Key issues surrounding the management of patients with NCDs including diabetes mellitus among LMICs focusing on Bangladesh

Godman, Brian and Akter, Farhana and Haque, Mainul (2022) Key issues surrounding the management of patients with NCDs including diabetes mellitus among LMICs focusing on Bangladesh. In: 1st National NCD Conferences in Bangladesh, 2022-01-26 - 2022-01-28, Bangladesh. (In Press)

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There has been a continual increase in the prevalence of non-communicable diseases (NCDs) globally especially among low- and middle-income countries (LMICs). As a result even in sub-Saharan Africa, the number of people dying from cardiovascular diseases and diabetes now exceeds those from infectious diseases. This is a concern as growing prevalence rates increase morbidity, mortality and health related costs, with complications having an appreciable impact especially in patients with diabetes. In Bangladesh, there are approximately 8.4 million with diabetes, expected to rise to 16.8 million by 2030 unless addressed. Alongside this, deaths from NCDs have increased from 43.4% of total deaths in 2000 to 66.9% in 2015. This growth is further exacerbated by lockdown measures introduced to control COVID-19. Other factors increasing NCD prevalence rates include access to diagnosis and effective management impacted by high co-payment levels, urbanisation and changing lifestyles. Encouragingly, the Government in Bangladesh has launched many NCD-related programmes to improve care. However, there are concerns with available facilities and follow-up with limited ICT resources to routinely track patient care including medication adherence. In a recent pilot study among public hospitals in Bangladesh, which is being expanded, there was poor control of blood glucose levels and a considerable number of missing knowledge gaps in patients’ records. Encouragingly, there was better control of BP and lipids. These findings and their implications, along with early findings from the expanded study, will be discussed to direct future planning. These include calls for increased ICT support to monitor patient care, improved diagnostic facilities including potentially community pharmacies, strategies to reduce co-payments which can be considerable, as well as educational programmes to improve adherence to lifestyle changes and prescribed medicines. Early detection, screening, treatment, as well as palliative care, are key issues to combat NCDs and should be introduced to improve future care.