Biomedical Publications On Diabetes Mellitus, Research Gap In Developing Countries

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Article Information:


Group: 2004
Subgroup: Volume 2, Issue 1, Winter
Date: March 2004
Type: Short Repport
Start Page: 51
End Page: 56

Authors:

  • Rezaei-Ghaleh N
  • Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, IR. Iran
  • Mirbolooki M
  • Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, IR. Iran
  • Shiva N
  • Endocrine Research Center, Shaheed Beheshti University of Medical SciencesiTehran, IR. Iran,
  • Azizi F
  • Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, IR. Iran

      Correspondence:

      Affiliation: Endocrine Research Center, Shaheed Beheshti University of Medical Sciences
      City, Province: Tehran,
      Country: IR. Iran
      Tel:
      Fax:
      E-mail: azizi@erc.ac.ir

Abstract:


Diabetes today is a worldwide problem. The purpose of this study is to assess, in developed and developing countries, the productivity of research on diabetes and to evaluate the gap between the burden of diabetes and research conducted on diabetes.
Materials and Methods: An extensive search in PubMed database for diabetes publications (all publication types, all languages) using diabetes as the MeSH term was carried out to ascertain the proportion of diabetes-related publications from countries of different regional (according to WHO regions) and economic (according to World Bank) classifications in 1992, 1997 and 2002. We excluded all publications without the name of a country as affiliation, as we did for publications from the U.S. following which the quota of international publications of countries was calculated. All information related to the distribution of the global burden of diabetes was extracted from the literature available.
Results: Worldwide, the overall growth rate of publications on diabetes during 1992-2002 was 66.3°/., with a higher rate during 1997-2002, as compared to that of 1992-1997 period (31% vs. 27%). The highest growth rate was found in the South and East Asia region (226%), and the second highest in the Eastern-Mediterranean region (138'Vo). However, the quota of the international publications of these two regions reached 3.9%  and 2.5% in 2002, respectively. Developed market economies (except for U.S.) contributed 85.4% (1668) of publications in 1992, 83.0'1., (2276) in 1997 and 76.7% (2806) in 2002. Contributions of developing countries increased from 12.3% (242) in 1992 to 13.8% (380) in 1997 and 19.8% (726) in 2002. Also, contributions of the developing eastern European countries rose from 2.2% (43) in 1992 to 3.1% (85) and 3.4% (125) in 1997 and 2002, respectively.
Conclusion: Despite the fast growth in prevalence of diabetes in developing countries, the quota of international publications on diabetes from developed countries is definitely higher than that of developing countries. Facilitating increases in financial resources and the indexing of national journals in these countries may serve to improve their quota.

Keywords: Diabetes;Publication;Developing;Countries;Developed countries

Manuscript Body:


Introduction

At the beginning of the 21 st century, the worldwide diabetes pandemic affected about 151 million persons. I The number of adults with type 2 diabetes is estimated to increase to 225 million by 2010 and to 300 million by 2025.2 Increasing levels of obesity, arising from energy-rich diets and sedentary lifestyles, associated with aging of the populations are the main factors contributing to this increasing prevalence.3 The major part of this numerical increase will occur in developing countries, so that it is expected that by the
year 2025, more than 75% of people with diabetes will reside in developing countries, as compared with 62% in 1995.4 The increasing costs and social burdens associated with diabetes and its complications5 make it reasonable to enhance research on diabetes in developed, and more particularly, in developing countries. The aim of this study is to assess the productivity of rese<\rch on diabetes in developed and developing countries and to evaluate the gap between the burdens imposed on them by the disease and the research conducted on it. 

Materials and Methods

We searched PubMed for publications (all publication types, all languages) using "diabetes" as a MeSH term to ascertain the proportion of diabetes-related publications from countries of different regional and economic groups in 1992, 1997 and 2002. To assign a publication to a country, we used the affiliation of the first author. All publications without the name of a country as affiliation were excluded as was done for publications from the U.S. The quota of international publications of countries was then calculated. Member countries of WHO were categorized according to WHO regions: Pan American region (except for the U.S.), Europe and Middle Asia, Africa, Eastern Mediterranean, South-East Asia and Western Pacific regions. They were also classified on the basis of World Bank criteria into three groups: Developed Market Economies (DME) except for the U.S., Developing Eastern European (DEE) countries (including also middle Asian republics) and developing countries. A list of countries with developed market ec onomies and developing eastern European countries is given in table 1. All other countries were considered as developing countries. To adjust numbers of publications according to the burden of diabetes imposed, the estimated  values of adult population and number of diabetics over 20 years were extracted and used. 4 

 

Table 1. Countries with developed market economies and developing eastern European countries

Developed Market
Economies

Developing Eastern European
Countries with middle
Asian republics

Andorra

Albania

Australia

Armenia

Austria

Azerbaijan

Belgium

Belarus

Canada

Bosnia and Herzegovina

Denmark

Bulgaria

Finland

Croatia

France

Czech republic

Germany

Estonia

Greece

Georgia

Iceland

Hungary

Ireland

Kazakhstan

Italy

Kyrgyzstan

Japan

Latvia

Luxembourg

Lithuania

Malta

Poland

Monaco

Moldova

Netherlands

Romania

New Zealand

Russian federation

Norway

Slovakia

Portugal

Tajikistan

San Marino

Turkmenistan

Spain

The fOlmer Yugoslav republic
of Macedonia

Sweden

Uzbekistan

Switzerland

Ukraine

U.K.

