Narayan K M, Rhodes E C
KM Narayan, 1518 Clifton Road NE, Atlanta, GA 30322, USA. E-mail
J R Coll Physicians Edinb. 2016 Dec;46(4):272-277. doi: 10.4997/JRCPE.2016.414.
The rapid growth of noncommunicable diseases represents a formidable global health challenge. Here we use type 2 diabetes as a case study to illustrate the rise of noncommunicable diseases and call attention to the important role of primary care systems in addressing these diseases in low- and middle-income countries. Comprehensive screening for diabetes should be implemented through primary care systems to increase early detection of prediabetes and undiagnosed diabetes - a first step to diabetes prevention and management. In addition, primary care systems should strengthen and expand capacity to link patients to appropriate interventions based on their diabetes status and provide care coordination (e.g. leveraging task-shifting and technology), and integrate clinic and community resources for diabetes prevention and control. Additional strategies should include continuous quality improvement, health systems strengthening, workforce development, and affordable and sustainable financing. Together, these actions could elevate the role of primary care in addressing diabetes in low- and middle-income countries and help advance global progress towards reducing diabetes complications, and also preventing or delaying diabetes among those at risk.
非传染性疾病的迅速增长是一项严峻的全球健康挑战。在此，我们以2型糖尿病为例，说明非传染性疾病的增加，并提请注意初级保健系统在低收入和中等收入国家应对这些疾病方面的重要作用。应通过初级保健系统实施全面的糖尿病筛查，以提高对糖尿病前期和未确诊糖尿病的早期检测——这是糖尿病预防和管理的第一步。此外，初级保健系统应加强并扩大能力，根据患者的糖尿病状况将其与适当的干预措施联系起来，并提供护理协调（例如利用任务转移和技术），整合诊所和社区资源以预防和控制糖尿病。其他策略应包括持续质量改进、卫生系统加强、劳动力发展以及负担得起的可持续融资。这些行动共同作用，可提升初级保健在低收入和中等收入国家应对糖尿病方面的作用，并有助于推动全球在减少糖尿病并发症以及预防或延缓高危人群患糖尿病方面取得进展。
