The Challenges in the Development of Diabetes Prevention and Care Models in Low-Income Settings
Open accessAbstract
In low- and middle-income countries (LMICs), the burden of non-communicable diseases such as diabetes is rapidly rising, overpassing the existing burden of communicable diseases. Patients with diabetes living in low-income communities face unique challenges related to lack of awareness, difficulty in accessing health care systems and medications, and consequently failure in achieving optimal diabetes management and preventing complications. Effective diabetes prevention and care models could help reduce the rising burden by standardizing guidelines for prevention and management, improving access to care, engaging community and peers, improving the training of professionals and patients and using the newest technology in the management of the disease. In this article, we review the latest research and evidence on effective models of diabetes prevention and diabetes care delivery in low- income settings. We also provide existing evidence relating to the effectiveness of these models in low-resource contexts, with the aim to highlight characteristics and strengths that make their implementation successful and long-lasting.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The high cost of programs that require coaching limits their reach.
“the high cost of such programs that require coaching limits their reach13,14”
From Impact of digital health interventions on glycemic control and weight management. (2025) · cites this paper as [14]
The Models of Care section says patients in low- and middle-income countries have difficulty accessing and affording health care, supporting a general link between cost and access. The Prevention Models section describes a low-cost peer-support program, but neither passage says that coaching-based programs are expensive or that their cost limits their reach. No page numbers are available in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
1 retracted
Barengo, N. C., Acosta, T., Arrieta, A., Ricaurte, C., Mayor, D., Tuomilehto, J. O., & the DEMOJUAN study group (2013) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2462 · Cited by 26 · see citing works
RetractedReduction in the incidence of type 2 diabetes with lifestyle intervention or metformin
(2002) · New England Journal of Medicine · doi:10.1056/nejmoa012512 · Cited by 19,011 · see citing works
Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004) · Diabetes Care · doi:10.2337/diacare.27.5.1047 · Cited by 15,297 · see citing works
Murray, C. J. L., Vos, T., Lozano, R., Naghavi, M., Flaxman, A. D., Michaud, C., Ezzati, M., Shibuya, K., Salomon, J. A., Abdalla, S., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61689-4 · Cited by 8,888 · see citing works
Global status report on noncommunicable diseases 2010.
Alwan, A. (2011) · Cited by 8,494 · see citing works
Global estimates of diabetes prevalence for 2013 and projections for 2035
Guariguata, L., Whiting, D. R., Hambleton, I., Beagley, J., Linnenkamp, U., & Shaw, J. E. (2014) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2013.11.002 · Cited by 4,642 · see citing works
Pan, X.-R., Li, G.-W., Hu, Y.-H., Wang, J.-X., Yang, W.-Y., An, Z.-X., Hu, Z.-X., Juan-Lin, Xiao, J.-Z., Cao, H.-B., et al. (1997) · Diabetes Care · doi:10.2337/diacare.20.4.537 · Cited by 4,320 · see citing works
Prevalence of Diabetes among Men and Women in China
Yang, W., Lu, J., Weng, J., Jia, W., Ji, L., Xiao, J., Shan, Z., Liu, J., Tian, H., Ji, Q., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa0908292 · Cited by 3,031 · see citing works
Hu, F. B. (2011) · Diabetes Care · doi:10.2337/dc11-0442 · Cited by 1,954 · see citing works
Ramachandran, A., Snehalatha, C., Mary, S., Mukesh, B., Bhaskar, A. D., Vijay, V., & Indian Diabetes Prevention Programme (IDPP) (2006) · Diabetologia · doi:10.1007/s00125-005-0097-z · Cited by 1,881 · see citing works
