Current gaps in management and timely referral of cardiorenal complications among people with type 2 diabetes mellitus in the Middle East and African countries: Expert recommendations

Abstract

The upsurge of type 2 diabetes mellitus is a major public health concern in the Middle East and North Africa (MENA) and Africa (AFR) region, with cardiorenal complications (CRCs) being the predominant cause of premature morbidity and mortality. High prevalence of cardiometabolic risk factors, lack of awareness among patients and physicians, deficient infrastructure, and economic constraints lead to a cascade of CRCs at a significantly earlier age in MENA and AFR. In this review, we present consensus recommendations by experts in MENA and AFR, highlighting region-specific challenges and potential solutions for management of CRCs. Health professionals who understand sociocultural barriers can significantly increase patient awareness and encourage health-seeking behavior through simple educational tools. Increasing physician knowledge on early identification of CRCs and personalized treatment based on risk stratification, alongside optimum glycemic control, can mitigate therapeutic inertia. Early diagnosis of high-risk people with regular and systematic monitoring of cardiorenal parameters, development of region-specific care pathways for timely referral to specialists, followed by guideline-recommended care with novel antidiabetics are imperative. Adherence to guideline-recommended care can catalyze utilization of sodium glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists with demonstrated cardiorenal benefits-thus paving the way for overcoming care gaps in a cost-effective manner. Leveraging digital technology like electronic medical records can help generate real-world data and provide insights on voids in adoption of newer antidiabetic medications. A patient-centric approach, collaborative care among physicians from different specialties, alongside involvement of policy makers are key for improving patient outcomes and quality of care in MENA and AFR.

Keywords: 2型糖尿病; Middle East and North Africa and Africa; cardiovascular risk management; diabetic cardiomyopathy; diabetic kidney disease; type 2 diabetes mellitus; 中东和非洲; 心血管风险管理; 糖尿病心肌病; 糖尿病肾病.

FIGURE 1

Prevalence of type 2 diabetes mellitus in the Middle East and Africa Region compared to the global scenario. AFR, Africa; EUR, Europe; IDF, International Diabetes Federation; MENA, Middle East and North Africa; NAC, North America and Caribbean; SACA, South and Central America; SEA, South‐East Asia; WP, Western Pacific

FIGURE 2

Decision cycle for patient‐centric management of type 2 diabetes mellitus and cardiorenal complications. DSMES, diabetic self‐management education and support, HbA1c, glycosylated hemoglobin; MENA and AFR, Middle‐East and Africa, SMART, specific, measurable, achievable, realistic, and time limited