Yugoslavia

U.S.

 

 

Results

In 1992, there were 5184 indexed publications in PubMed with the MeSH term of diabetes, a figure which rose to 6576 in 1997 and then increased until it reached 8624 in the year 2002. Worldwide the overall growth rate of publications was 66.3% during 1992- 2002, with a higher rate during 1997-2002 as compared to that of 1992-1997 (31 % vs. 27%). Excluding U.S. publications and those without a country name in the affiliation, worldwide publications on diabetes reached 1953, 2741 and 3657 in 1992, 1997 and 2002, respectively, and the overall growth rate was 87.3% over ten years (Table 2). The highest growth rate of diabetes related publications was found in the South and East Asia region (226%), the second being in the Eastern- Mediterranean region (138%). However, the quota of these two regions reached 3.9% and 2.5% in 2002, respectively. In the Eastern Mediterranean region, Saudi Arabia, Kuwait, Egypt, Iran and Jordan in order of precedence made the most contributions in research publications in 2002. Consider ing the growth rate of publications, Iran's growth from nil in 1992 to 9 in 2002 was the highest rate in the EM region, although its quota on the international scale was only 0.2%. Developed market economies (except for the U.S.) contributed 85.4% (1668) of publications in 1992, 83.0% (2276) in 1997 and 76.7% (2806) in 2002 (Fig. 1). Contributions of developing countries increased from 12.3% (242) in 1992 to 13.8% (380) in 1997 and 19.8% (726) in 2002. The contributions of developing Eastern European countries also rose from 2.2% (43) in 1992 to 3.1 % (85) and 3.4% (125) in 1997 and 2002, respectively.

 

Table 2. Distribution of biomedical publications on diabetes in different WHO regions in 1992, 1997 and 2002

 

Location

Number of Publications

Growth Rate(%)

1992

1997

2002

Worldwidea

5184

6576

8624

66.3

Worldwideb

1953

2741

3657

87.3

Africa

24

27

44

83.3

Nigeria

6

6

11

83.3

South Africa

8

7

10

25 .0

Cameroon

0

1

1

-

EMRc

37

53

88

138

Egypt

7

6

11

57.1

Iran

0

2

9

-

Jordan

1

2

7

600

Kuwait

2

8

14

600

Saudi Arabia

14

13

20

42.9

Europed

1137

1640

2034

78.9

Eastern Europe and Middle Asia

43

85

125

19.0

PARe

185

244

314

69.7

Brazil

18

27

43

138

Canada

123

171

230

86.9

SEARf

42

63

137

226

India

35

46

116

231

WPRg

468

608

877

87.3

China

20

30

111

455

New Zealand

13

21

32

146

Australia

87

130

160

83.9

Japan

333

396

508

52.5

a All publications worldwide
b Except for the U.S. and those without the name of any country in the affiliation
c Eastern Mediterranean Region
d including middle Asian republics
e Pan-American Region (except U.S.)
f South-East Asian Region
g Western Pacific Region.

 

 

 

 

Fig. 1. Distribution of biomedical publications on diabetes in Developed Market Economies (DME) except U.S., Developing Eastern European Countries (DEEC) with middle Asian republics, and developing countries in 1992, 1997 and 2002

 

 

 

Calculating the numbers of publications per one million of adult people and adult diabetics showed that, considering the increasing prevalence of diabetes, this was only a small growth in publications in the world. As shown in Table 3, in 1997, the numbers of publications per one million adult diabetics in developing and DEE countries were very close; however in 2002, this number was 1.2 times higher in developing than in DEE countries.  

 

Table 3. Distribution of adult general and diabetic population and biomedical publications on diabetes in Developed Market Economies (DME) except for U.S., Developing Eastern European Countries (DEEC) with middle Asian republics, and developing countries in 1997 and 2002

 

1997

2002

 

Population c

Diabeticsc

Number of Publications

Popnlationd

Diabeticsd

Number of Publications

 

(× 1000)

(× 1000)

Total

per 106 population

per 106 diabetics

(× 1000)

(× 1000)

Total

per 10 6 population

per 10 6 population

World

3,397,604

135,904

6576

1.9

4.84

3,71 9,551

156,221

8624

2.3

5.52

DMEa

424,870

20,4 16

2276

5.35

111.5

437,168

21,820

2806

6.42

128.5

DEECb

284,285

18,805

85

0.35

4.5

293 ,841

20,155

125

0.42

6.2

Developingcountries

2,500,842

81,905

380

0.15

4.6

2,792,135

97,099

726

0.26

7.5

a Except the US.
b Including middle Asian republics
c Estimated values for 1995 were used accordi ng to reference 4.
d Estimated values for 2000 were used according to reference 4.

