Gaps and challenges to integrating diabetes care in Myanmar

In common with other low-income countries, diabetes is a growing challenge forMyanmar. Gaps and challenges exist in political commitment, policy development,the health system, treatment-seeking behaviour and the role of traditional medicine.National policies aimed at prevention – such as to promote healthy food, createa healthy environment conducive to increased physical activity, restrict marketingof unhealthy food, and initiate mass awareness-raising programmes – need to bestrengthened. Moreover, existing initiatives for prevention of noncommunicabledisease (NCD) are channelled vertically rather than being horizontally integrated.Primary health care is traditionally orientated more towards prevention of infectiousdiseases and staff often lack training in prevention and control of NCDs. Capacitybuilding activities have been modest to date, and retaining trained health workers indiabetes-oriented activities is a challenge. The World Health Organization Packageof Essential Noncommunicable (PEN) disease interventions for primary healthcare in low-resource settings has been piloted in Yangon Region and countrywide expansion awaits ministerial approval. Recently, the Myanmar Diabetes CareModel was proposed by the Myanmar Diabetes Association, with the aims of bothbridging the gap in diabetes care between rural and urban areas and strengtheningcare at the secondary and tertiary levels. However, implementation will requirepolicy development for essential drugs and equipment, capacity-strengthening ofhealth-care workers, and an appropriate referral and health-information system.

Myanmar diabetes care model: Bridging the gap between urban and rural healthcare delivery / Journal of the ASEAN Federation of Endocrine Societies

@#There has been significant magnitude of problems of diabetes in Myanmar, according to the estimates of International Diabetes Federation (IDF) and the recent National Survey on the prevalence of diabetes. There has been a wide gap of equity between the urban and rural healthcare delivery for diabetes. Myanmar Diabetes Care Model (MMDCM) aims to deliver equitable diabetes care throughout the country, to stem the tide of rising burden of diabetes and also to facilitate to achieve the targets of the Global Action Plan for the Prevention and Control of NCDs (2013-2020). It is aimed to deliver standard of care for diabetes through the health system strengthening at all level. MMDCM was developed based on the available health system, resources and the country's need. Implementation for the model was also discussed.

Effect of oral calcium supplementation on lipid profile and atherogenic index of plasma / Journal of the ASEAN Federation of Endocrine Societies

Objective@#To assess the effect of oral calcium supplementation on lipid profile and atherogenic index of plasma (AIP). @*Methodology@#This study was undertaken in 28 centrally obese male subjects [age 26.4 (6.5) years], BMI 31.6 (4.7) kg/m2, WC 99.4 (6.4) cm. All participants received six tablets of CaCO3 (250 mg of elemental calcium/ capsule, for a total of 1500 md/day) for 8 weeks. Serum lipid profile including triglyceride, total cholesterol, HDL-C, LDL- C was measured at baseline and after intervention. AIP was calculated by using formula = log (TG/HDL-C). @*Results@#Oral calcium supplementation achieved a 22% (36 mg/dL, p<0.001) reduction in Triglyceride from baseline [163.4 (37.9) mg/dL] and 19.2% ( 5.8 mg/dL, p<0.001) increase in HDL-C from baseline [30.4 (7.4) mg/dL)]. There were no significant treatment effects on total cholesterol [217.1 (41.21) mg/dL vs 196.3 (46.2) mg/dL] and LDL-C [155.4 (45.1) mg/dL vs 136.3 (45.1) mg/dL]. Significant reduction in serum total cholesterol and LDL-C level was only found in dyslipidemic centrally obese subjects. AIP decreased significantly by 51% with calcium carbonate treatment [median and interquartile range; 0.35 (0.29-0.44) vs 0.17 (0.04-0.44), p<0.01]. @*Conclusion@#Eight-week calcium supplementation at 1500 mg/day led to a significant change in lipid levels and AIP.

