LINK TO RESEARCH
Annals of Global Health
Ramfis Nieto-Martínez 1 ,
Juan P González-Rivas 2 ,
Marcos Lima-Martínez 3 ,
Victoria Stepenka 4 ,
Alejandro Rísquez 5 ,
Jeffrey I Mechanick 6
Background: The incidence of type 2 diabetes (T2D) and its economic burden have
increased in Venezuela, posing difficult challenges in a country already in
Objectives: The aim of this study was to review the prevalence, causes, prevention,
management, health policies, and challenges for successful management of
diabetes and its complications in Venezuela.
Methods: A comprehensive literature review spanning 1960 to 2015 was performed.
Literature not indexed also was reviewed. The weighted prevalence of
diabetes and prediabetes was estimated from published regional and
subnational population-based studies. Diabetes care strategies were
Findings: In Venezuela, the weighted prevalence of diabetes was 7.7% and prediabetes
was 11.2%. Diabetes was the fifth leading cause of death (7.1%) in 2012
with the mortality rate increasing 7% per year from 1990 to 2012. In 2012,
cardiovascular disease and diabetes together were the leading cause of
disability-adjusted life years.T2D drivers are genetic, epigenetic, and
lifestyle, including unhealthy dietary patterns and physical inactivity.
Obesity, insulin resistance, and metabolic syndrome are present at lower
cutoffs for body mass index, homeostatic model assessment, and visceral or
ectopic fat, respectively. Institutional programs for early detection
and/or prevention of T2D have not been established. Most patients with
diabetes (∼87%) are cared for in public facilities in a fragmented health
system. Local clinical practice guidelines are available, but
implementation is suboptimal and supporting information is limited.
Conclusions: Strategies to improve diabetes care in Venezuela include enhancing
resources, reducing costs, improving education, implementing screening
(using Latin America Finnish Diabetes Risk Score), promoting diabetes care
units, avoiding insulin levels as diagnostic tool, correct use of oral
glucose tolerance testing and metformin as first-line T2D treatment, and
reducing health system fragmentation. Use of the Venezuelan adaptation of
the transcultural Diabetes Nutrition Algorithm for lifestyle
recommendations and the Latin American Diabetes Association guidelines for
pharmacologic interventions can assist primary care physicians in diabetes
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