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Approaches for the Prevention of Diabetes in Low and Middle-Income Countries

Apr 01, 2019

Like other non-communicable diseases, diabetes mellitus (DM) across the world is a leading cause of morbidity and premature mortality. It disproportionately affects low- and middle-income countries (LMICs). Prevention of diabetes saves lives, improves quality of life and preserves health resources.

These countries face unique and substantial barriers in their attempts to meet and prevent this challenge. Societal pressures in LMICs including political instability, insufficient health literacy among the populace at risk, constraints on health budgets, lack of trained personnel, unreliable stocks of medications,  high out-of-pocket expenditures, dysfunctional health insurance systems, combine with an individual’s unhealthy behaviors to make prevention efforts even more challenging. (4–8).

Guidelines that address prevention of diabetes exist in many high-income countries (HIC). Yet, there is a significant lack of evidence specifically from LMICs of successful intervention implementation. Not surprisingly due in part to the constraints mentioned above, many of the current guidelines lack applicability in LMICs.


Given the effectiveness of efforts to prevent diabetes:

  1. Who are the key players/stakeholders in diabetes prevention? Describe their interplay in a LMIC setting.
  2. What prevention intervention frameworks could be adapted to have the greatest impact?
  3. Given the complexity of prevention in many LMICs, in what order could the topics be addressed?
  4. How can technology enhance prevention efforts?
  5. What are the signs of success? Are they the same in LMICs as in HICs?


Recommended Readings:

Aziz, Z., Mathews, E., Absetz, P., Sathish, T., Oldroyd, J., Balachandran, S., ... & Oldenburg, B. (2018). A group-based lifestyle intervention for diabetes prevention in low-and middle-income country: implementation evaluation of the Kerala Diabetes Prevention Program. Implementation Science, 13(1), 97.

Chamberlain, C. R., Oldenburg, B., Wilson, A. N., Eades, S. J., O'dea, K., Oats, J. J., & Wolfe, R. (2016). Type 2 diabetes after gestational diabetes: greater than fourfold risk among Indigenous compared with non‐Indigenous Australian women. Diabetes/metabolism research and reviews, 32(2), 217-227.

Gong, E., Gu, W., Sun, C., Turner, E. L., Zhou, Y., Li, Z., ... & Xu, L. Q. (2019). System-integrated technology-enabled model of care to improve the health of stroke patients in rural China: protocol for SINEMA—a cluster-randomized controlled trial. American heart journal, 207, 27-39.

Owolabi, M. O., Yaria, J. O., Daivadanam, M., Makanjuola, A. I., Parker, G., Oldenburg, B., ... & Herasme, O. (2018). Gaps in guidelines for the management of diabetes in low-and middle-income versus high-income countries—a systematic review. Diabetes Care, 41(5), 1097-1105.

Rarau, P., Pulford, J., Gouda, H., Phuanukoonnon, S., Bullen, C., Scragg, R., ... & Oldenburg, B. (2019). Correction: Socio-economic status and behavioural and cardiovascular risk factors in Papua New Guinea: A cross-sectional survey. PloS one, 14(2), e0212894.


Information about the discussion leader

Professor Brian Oldenburg (BSc, MPsychol, PhD) is a public health scientist and world-renowned expert in the prevention and control of chronic diseases. He is the head of the Non-Communicable Diseases Unit at the University of Melbourne and Director of the WHO Collaborating Centre for Prevention and Control of NCD’s. He has undertaken considerable research in developing countries – particularly in Asia and Africa - and he has pioneered new technology platforms and innovative interventions to improve chronic disease and wellbeing outcomes. He has been an expert advisor for many years for WHO, NGOs and governments about public health, health systems and health policy issues. He has extensive expertise in developing, implementing and evaluating community-based and peer-led interventions that have had significant impact. He has more than 350 publications and has given more than 60 invited keynote conference presentations in the last 5 years. He is a world leader in the methods of implementation science (IS) and program evaluation and he has developed the IS training and capacity building program for the Global Alliance for Chronic Diseases. 

This is the thrid in a series of discussions introducing some of the programme sessions that will be featured at the IDF Congress 2019 in Busan, Korea, 2-6 December 2019.