GENERAL

• Global diabetes burden:
  • As a result of population aging and growth, rise in obesity, unhealthy diets, and sedentary lifestyles, the prevalence of diabetes is increasing rapidly worldwide and is expected to increase from 10.5% in 2021 to 12.2% by 2045. Most of this increase will occur in developing countries.[7]
  • Global diabetes-health-related expenditures are projected to increase from $966 billion in to $1054 billion USD in 2045.[7]
• Global trends in diabetes and diabetes-related complications:
  • The prevalence of type 2 diabetes (T2D) has been increasing globally over the past four decades, with countries in Asia, the Middle East and North Africa seeing the most rapid rate of rise.[2]
  • These increases in T2D have been largely attributed to changes in the environment and lifestyle that have increased rates of obesity in regions that once experienced undernutrition. Increased sedentary behaviors and a decline in nutritional quality also influence these increases in T2D.[2]
  • Differences in patterns of body fat accumulation driven by gene-environmental influences during early development combined with unhealthy lifestyles may drive global and ethnic differences in diabetes prevalence.[2]
  • There are limited large, systematic studies on the public awareness of diabetes and its health and economic impacts in low- and middle-impact countries. Recent studies suggest that low- and middle-income countries have experienced increased cardiovascular complications and all-cause mortality in people with T2D, in contrast to these rates decreasing over time in high-income countries.[1]
  • Furthermore, while rates of macrovascular complications and mortality have declined, rates of cancer, dementia, infection, tuberculosis, and tropical disease have increased globally in older adults. In comparison, younger adults in both high and low-income countries have not seen a decreased decline in rates of vascular complications.[1]
  • Diabetes increases the risk of tuberculosis infection two to fourfold and poses a significant threat to global tuberculosis control.[6]
• Barriers to care in resource-poor settings:
  • In many developing countries, physicians may lack training specific to diabetes management. There may also be limited training of nurses dedicated to diabetes, an absence of standardized guidelines and protocols, frequent fluctuations in drug availability, and a lack of health records.[5]
  • Drug availability: Insulin is not universally accessible to all those who need it in the majority of the world and is particularly a problem in sub-Saharan Africa. This is especially problematic for patients with type 1 diabetes in some parts of the world if patients cannot afford necessary insulin or it is unavailable. Interruptions to general forms of cheap and/or generic oral hypoglycemic medications, such as metformin and glibenclamide, are not uncommon.[5]
  • Drug affordability: Studies have shown that the price of a 10 ml vial of U-100 insulin varied across country income groups, with higher median prices in low-income and lower middle-income countries to high-income countries (i.e., $6.90 vs. $4.70 vs. $3.10). Furthermore, lifestyle, diet, and medication changes are perceived as expensive and not a priority in families with limited income.[5][3]
  • Insulin storage: There are practical issues related to insulin storage in hotter climates.
  • Cultural perceptions: In some parts of the world, being overweight or obese is perceived as a marker of social success, so engaging patients to lose weight can be challenging. There are also cultural misconceptions and stigma regarding self-injection and the cause and treatment of diabetes.[5][4]
  • Poor infrastructure: Lack of access to sustainable laboratory services, patient education in nutrition and self-care, or routine monitoring and clinical care makes it challenging to treat a chronic disease that requires follow-up. Access to glucometers for self-monitoring of glucose is limited in many parts of the world.
• Worldwide diabetes initiatives:
  
  • World Diabetes Day is November 14 each year, devoted to global activities to raise awareness of different aspects of diabetes and its complications.
  • The World Health Organization (WHO) established a Global Diabetes Compact in 2021 to address the growing burden of diabetes. The Compact includes eight main initiatives:[8]
    • Collaboratively unite stakeholders, including people living with diabetes, around a common agenda
    • Integrate diabetes prevention and management in primary health care and universal health coverage
    • Close research and normative gaps while spurring innovation
    • Improve access to diabetes diagnostics, medicines, and health products, particularly insulin, in low- and middle-income countries
    • Develop global coverage targets for diabetes care, accompanied by a “global price tag”
    • Improve diabetes care for those living through humanitarian emergencies
    • Improve understanding of diabetes
    • Build back better based on experiences from the COVID-19 pandemic
  • In May 2022, WHO member states set the first global targets for diabetes, stating that by 2030:[12]
    • 80% of people living with diabetes are diagnosed
    • 80% have good control of glycemia
    • 80% of people with diagnosed diabetes have good control of blood pressure
    • 60% of people with diabetes of 40 years or older receive statins
    • 100% of people with type 1 diabetes have access to affordable insulin and blood glucose self-monitoring
• United Nations (UN) Non-Communicable Disease (NCD) Summit:
  • The UN convened the third high-level summit on the five most prominent NCDs: cancers, cardiovascular diseases, chronic respiratory diseases, diabetes, and mental health conditions in September 2018. The next high-level meeting on NCDs will be in 2025.
  • Five major NCD risk factors were identified: 1) unhealthy diet; 2) tobacco use; 3) air pollution; 4) harmful use of alcohol; 5) physical inactivity
  • Summit Recommendations to UN Member States
    • Health strategies for the prevention and control of NCDs should be priorities at all levels of government. Governments should:
      • Identify and implement a specific set of priorities within the overall NCD and mental health agenda, based on public health needs
      • Reorient health systems to include the prevention and control of NCDs and mental health services in their healthcare policies and plans
      • Increase collaboration and engagement with the private sector, academia, civil society and communities to build a society-wide collaborative approach to NCDs
      • Work with the international community to develop a new economic paradigm for funding action on NCDs and mental health.
      • Strengthen accountability to their citizens for action on NCDs
• WHO global strategy on diet and physical activity for people living with chronic conditions:[11][10]
  • Achieve energy balance and healthy weight
  • Limit energy intake from total fats and shift fat consumption away from saturated fats to unsaturated fats and eliminate trans- fatty acids
  • Increase consumption of fruits and vegetables, legumes, whole grains, and nuts
  • Limit intake of free sugars
  • Limit salt (sodium) consumption from all sources and ensure that salt is iodized
  • Limit the amount of time spent being sedentary, and engage in at least 150 to 300 minutes of moderate-intensity aerobic physical activity or at least 75 to 150 minutes of vigorous-intensity aerobic physical activity
• PAHO/WHO global strategy on diabetes prevention:[9]
  • Achieve and maintain a healthy body weight
  • Be physically active – doing at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control.
  • Eat a healthy diet, avoiding sugar and saturated fats
  • Avoid tobacco use