 


Discussion

The percentage of contributions in publications on diabetes by developing countries has increased from 12.3% in 1992 to 19.8% in 2002. However, there is still a large gap between developed and developing countries regarding research on diabetes especially when the burdens of diabetes in these countries are considered.
The number of biomedical publications worldwide on diabetes has grown with rates of 27% and 31 % during 1992-7 and 1997- 2002, respectively. This growth has slightly exceeded the rise in population and number of adult diabetic patients during the same period. Hence, the number of publications per one million adults of the general population increased from about 1.9 in 1997 to 2.3 in 2002. In addition, this number per 106 of adult diabetic patients rose from 4.84 in 1997 to 5.52 in 2002. This could be due to an actual increase in diabetes research or to more extended indexing of journals in the PubMed database.
Promising evidence regarding diabetes research in developing countries has been found. Not only has the absolute number of publications on diabetes from developing countries increased prominently, but their relative quota of diabetes publications has also grown. Even more, both the ratios of their publications per 106 of the adult general population and that per 106 of adult diabetic  patients have improved between 1997 and 2002. Nevertheless, these ratios (for developing countries and also, developing eastern European countries) are still far from their cOlTesponding values in developed market economies. While 6.4 articles per 106 adults of the general population were published from countries with developed market economies (except U.S.) in 2002, the corresponding number was only 0.3 for developing countries. Again, the number of articles per 106 of adult diabetic patients in 2002 was 128.5 for developed market economies (except U.S.) and only 7.5 for developing countries. Taking into account the related dat a on diabetes research publications from the U.S. will surely widen the above mentioned gap between developing and developed countries regarding diabetes research.
The percentage of contributions in diabetes related publications, from European countries, more than 90% of which are are from western Europe, has been relatively constant at about 58%. However, the fraction ofpublications from eastern Europe and the middle Asian republics has increased slightly during 1992-2002. The Western Pacific Region (WPR) countries contribute about 25% of diabetes-related publications at present. Of course, most publications from this region are from the four countries of Australia, China, Japan and New Zealand, indicating a paucity f diabetes research in other countries of this regIOn.
In the Pan-American Region (PAR), a similar gap is observed between the North and South. Regardless of U.S. (excluded from this study due to its totally different situation), about two thirds of publications from this region are from Canada, and less than 1.5% of publications are from the Central or Latin American countries.
A prominent rising trend is observed for the South-East Asian Region (SEAR); however, its contribution is still too low especially in view of its high population. In addition, one must not overlook the fact that most of publications from this region are from India.
The most dismal situation regarding diabetes research is found in Africa. Not only is their contribution in diabetes-related publica- tions very low, about half of which are from Nigeria or South Africa, but it has also remained nearly constant during this period.
The Eastern Mediterranean Region (EMR) also shows a rising trend in the number of diabetes publications, its contribution increasing from 1.9% in 1992 to 2.5% in 2002. However, over two thirds of publications in 2002 are from only the five countries of Saudi Arabia, Kuwait, Egypt, Iran and Jordan, the contributions of other countries being far too low. Among these five countries, Iran, Kuwait and Jordan show rapidly rising trends in publications.
Although the quota of international publications of developing countries has increased over the past years, it has done so very slowly and there is still a wide gap between developed and developing countries regarding research on diabetes. Considering the rising trend of the burdens imposed by diabetes, especially in developing countries, it seems vital to increase the financial support allocated for diabetes research in these countries. The gap, however, may be due to the fact that most articles from developing countries are published in journals not-indexed in PubMed. Development of a new database including such journals is suggested with a view to enhancing presentation of publications from developing countries.

References: (5)

  1. Engelgau MM, Narayan KM, Saaddine JB, Vinicor F. Addressing the burden of diabetes in the 21 st century: better care and primary prevention. J Am Soc Nephrol. 2003 Jul; 14(7 SuppI2):S88-91.
  2. Zinunet P. The burden of type 2 diabetes: are we doing enough? Diabetes Metab. 2003 Sep;29(4 Pt 2):6S9-18 .
  3. Mayer-Davis EJ, Costacou T. Obesity and sedentary lifestyle: modifiable risk factors for prevention of type 2 diabetes. Curr Diab Rep. 20010ct;I(2):170-6.
  4. King H, Aubert RE, Herman WHo Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998 Sep;21(9):1414-31.
  5. World Health Organization. Noncommunicable Disease Prevention and Control: Report by the Director General EBI0lIl4. Geneva: World Health Organization; 1997.