Vol. 16 No. 1 (2024): Arch Pub Health
Public Health

Diabetes in the Republic of North Macedonia: epidemiology and economic burden, 2018-2021

Vjosa Recica
Institute of Public Health of the Republic of North Macedonia, Skopje, Republic of North Macedonia
Zorica Naumovska
Faculty of Pharmacy, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia

Published 2024-04-16

Keywords

  • diabetes,
  • mortality,
  • morbidity,
  • health care costs

How to Cite

1.
Recica V, Naumovska Z. Diabetes in the Republic of North Macedonia: epidemiology and economic burden, 2018-2021. Arch Pub Health [Internet]. 2024 Apr. 16 [cited 2024 Jul. 16];16(1). Available from: https://id-press.eu/aph/article/view/6117

Abstract

Diabetes is a chronic, metabolic disease with hyperglycemia caused by defects in insulin secretion, insulin action, or both, results in dysfunction and failure of various organs, reduced quality of life, increased medical costs, reduced productivity and premature mortality in diabetic patients. The main goal of the study is presentation of epidemiological data for diabetes, evaluation of complications associated with the disease and economic burden of diabetes in the Republic of North Macedonia. Materials and methods: A retrospective epidemiological study based on prevalence data from the Diabetes Registry in the Republic of North Macedonia, as well as data from primary and specialized healthcare centers was conducted. It combined population demographics in our country in 2021 with epidemiological data for diabetes, as well as healthcare costs associated with diabetes obtained from WHO, Institute of Health Metrics and Evaluation and National Health Insurance Fund. Results: The incidence rate of type 1 diabetes (T1DM) in the Republic of North Macedonia was presented with 1.21%ooo newly diagnosed in 2018 and 2.8%ooo in 2021 with is highest rate in the age group of youths from 10-14 (12.4%ooo) in 2021. In time period 2018-2021, the incidence rate of patients with type 2 diabetes (T2DM) also enlarged from 323.3%ooo to 355.5%ooo, while the prevalence rate increased from 5554.4%ooo to 6549.3%ooo.  The highest prevalence rates for T2DM analyzed by age were observed in age groups between 55 and 79 years. The highest rate of diabetes-associated complications in North Macedonia are complication on peripheral circulation, followed by ketoacidosis, neurological complications, ophthalmic complication, diabetic coma and multiple complications. The percentage of prescriptions for blood glucose lowering drugs (excluding insulin) in our country rose form 7.3% in 2018 up to 7.6% in 2020, whereas the cost of provision of diabetes treatment supplies in 2021 for patients on insulin amounted to approximately 13,457,508,62 USD. The calculated burden of diabetes mellitus and diabetic complications in the Republic of North Macedonia amounted to 42,806.59 disability-adjusted life-years (DALYs). Conclusions: Diabetes rates are increasing worldwide and in the Republic of North Macedonia, too. This epidemiological study is a solid base for implementation of the national strategy for diabetes and will contribute in effective planning and evaluation of all aspects of diabetes control in the Republic of North Macedonia.