Salomon, J. A., Wang, H., Freeman, M. K., Vos, T., Flaxman, A. D., Lopez, A. D., & Murray, C. J. (2012) · The Lancet · doi:10.1016/s0140-6736(12)61690-0 · Cited by 1,116 · see citing works
Health-system reform and universal health coverage in Latin America
Atun, R. A., de Andrade, L. O. M., Almeida, G., Cotlear, D., Dmytraczenko, T., Frenz, P., Garcia, P. J., Gómez‐Dantés, O., Knaul, F. M., Muntaner, C., et al. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61646-9 · Cited by 898 · see citing works
Price, A., Crampin, A. C., Amberbir, A., Kayuni-Chihana, N., Musicha, C., Tafatatha, T., Branson, K. R., Lawlor, D. A., Mwaiyeghele, E., Nkhwazi, L., et al. (2018) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30432-1 · Cited by 340 · see citing works
Ramachandran, A., Snehalatha, C., Ram, J., Selvam, S., Simon, M., Nanditha, A., Shetty, A. S., Godsland, I. F., Chaturvedi, N., Majeed, A., et al. (2013) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(13)70067-6 · Cited by 330 · see citing works
Manne‐Goehler, J., Geldsetzer, P., Agoudavi, K., Andall‐Brereton, G., Aryal, K. K., Bicaba, B. W., Bovet, P., Brian, G. R., Dorobanţu, M., Gathecha, G. K., et al. (2019) · PLoS Medicine · doi:10.1371/journal.pmed.1002751 · Cited by 325 · see citing works
Peer Support For Self-Management Of Diabetes Improved Outcomes In International Settings
Fisher, E. B., Boothroyd, R. I., Coufal, M. M., Baumann, L. C., Mbanya, J. C., Rotheram‐Borus, M. J., Sanguanprasit, B., & Tanasugarn, C. (2012) · Health Affairs · doi:10.1377/hlthaff.2011.0914 · Cited by 310 · see citing works
Laatikainen, T. K., Dunbar, J., Chapman, A., Kilkkinen, A., Vartiainen, E. A., Heistaro, S., Philpot, B., Absetz, P., Bunker, S. J., O'Neil, A. E., et al. (2007) · BMC Public Health · doi:10.1186/1471-2458-7-249 · Cited by 250 · see citing works
Atun, R. A., de Jongh, T. E., Secci, F., Ohiri, K., & Adeyi, O. (2009) · Health Policy and Planning · doi:10.1093/heapol/czp053 · Cited by 229 · see citing works
Relationship Between Avoidable Hospitalizations for Diabetes Mellitus and Income Level
Booth, G. L., & Hux, J. E. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.1.101 · Cited by 223 · see citing works
Thankappan, K. R., Sathish, T., Tapp, R. J., Shaw, J. E., Lotfaliany, M., Wolfe, R. S., Absetz, P., Mathews, E., Aziz, Z., Williams, E. D., et al. (2018) · PLoS Medicine · doi:10.1371/journal.pmed.1002575 · Cited by 191 · see citing works
The Stepwise Approach to Diabetes Prevention: Results From the D-CLIP Randomized Controlled Trial
Weber, M. B., Ranjani, H., Staimez, L. R., Anjana, R. M., Ali, M. K., Narayan, K. M. V., & Mohan, V. (2016) · Diabetes Care · doi:10.2337/dc16-1241 · Cited by 189 · see citing works
Piette, J. D., Datwani, H., Gaudioso, S., Foster, S. M., Westphal, J., Perry, W., Rodríguez-Saldaña, J., Mendoza-Avelares, M. O., & Marinec, N. (2012) · Telemedicine and e-Health · doi:10.1089/tmj.2011.0271 · Cited by 172 · see citing works
Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012
Bullock, A., & Sheff, K. (2017) · New England Journal of Medicine · doi:10.1056/nejmc1706291 · Cited by 166 · see citing works
Goldhaber‐Fiebert, J. D., Goldhaber-Fiebert, S. N., Tristán, M. L., & Nathan, D. M. (2003) · Diabetes Care · doi:10.2337/diacare.26.1.24 · Cited by 163 · see citing works
Coleman, R., Gill, G., & Wilkinson, D. (1998) · PubMed · Cited by 150 · see citing works
Stokes, A. C., Berry, K. M., Mchiza, Z. J., Parker, W., Labadarios, D., Chola, L., Hongoro, C., Zuma, K. K., Brennan, A. T., Rockers, P. C., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0184264 · Cited by 119 · see citing works
Owolabi, M. O., Yaria, J. O., Daivadanam, M., Makanjuola, A., Parker, G., Oldenburg, B. F., Vedanthan, R., Norris, S. A., Oguntoye, A. R., Osundina, M. A., et al. (2018) · Diabetes Care · doi:10.2337/dc17-1795 · Cited by 114 · see citing works
Mogre, V., Johnson, N. A., Tzelepis, F., Shaw, J., & Paul, C. (2019) · Journal of Advanced Nursing · doi:10.1111/jan.14190 · Cited by 103 · see citing works
