Latent Class Analysis Of The Capacity Of Countries To Manage Diabetes And Its Relationship With Diabetes-Related Deaths And Healthcare Costs.

Abstract

Abstract Background The prevalence of diabetes is escalating globally, underscoring the need for comprehensive evidence to inform health systems in efectively addressing this epidemic. The purpose of this study was to examine the pat terns of countries’ capacity to manage diabetes using latent class analysis (LCA) and to determine whether the pat terns are associated with diabetes-related deaths and healthcare costs. Methods Eight indicators of country-level capacity were drawn from the World Health Organization Global Health Observatory dataset: the widespread availability of hemoglobin A1C (HbA1c) testing, existence of diabetes registry, national diabetes management guidelines, national strategy for diabetes care, blood glucose testing, diabetic retin opathy screening, sulfonylureas, and metformin in the public health sector. We performed LCA of these indicators, testing 1–5 class solutions, and selecting the best model based on Bayesian Information Criteria (BIC), entropy, cor rected Akaike Information Criteria (cAIC), as well as theoretical interpretability. Multivariable linear regression was used to assess the association between capacity to manage diabetes (based on the latent class a country belongs) and dia betes-related deaths and healthcare costs. Results We included 194 countries in this secondary analysis. Countries were classifed into“high capacity” (88.7%) and“limited capacity” (11.3%) countries based on the two-class solution of the LCA (entropy=0.91, cAIC=1895.93, BIC=1862.93). Limited capacity countries were mostly in Africa. Limited capacity countries had signifcantly higher percentage of their deaths attributable to diabetes (adjusted beta=1.34; 95% CI: 0.15, 2.53; p=0.027) compared to high capacity countries even after adjusting for income status and diabetes prevalence. Conclusions Our fndings support the report by the Lancet commission on diabetes, which suggests that difer ences in diabetes outcomes among countries may be explained by variations in the capacity of and investments made in their health systems. Future studies should evaluate initiatives such as the WHO Global Diabetes Compact that are currently underway to improve the capacity of resource-limited countries.