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References

  1. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2014 Jan 1;37(Suppl 1):S81-S90. DOI: 10.2337/dc14-S081.
  2. World Health Organization. Global Report on Diabetes; WHO: Geneva, Switzerland, 2017.
  3. Report of a WHO Consultation. Geneva, Switzerland: World Health Organization; 1999.
  4. American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44(Suppl. 1): S15-S33. DOI: 10.2337/dc21-ad09.
  5. Donath MY, Meier DT, Böni-Schnetzler M. Inflammation in the pathophysiology and therapy of cardiometabolic disease. Endocrine Reviews 2019; 40(4): 1080-1091. DOI: 10.1210/er.2019-00002.
  6. The Effect of Insulin on the Alpha-Cell Response to Hyperglycaemia in long-standing alloxan diabetes. PMC333086.
  7. Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001; 345:790–797.
  8. Guilherme A, Virbasius JV, Puri V, Czech MP. Adipocyte dysfunctions linking obesity to insulin resistance and type 2 diabetes. Nat Rev Mol Cell Biol 2008; 9(5):367-77. DOI: 10.1038/nrm2391.
  9. Weyer C, Bogardus C, Mott DM, Pratley RE. The natural history of insulin secretary dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. The Journal of Clinical Investigation 1999; 104: 787-794. DOI: 10.1172/JCI7231.
  10. Spellman CW. Pathophysiology of type 2 diabetes: targeting islet cell dysfunction. J Am Osteopath Assoc 2010;110(3 Suppl 2):S2-7. PMID: 20382838.
  11. Lopez J. Carl A. Burtis, Edward R. Ashwood and David E. Bruns (eds): Tietz Textbook of Clinical Chemistry and Molecular Diagnosis (5th edition): Elsevier, St. Louis, USA, 2012, 2238 pp, 909 illustrations. Indian J Clin Biochem. 2013 Jan;28(1):104–5. DOI: 10.1007/s12291-012-0287-7. PMCID: PMC3547451.
  12. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: Committee Report 2001, American Diabetes Association.
  13. Centers for Disease Control and Prevention. National Diabetes Statistics Report. Accessed in 12.06.2022.
  14. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001; 414:782–787.
  15. Scott A, Chambers D, Goyder E, O’Cathain A. Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: a systematic review. PLoS One. 2017;12 (5): e0177210. DOI: 10.1371/journal.pone.0177210.
  16. Mazidi M, Toth P P, Banach M. C-reactive protein is associated with prevalence of the metabolic syndrome, hypertension, and diabetes mellitus in US adults. Angiology. 2017;(article 331971772928). DOI: 10.1177/0003319717729288.
  17. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998 Jul;15(7):539-53. DOI: 10.1002/(SICI)1096-9136(199807)15:7<539:AID-DIA668>3.0.CO;2-S.
  18. Deshpande A D, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Physical Therapy 2008; 88(11):1254–1264. DOI: 10.2522/ptj.20080020.
  19. Tuttolomondo A, Maida C, Pinto A. Diabetic foot syndrome as a possible cardiovascular marker in diabetic patients. Journal of Diabetes Research. 2015; 2015:12. DOI: 10.1155/2015/268390.
  20. Lee ET, Keen H, Bennett PH, Fuller JH, Lu M. Follow-up of the WHO Multinational Study of Vascular Disease in Diabetes: general description and morbidity. Diabetologia. 2001;44(Suppl 2(2)):S3–13. DOI: 10.1007/PL00002936.
  21. LeRoith D, Fonseca V, Vinik A. Metabolic memory in diabetes--focus on insulin. Diabetes Metab Res Rev. 2005;21(2):85–90. DOI: 10.1002/dmrr.530.
  22. Solli O, Stavem K, Sonbo Kristiansen I. Health-related quality of life in diabetes: The associations of complications with EQ-5D scores. Health and Quality of Life Outcomes. 2010;8(1):18. DOI: 10.1186/1477-7525-8-18.
  23. Linda SG, William HH, Smith PJ. National Diabetes Data Group. Diabetes in America. Bethesda. 2. 1995. Mortality in Non-Insulin-Dependent Diabetes[A] NIH Publication NO.9521468.
  24. International Diabetes Federation. Diabetes Atlas. 2. Brussels.
  25. Available at https://fzo.org.mk/. Accessed in 10.11.2022.
  26. International Diabetes Federation. Available at: https://idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html.
  27. Deshpande A D, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Physical Therapy 2008; 88(11):1254–1264. DOI: 10.2522/ptj.20080020.
  28. American Diabetes Association. Economic costs of diabetes in the U.S. in 2007. Diabetes Care 2008; 31:596–615.
  29. Chen L, Magliano DJ, Zimmet PZ. The worldwide epidemiology of type 2 diabetes mellitus-present and future perspectives. Nat Rev Endocrinol 2012;8(4):228–36.
  30. Source: RSM Government. 2020 program to provide insulin, glucagon, insulin needles, sugar test strips and diabetes treatment and control education. Skopje: 2020.
  31. Available at https://fzo.org.mk/izvestai-potrosuvacka-lekovi-pzz. Accessed in 13.10.2023.
  32. Afroz A, Alramadan MJ, Hossain MN. et al. Cost-of-illness of type 2 diabetes mellitus in low and lower-middle income countries: a systematic review. BMC Health Serv Res 2018; 18: 972. DOI: 10.1186/s12913-018-3772-8.
  33. International Diabetes Federation. International Diabetes Atlas. Available at https://diabetesatlas.org/.
  34. American Diabetes Association. The cost of Diabetes. Available at: https://diabetes.org/about-us/statistics/cost-diabetes.
  35. www.iph.mk. Accessed in 12.12.2022.
  36. Mata-Cases M, Benito-Badorrey B, Roura-Olmeda P, Franch-Nadal J, Pepió-Vilaubí JM, Saez M, Coll-de-Tuero G, GEDAPS (Primary Care Group for the study of Diabetes) of the Catalonian Society of Family and Community Medicine. Clinical inertia in the treatment of hyperglycemia in type 2 diabetes patients in primary care. Curr Med Res Opin 2013; 29:1495–502.
  37. "Global Burden of Disease Study 2019 (GBD 2019) Covariates 1980-2019." 03 Mar.2023, https://ghdx.h