Summary of Myanmar clinical practice guidelines on the management of Dyslipidaemia in Type 2 Diabetes Mellitus / Journal of the ASEAN Federation of Endocrine Societies

@#Cardiovascular disease is a significant cause of morbidity and mortality in patients with diabetes mellitus (DM). According to the IDF Diabetes Atlas 2013, the prevalence of diabetes in Myanmar is 5.7%.(1) Diabetes is recognized as a risk equivalent for coronary heart disease. The lipid profile in patients with type 2 DM is characterized by elevated triglycerides, low high-density lipoprotein cholesterol and raised small dense low-density lipoprotein cholesterol (LDL-C) particles. This is believed to be a key factor in promoting atherosclerosis in these patients. There is ample evidence that aggressive statin therapy reduces cardiovascular end points in patients with DM in both primary and secondary prevention studies. In all persons with DM, current treatment guidelines recommend reduction of LDLC to less than 100 mg/dL, regardless of baseline lipid levels. In very high risk patients with DM and coronary heart disease lowering of LDL-C to less than 70 mg/dL may provide even greater benefits. Treatment for hypertriglyceridaemia is recommended only if TG levels is very high (>500 mg/dL).

A summary of the clinical practice guidelines for the management of patients with Peripheral Arterial Disease in Myanmar / Journal of the ASEAN Federation of Endocrine Societies

@#Peripheral artery disease (PAD) broadly encompasses vascular diseases caused primarily by atherosclerosis and thromboembolic pathophysiologic processes that alter the normal structure and function of the aorta, its visceral arterial branches, and the arteries of the lower extremity. The aims of the Myanmar clinical practice guidelines for the management of patients with PAD are to assist physicians in selecting the best management strategies for an individual patient with peripheral artery disease with main focus on lower extremity artery disease (LEAD) due to atherosclerosis, to help the physician to make decisions in their daily practice, and to aid in appropriate referrals to specialists. Early detection and treatment guidelines for the treatment of PAD are important to reduce the morbidity and mortality of patients with vascular problems in Myanmar.

Beta cell function, insulin resistance and low grade systemic inflammation in Myanmar adults with different categories of glucose tolerance / Journal of the ASEAN Federation of Endocrine Societies

Objective@#The aim of the study was to evaluate the beta cell function, insulin sensitivity and low grade systemic inflammation in different categories of glucose tolerance in Myanmar. @*Methodology@#A cross-sectional study was conducted on 202 Myanmar subjects of both sexes, aged between 45-65 years old. Fasting blood glucose, insulin, C-peptide and hs-CRP levels were measured. A 75g oral glucose tolerance test was performed. Insulin resistance and beta cell function were assessed by homeostasis-model-assessment (HOMA). @*Results@#The subjects were categorized as normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes mellitus (DM) according to WHO-2006 criteria. Fasting serum insulin, C-peptide and hs-CRP levels and insulin resistance index (HOMA-IR) progressively increased from NGT through prediabetes (IFG, IGT) to DM (p<0.01). Beta-cell function did not change significantly in any other group as compared to normal group. @*Conclusion@#After multivariate analysis, increases in fasting C-peptide, hs-CRP and HOMA-IR index were significantly associated with diabetes. It was also found that insulin resistance was a predominant feature in deterioration of the glucose tolerance in Myanmar subjects.

Summary of the clinical practice guidelines for diabetes mellitus in pregnancy in Myanmar / Journal of the ASEAN Federation of Endocrine Societies

@#The aims of the Myanmar CPG for Diabetes in Pregnancy were to provide a framework to assist healthcare professionals in the management of diabetes in pregnancy and to aid primary care physicians in referrals to specialists, when necessary, in an appropriate manner. This article summarizes clinical practice guidelines developed for assisting Myanmar healthcare providers (physicians, endocrinologists, obstetricians, general practitioners) to better diagnose and effectively manage diabetes in pregnancy. It recommends a multidisciplinary approach in the management of diabetes in pregnancy in Myanmar.

Prevalence of hypertension and its associated factors in the adult population in Yangon Division, Myanmar.

A study was performed among 4616 people aged 20 years and above in Yangon Division in 2003 to determine the prevalence of hypertension and its associated factors. The prevalence of hypertension (systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or use of antihypertensive drugs) was 33.8% (95% confidence interval [CI] = 32.1%-35.6%). The prevalence of prehypertension (systolic blood pressure = 120 to 139 mm Hg or diastolic blood pressure = 80 to 89 mm Hg) was 29% (95% CI = 27.2%-30.8%). The multiple logistic regression showed that age, low physical activity, high intake of alcohol, obesity, high level of total cholesterol, and diabetes mellitus were associated with hypertension. Among the hypertensive participants, 53% were aware of their hypertension, and 32% were currently taking antihypertensive medication, but only 11% had their hypertension controlled. The study highlights the low level of control despite the high level of hypertension prevalence in Yangon Division.