Comparative healthcare: Diabetes Mellitus

In the third in this series of ‘comparative healthcare’ medical practitioners explore the approach to diabetes inBangaldesh and Australia respectively. The social and medical consequences of this chronic conditionare highlighted through the approach to patients at various stages of the disease from two nationalperspectives. An astonishing 7% of the 153 million people are reported to have diabetes in Bangladesh. Manyremain undiagnosed. Delays in diagnosis or management of diabetes have life limiting consequences for thosewho can ill afford private health care in the poorer nation. Screening and early intervention appear to bedenied to many in the developing country. The context is very different with Australians very fortunate to havea coordinated primary health care sector. The outlook for Bangladeshis with uncontrolled diabetes or withtreatable sequela would be unacceptable in Australia. At every stage in the disease trajectory the doctorsemphasise the importance of life style modification, a particular challenge in affluent Australia with its growingincidence of life style related pre morbid conditions in an increasingly sedentary population. A corner stone ofthe support of people with diabetes is the role of nurses and allied health professionals. With a fundedcommitment to multidisciplinary care in the community people with diabetes in Australia have access tosupport closer to home whereas those in Bangladesh remain heavily dependent on specialist, hospital basedservices. One can only speculate how Bangladesh will cope as its population ages and there are an everincreasing proportion of people who require urgent and expensive medical interventions. At the very leastthere is a strong case for greater investment in primary care especially to limit the economic consequences ofdiabetes and other chronic conditions. Finally as in other articles in this series we would like to emphasise that,the views expressed are those of the authors and do not necessarily reflect health policy or practice in theirrespective countries. Nonetheless we believe they offer a valuable perspective on common health care issuesand commend the article to our readers.