Piette, J. D., Mendoza-Avelares, M. O., Ganser, M. A., Mohamed, M. A., Marinec, N. S., & Krishnan, S. (2011) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2011.02.014 · Cited by 83 · see citing works
Prevention of Diabetes in Rural India with a Telemedicine Intervention
Mohan, V., Deepa, M., Pradeepa, R., et al. (2012) · Journal of Diabetes Science and Technology · doi:10.1177/193229681200600614 · Cited by 77 · see citing works
Mamo, Y., Seid, E., Adams, S., Gardiner, A., & Parry, E. H. O. (2007) · Clinical Medicine · doi:10.7861/clinmedicine.7-3-228 · Cited by 77 · see citing works
Shirinzadeh, M., Afshin‐Pour, B., Angeles, R. N., Gaber, J., & Agarwal, G. (2019) · Globalization and Health · doi:10.1186/s12992-019-0451-4 · Cited by 74 · see citing works
Allain, T. J., van Oosterhout, J. J., Douglas, G. P., et al. (2011) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2011.02808.x · Cited by 72 · see citing works
Mohan, V., & Anbalagan, V. P. (2013) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.107825 · Cited by 70 · see citing works
Pimentel, G. D., Portero‐McLellan, K. C., de Oliveira, E. P., Spada, A. P. M., Oshiiwa, M., Zemdegs, J. C. S., & Barbalho, S. M. (2010) · Nutrition Research · doi:10.1016/j.nutres.2010.03.003 · Cited by 68 · see citing works
Carrara, A., & Schulz, P. J. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.07.005 · Cited by 66 · see citing works
Sun, J., Wang, Y., Chen, X., Chen, Y., Feng, Y., Zhang, X., Pan, Y., Hu, T., Xu, J., Lu-yuan, D., et al. (2008) · PubMed · Cited by 65 · see citing works
Shivashankar, R., Kirk, K., Kim, W. C., Rouse, C. D., Tandon, N., Narayan, K. M. V., & Ali, M. K. (2014) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2014.11.004 · Cited by 63 · see citing works
Abbas, Z. G., Lutale, J. K., Bakker, K., Baker, N., & Archibald, L. K. (2011) · International Wound Journal · doi:10.1111/j.1742-481x.2010.00764.x · Cited by 63 · see citing works
The step-by-step program for reducing diabetic foot problems: A model for the developing world
Pendsey, S., & Abbas, Z. G. (2007) · Current Diabetes Reports · doi:10.1007/s11892-007-0071-x · Cited by 61 · see citing works
Diabetic foot problems in India: An overview and potential simple approaches in a developing country
Shankhdhar, K., Shankhdhar, L. K., Shankhdhar, U., et al. (2008) · Current Diabetes Reports · doi:10.1007/s11892-008-0078-y · Cited by 58 · see citing works
Weber, M. B., Ranjani, H., Meyers, G. C., Mohan, V., & Narayan, K. M. V. (2011) · Primary care diabetes · doi:10.1016/j.pcd.2011.04.005 · Cited by 57 · see citing works
Managing type 2 diabetes in Soweto—The South African Chronic Disease Outreach Program experience
Katz, I. J., Schneider, H. M., Shezi, E. Z., Mdleleni, G., Gerntholtz, T. E., Butler, O., Manderson, L. H., & Naicker, S. (2009) · Primary care diabetes · doi:10.1016/j.pcd.2009.06.007 · Cited by 57 · see citing works
Bovet, P., Romain, S., Shamlaye, C. F., Mendis, S., Darioli, R., Riesen, W., Tappy, L., & Paccaud, F. M. (2009) · Cardiovascular Diabetology · doi:10.1186/1475-2840-8-34 · Cited by 54 · see citing works
Limaye, T., Kumaran, K., Joglekar, C., Bhat, D., Kulkarni, R., Nanivadekar, A., & Yajnik, C. (2017) · Diabetic Medicine · doi:10.1111/dme.13258 · Cited by 50 · see citing works
Piette, J. D., Mendoza-Avelares, M. O., Milton, E. C., Lange, I., & Fajardo, R. (2010) · Telemedicine and e-Health · doi:10.1089/tmj.2010.0074 · Cited by 45 · see citing works
Tran, V. D., James, A. P., Lee, A. H., Jancey, J. M., Howat, P. A., & Phượng, L. T. (2016) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2016.0113 · Cited by 43 · see citing works
Shah, S., Singh, K., Ali, M. K., Mohan, V., Kadir, M. M., Unnikrishnan, A. G., Sahay, R. K., Varthakavi, P. K., Dharmalingam, M., Viswanathan, V., et al. (2012) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2012.09.023 · Cited by 33 · see citing works
