WHO Global Diabetes Compact sets targets for improving diabetes outcomes worldwide
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Key takeaways:
- The WHO Global Diabetes Compact identified five key diabetes metrics and established target goals.
- Better international surveillance systems and monitoring are needed to measure progress toward targets.
Increasing the percentage of people with diabetes who are diagnosed, improving glucose and lipid levels and expanding access to care are key goals detailed in the WHO Global Diabetes Compact.
In a health policy paper published in The Lancet, an international group of diabetes stakeholders set a series of targets for the Global Diabetes Compact, a WHO-driven initiative that was established to reduce diabetes risk and ensure equitable access to diabetes care for all people around the globe. The compact identified five key metrics and set targets for all countries in the world to monitor and attempt to achieve.
“Current surveillance data indicates that virtually all countries of the world fall short in providing the evidence-based care that can reduce the complications and early mortality that occurs with diabetes,” Edward W. Gregg, PhD, professor and head of the Royal Colleges of Surgeons in Ireland School of Population Health and lead author of the Global Diabetes Compact, told Healio. “Setting ambitious but achievable targets for countries or health systems within countries to shoot for can mobilize action for better care and prevention.”
Gregg and colleagues organized metrics into four domains. The researchers chose key structural, systemic or policy-levels factors that played a key role across the entire health care delivery system; processes of care metrics such as HbA1c testing that may be essential to affecting diabetes outcomes; biomarker metrics such as HbA1c and lipids that were independently associated with long-term diabetes-related outcomes; and health events or outcomes that exemplify diabetes morbidity. The researchers also examined metrics that affected three groups: people with diagnosed diabetes, people at high risk for diabetes and the overall population. Gregg said the expert panel identified metrics and developed targets through literature review and consensus-seeking discussion.
Establishing five key targets
The authors identified five core metrics in the paper:
- the proportion of the population with diabetes who have been diagnosed;
- the percentage of people with type 1 diabetes who have access to insulin, blood glucose meters and test strips;
- the proportion of people with diabetes and an HbA1c of less than 8%;
- the percentage of people with diabetes and a blood pressure of less than 140/90 mm Hg; and
- the proportion of people with diabetes taking a statin.
The expert panel also detailed individual targets for each metric. The panel recommended that each country should have at least 80% of people with diabetes receiving a diagnosis and 80% of people with diabetes should achieve an HbA1c of less than 8%.
“The 80% [HbA1c] level was chosen because it tended to correspond with what the highest countries in the world are currently achieving, and thus were an indication of what is potentially realistic,” Gregg said.
The experts also recommended that 80% of people with diabetes achieve a BP of less than 140/90 mm Hg and said 60% of people with diabetes should being using a statin. For access to insulin, blood glucose meters and test strips, the panel said countries should aim for 100% because of insulin’s essential role in survival for people with type 1 diabetes.
“Most of these targets are achievable by improving the delivery of what has already been shown to work; these include ensuring access to primary care, access to medications and primary care to ensure that people with diabetes achieve good levels of glucose and blood pressure control, and medication for lipids,” Gregg said.
The panel also identified several complementary metrics, which included the prevalence of people at risk for diabetes due to obesity, insufficient physical activity or an unhealthy diet; the percentage of people with diabetes receiving team-based care; and five long-term outcomes that included all-cause mortality, end-stage kidney disease, lower extremity amputation, diabetic ketoacidosis at type 1 diabetes diagnosis and diabetes incidence per year. Targets were not set for the complementary metrics, but the authors wrote that they warrant scale-up in population monitoring settings.
Improvement needed to global monitoring
In order to measure each of the key metrics, the authors recommended population-based surveys, utilization of WHO surveillance systems, data pooling studies, health system-based registries and new WHO efforts supporting facility-based monitoring of quality of care.
“The main gap at present is that surveillance and monitoring systems are not continuous in most countries, and in most low- and middle-income countries of the world, there is not adequate surveys or registries to measure the attainment of these metrics,” Gregg said. “A next step is also to improve the ability of countries to measure and monitor the long-term health outcomes of diabetes, like diabetic eye disease, kidney disease, amputations and cardiovascular disease.”
For more information:
Edward W. Gregg, PhD, can be reached at edwardgregg@rcsi.ie.
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