In a recent study published in The Lancet, researchers described the targets of the World Health Organization’s (WHOs) Global Diabetes Compact (GDC) to improve the health outcomes for all individuals affected by this fatal, non-communicable disease. They reviewed key metrics and treatment targets developed by the GDC, their scientific basis, prioritization, variations, and coverage at a global level.
Inspired by previous successes in human immunodeficiency virus (HIV) and the premise that measurement drives action, the GDC united diverse stakeholders to achieve the target of reducing the risk of diabetes on a global scale. In addition, they ensured that people with a confirmed diagnosis of diabetes received affordable and quality care equitably. An assessment of the attainment of these GDC goals at global and national levels is due by 2030.
Per recent global estimates, over 530 million adults have diabetes, of which ~80% live in low- and middle-income countries (LMICs). As the prevalence and financial burden of diabetes rise, it will disproportionately affect LMICs. Population-based studies have demonstrated that even in developed countries with well-financed healthcare systems, delivery of evidence-based care for a diabetic patient remains suboptimal.
20% of high-income countries meet recommended targets for diabetes, and the situation is worse in LMICs. So, while in the former settings, glycated hemoglobin (HbA1c) or blood pressure control ranges between 50% and 70%, in the latter, only 50% of the people with confirmed diabetes have adequate glycemic control, and one in four can control their blood pressure.
Proposed core and complementary GDC metrics
The GDC has set and prioritized core and complementary metrics to work as catalysts for action against the further increase of diabetes. This framework also monitors progress in improving diabetes diagnosis, HbA1c and blood pressure control, statin use in people with type 1 diabetes, and ensuring adequate insulin supplies.
Intriguingly, the percentage of people with diagnosed diabetes on average was 61% across all nations. Of these, the average number of people with HbA1c less than 8% and blood pressure lower than 140/90 mm Hg was 68% and 56%, respectively, and those using statins were 12%. In the United States, the proportion of people with confirmed diabetes who met targets surged by 12 to 13 percentage points between 1999 and 2009 but remained relatively stagnant thereafter.
The GDC metrics encompassed four domains:
i) factors at play on a system, structural, or policy level,
ii) care processes,
iii) biomarkers, e.g., HbA1c, and
iv) health outcomes
Likewise, these metrics had three risk tiers, e.g., confirmed diabetes diagnosis or at high risk, which they reviewed based on data availability, modifiability, and global inequality. In addition, the researchers reviewed the global distribution of each key metric to set future targets.
Finally, they proposed complementary metrics, e.g., the incidence of end-stage kidney disease and lower-extremity amputations, that need to be covered by global population-level surveillance systems.
The researchers also discussed three types of evidence to assess the global status of metrics. The first one assessed the most recent population-based estimates for realistic baselines at a national level. The second estimated trends in metric rates from various settings to find a realistic magnitude of change over time. Lastly, they estimated projected health benefits and costs incurred with meeting vis-a-vis not meeting these targets.
They also assembled data from published literature from various sources, e.g., country-based and sub-national population-based studies, to name a few.
Indeed, the GDC has set ambitious goals for diabetes management globally. Upon their attainment, they would benefit millions living with this debilitating disease.
Nonetheless, the metrics and targets of the GDC shall drive multidimensional action at individual and policy levels across nations. Primary prevention of diabetes and integrated care for those affected by diabetes would help prevent its long-term repercussions and inform the development of new metrics and targets. Achieving the targets might also substantially reduce acute heart-related complications among people with diabetes at the population level.
In addition, the authors highlighted the importance of developing improved data systems to measure complementary metrics in LMICs. Most importantly, they highlighted the need to promote what would improvements in health outcomes for people with diabetes amount to in the context of innovation in health financing, access to care, and healthcare systems.