Early Identification of Type 2 Diabetes
Narayan, K. M. V., Chan, J. C. N., & Mohan, V. (2010) · Diabetes Care · doi:10.2337/dc10-1952 · Cited by 33 · see citing works
Factors associated with diet barriers in patients with poorly controlled type 2 diabetes
Li, C., Leung, D. Y. P., Sit, J. W. H., Li, X., Wu, Y., Yang, M., Gao, C., & Rong, H. (2016) · Patient Preference and Adherence · doi:10.2147/ppa.s94275 · Cited by 32 · see citing works
Wikström, K., Peltonen, M., Eriksson, J. G., Aunola, S., Ilanne‐Parikka, P., Keinanen-Kiukaanniemi, S. M., Uusitupa, M. I. J., Tuomilehto, J. O., & Lindström, J. (2009) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2009.06.014 · Cited by 31 · see citing works
A national diabetes care and education programme: the Ghana model
Amoah, A. G. B., Owusu, S., Acheampong, J., et al. (2000) · Diabetes Research and Clinical Practice · doi:10.1016/s0168-8227(00)00140-6 · Cited by 30 · see citing works
Reducing diabetic limb amputations in developing countries
Abbas, Z. G. (2015) · Expert Review of Endocrinology & Metabolism · doi:10.1586/17446651.2015.1058151 · Cited by 29 · see citing works
Srikanth, S., & DEEDWANIA, P. C. (2005) · Cardiology Clinics · doi:10.1016/j.ccl.2004.11.002 · Cited by 13 · see citing works
Introduction: priority setting in global health
Bloom, D. E., Cadarette, D., Dayalu, R., et al. (2018) · Cost Effectiveness and Resource Allocation · doi:10.1186/s12962-018-0115-x · Cited by 12 · see citing works
Diabetes—A global problem needing global solutions
Narayan, K. M. V., & Williams, R. (2009) · Primary care diabetes · doi:10.1016/j.pcd.2008.12.001 · Cited by 8 · see citing works
Primary prevention of type 2 diabetes by lifestyle intervention in primary care setting
Umpierrez, G. E., & Pasquel, F. J. (2013) · Revista Clínica Española · doi:10.1016/j.rce.2013.11.004 · Cited by 7 · see citing works
Allain, T. J., Mang’anda, G. D., Kasiya, M., et al. (2018) · Malawi Medical Journal · doi:10.4314/mmj.v29i4.8 · Cited by 6 · see citing works
Multi-criteria decision analysis: of politics, policy entrepreneurs, and processes
Fan, V. Y. (2018) · Cost Effectiveness and Resource Allocation · doi:10.1186/s12962-018-0131-x · Cited by 6 · see citing works
Sullivan, F. (2007) · BMJ Evidence-Based Medicine · doi:10.1136/ebm.12.2.50 · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [2]Han Cho N Forouhi N Guariguata L Hambleton I Li R Majeed A IDF Diabetes Atlas- Seventh Edition. (2015) Retrieved from: www.diabetesatlas.org (accessed June 24, 2020).
Cited by
Sorted by citations
Impact of digital health interventions on glycemic control and weight management.
Veluvali, A., Dehghani Zahedani, A., Hosseinian, A., Aghaeepour, N., McLaughlin, T., Woodward, M., DiTullio, A., Hashemi, N., & Snyder, M. P. (2025) · npj Digital Medicine · doi:10.1038/s41746-025-01430-7 · Cited by 39 · see citing works
- Authors
- Karachaliou, F., Simatos, G., & Simatou, A.
- Affiliations
- University General Hospital Attikon (GR)
- St Savas Hospital (GR)
- Corresponding author
- Karachaliou, Feneli
- Venue
- Frontiers in Endocrinology
- Publisher
- Frontiers Media SA
- Published
- 2020-08-13
- Volume
- 11
- Pages
- 518-518
- ISSN
- 1664-2392 (ISSN-L)
- PMC
- PMC7438784
- OpenAlex
- W3049301313
- Cited by
- 120
- References
- 60
- Citations by year
- 2026: 29 · 2025: 24 · 2024: 29 · 2023: 18 · 2022: 15 · 2021: 5
- FWCI
- 1.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Endocrinology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- diabetes prevention, diabetes care model, low-income settings, low- and middle-income countries, non-communicable diseases, health care access, access to medicines, diabetes management, diabetes complications, community participation, peer support, health professions education, diabetes technology, implementation effectiveness
- MeSH terms
- Delivery of Health Care, Diabetes Mellitus, Humans, Models, Theoretical, Poverty, Disease Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
