men and women were not adequately treated for these risk factors. Some had never been screened: of 3.2 million people nationwide with diabetes in 2004, 1.8 million people were unaware of their condition.
"This is an insidious disease that can be asymptomatic," said the study's Thailand-based researcher, Wichai Aekplakorn, at Ramathibodi Hospital.
Diabetes, which the UN World Health Organization (WHO) says causes about 6 percent of deaths worldwide (mostly in developing countries) every year, is a chronic condition that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.
But since 2009, Aekplakorn said, things have been improving. Of the 3.5 million estimated to have the disease that year, 2.4 million people knew. Of those seeking treatment, 28.5 percent were considered to be under "good control" versus 12.2 percent five years earlier.
Universal health coverage, launched in 2002, has slowly extended care to more people, now reaching some 48 million, he added.
The still-low numbers being screened for diabetes may be concentrated in groups that do not have national identity cards - needed to obtain subsidized medical care - or those who migrate frequently, said Jureephon Congprasert, deputy director of the Health Ministry's Bureau of Non-communicable Diseases.
Poor diabetes management is in part due to the shortage of trained medical staff (such as ophthalmologists, nephrologists, dieticians) to deal with disease complications, she added.
Diabetes is the main cause of partial vision loss and blindness in adults in developed countries and accounts for most limb amputations that are not caused by accidents, according to WHO.
While Thailand has been lauded for its performance in HIV care
, reaching near universal coverage, chronic disease care lags behind.
"Having a system in place for one condition does not necessarily translate into good care for other conditions," said Stephen Lim, a former research fellow in Thailand's Ministry of Health from 2004 to 2007 and one of the authors of the new diabetes management study.
"For HIV, awareness and advocacy for treatment... has been very high, ie. there is a very public face to the disease. In general there is not the same movement behind combating chronic diseases like diabetes."
Unlike infectious diseases, which have a culprit "agent", chronic diseases have multiple causes, which make them harder to find, treat and wipe out, said Aekplakorn.
"Most NCDs [non-communicable diseases] have several factors - urbanization, [health] behaviours, global consumer trends. It is more complicated and we cannot end them by tackling only one issue."