For the health of people with diabetes: goals of the WHO Global Diabetes Compact

In a recent study published in The lancet, researchers described the goals of the World Health Organization (WHO) Global Diabetes Compact (GDC) to improve health outcomes for all individuals affected by this fatal, noncommunicable disease. They reviewed key indicators and treatment targets developed by the GDC, their scientific basis, prioritization, variation and coverage at a global level.

Study: Improving health outcomes for people with diabetes: target setting for the WHO Global Diabetes Compact. Image credit: Minerva Studio/Shutterstock

Background

Inspired by previous successes with the human immunodeficiency virus (HIV) and the premise that measurement leads to action, the GDC brought together diverse stakeholders to achieve the goal of reducing diabetes risk on a global scale. They also ensure that people with a confirmed diagnosis of diabetes receive affordable, quality care in an equitable manner. By 2030, the achievement of these GDC targets should be assessed at global and national levels.

According to recent global estimates, over 530 million adults have diabetes, of which ~80% live in low- and middle-income countries (LMIC). As the prevalence and financial burden of diabetes increases, it will disproportionately affect LMICs. Population-based studies show that even in developed countries with well-funded health systems, the provision of evidence-based care for patients with diabetes remains suboptimal.

20% of high-income countries meet the recommended targets for diabetes, and the situation is worse in LMICs. So, while in the former settings glycated hemoglobin (HbA1c) or blood pressure control varies between 50% and 70%, in the latter only 50% of people with confirmed diabetes have adequate glycemic control and one in four can control their blood pressure.

Suggested core and additional GDC metrics

The GDC has identified and prioritized core and additional indicators to act as catalysts for action against further increases in diabetes. This framework also monitors progress in improving diabetes diagnosis, HbA1c and blood pressure control, the use of statins in people with type 1 diabetes and ensuring adequate supplies of insulin.

Intriguingly, the percentage of people diagnosed with diabetes averages 61% across all nations. Of these, the average number of people with HbA1c below 8% and blood pressure below 140/90 mm Hg was 68% and 56%, respectively, and 12% were using statins. In the United States, the proportion of people with confirmed diabetes who met the targets increased by 12 to 13 percentage points between 1999 and 2009, but remained relatively stagnant thereafter.

The GDC metrics cover four domains:

i) factors operating at a systemic, structural or political level,

ii) care processes,

iii) biomarkers eg HbA1c and

iv) health outcomes

Similarly, these indicators had three levels of risk, for example, a confirmed diagnosis of diabetes or high risk, which they reviewed based on data availability, modifiability and global inequality. In addition, the researchers reviewed the global distribution of each key indicator to determine future targets.

Finally, they suggested additional indicators, for example the incidence of end-stage renal disease and lower limb amputations, should be covered by global population-level surveillance systems.

The researchers also discussed three types of evidence for assessing the global status of indicators. The first evaluated the most recent population-based estimates for realistic baselines at the national level. The second predicts trends in metric percentages from different settings to find a realistic magnitude of change over time. Finally, they estimate the predicted health benefits and costs of achieving these goals versus not achieving them.

They also collected data from published literature from a variety of sources, for example country-based and sub-national population surveys, to name a few.

Conclusions

Indeed, the GDC has set ambitious goals for global diabetes management. If achieved, they will benefit millions living with this debilitating disease.

Nevertheless, the GDC indicators and targets will stimulate multidimensional action at the individual and policy levels in nations. Primary prevention of diabetes and integrated care for people affected by diabetes would help prevent its long-term consequences and inform the development of new indicators and targets. Achieving the targets could also significantly reduce acute cardiac complications among people with diabetes at the population level.

In addition, the authors emphasized the importance of developing improved data systems to measure additional indicators in LMICs. Most importantly, they highlighted the need to promote what would lead to improvements in health outcomes for people with diabetes in the context of innovations in health care financing, access to care, and health care systems.

Written by

Neha Mathur

Neha is a digital marketer based in Gurugram, India. She holds an MSc from the University of Rajasthan with specialization in Biotechnology in 2008. She has experience in pre-clinical research as part of her research project in the Department of Toxicology at the prestigious Central Drug Research Institute (CDRI), Lucknow, India. She also holds a C++ programming certification.

For the health of people with diabetes: goals of the WHO Global Diabetes Compact

Background

Suggested core and additional GDC metrics

Conclusions

Neha Mathur

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