At first, the International Diabetes Federation South and Central America (SACA) region can appear homogenous, with cultural, linguistic and historical similarities. However, unique geographical, economic and population characteristics distinguish the 19 countries in the IDF SACA region. The diabetes landscape in South and Central America is characterised by an increase in diagnosis, financial burden and public health challenges.
Although the region is not one of the most at risk for diabetes, estimates released by the IDF in 2021 show that approximately 33 million adults live with some form of diabetes in the region, with a further 11 million – 1 in 3 – living undiagnosed. Moreover, 80% of patients with type 2 diabetes in the region experience diabetes-related complications, including the most common ones: cardiovascular diseases (CVD), chronic kidney disease (CKD), and neuropathy.
While type 2 diabetes is more prevalent in the SACA region, 121,000 children and adolescents live with type 1 diabetes, with about 9,500 new cases diagnosed annually in this age group.
Common challenges for people with all types of diabetes include access to insulin and supplies, and navigating healthcare systems, where a shortage of trained healthcare professionals can impede effective diabetes management.
Common challenges for people with all types of diabetes include access to insulin and supplies, and navigating healthcare systems, where a shortage of trained healthcare professionals can impede effective diabetes management.
In a region that experiences high levels of income disparity, the economic impact of the diabetes burden costs around USD 70 billion annually, forming a significant part of national health budgets. Only a few countries — Chile, Costa Rica, and Colombia — have universal health coverage for people with diabetes, while Argentina, Brazil, Guatemala, Peru, and Uruguay provide a high portion of coverage.
Some countries have incorporated national screening programmes to identify risk factors, resulting in more people being diagnosed with diabetes. When diabetes — whether type 1 or type 2— is diagnosed early, trained healthcare professionals can collaborate with their patients to set up a diabetes management plan to delay or prevent complications and maintain overall well-being.
Like other regions, the prevalence of diabetes, especially type 2 diabetes, is primarily driven by urbanisation, dietary changes and sedentary lifestyles. The last determining factor is the most alarming. Globally, 11.2 million new cases of diabetes due to physical inactivity are predicted between 2020 and 2030. In contrast, in rural settings, outside of metropoles and large cities, the prevalence is much lower, partly due to more physical activity and limited access to processed foods.
Diabetes has become a major public health issue in Brazil due to its increasing prevalence caused by lifestyle changes, ageing populations and rising obesity rates. The region’s largest and most populated country, Brazil accounts for just under half—15 million—of the region’s people with diabetes and ranks sixth globally. In the SACA region, the prevalence of type 2 diabetes is the highest in Brazil.
The public healthcare system, Sistema Único de Saúde (SUS), provides free treatment, including insulin and medications. Despite this, access to specialised care is not always straightforward, especially in rural areas. Diabetes complications like cardiovascular disease, kidney failure and limb amputations are common and add to the already overstretched healthcare system. Government initiatives focus on prevention, awareness and diabetes screening for early diagnosis. Still, socioeconomic inequalities make it challenging to reach all affected populations.
The increasing prevalence of diabetes and the need for effective diabetes management drive the uptake of diabetes technology in South and Central America. Though adoption rates vary across the region, continuous Glucose Monitoring (CGM) systems, insulin delivery devices, and digital management tools are increasingly used in diabetes management.
Ronaldo Wieselberg, an IDF diabetes advocate from Brazil, remembers all the changes in treatment that have occurred since he was diagnosed with type 1 diabetes at the age of two. In 1993, diabetes treatment was vastly different from what it is now. Multiple insulin dose therapy was new and not commonly prescribed, and technology to deliver insulin and monitor blood glucose levels was much less technologically advanced.
Nonetheless, the prohibitive cost of diabetes devices and varying levels of healthcare training hinder widespread adoption, particularly in countries with limited healthcare funding.
Like other regions, the prevalence of diabetes, especially type 2 diabetes, is primarily driven by urbanisation, dietary changes and sedentary lifestyles. Globally, 11.2 million new cases of diabetes due to physical inactivity are predicted between 2020 and 2030.
According to a study published in 2014, Indigenous people account for more than 5% of the total population in Honduras, Nicaragua, Panama, Ecuador and Peru, and more than 40% in Guatemala and Bolivia. Although Indigenous Populations are the region’s first inhabitants, they were previously underrepresented in many aspects of diabetes research.
The risk of developing diabetes and diabetes-related complications increases when lifestyle changes occur. For example, the Mapuches and Aymaras in Chile living in rural areas had the lowest rates of type 2 diabetes worldwide, at less than 1%. However, this increased to 8.2% and 6.9%, respectively, in those who moved from rural to urban environments.
Rural Indigenous populations have traditionally used local plant leaves, cacti, and tree bark to help regulate blood sugar levels. Healthy nutrition also contributes to diabetes prevention in rural communities, where whole, unprocessed foods, including beans, corn, quinoa, and other high-fibre foods, are common and help regulate blood sugar. Traditional fasting practices and meal timing may also influence glucose control. Physical activity — walking long distances, farming, and traditional dance — is a natural part of daily life in many communities and helps prevent obesity and diabetes.
Given these traditional lifestyles, tailoring diabetes prevention programmes to respect and incorporate local cultures and traditions can enhance their effectiveness and acceptance.
A second at-risk population is people of African descent, who experience higher rates of diabetes. In the region, 134 million people identify as Afro-descendants. While specific data on diabetes prevalence among Afro-descendants in SACA are limited, studies from related regions provide insights. Their findings suggest that people of African descent may have a higher predisposition to diabetes, possibly due to genetic factors, lifestyle and environmental influences. These communities often encounter starkly unequal social and economic conditions that adversely affect their health outcomes.
Genetics make Afro-descendants susceptible to sickle cell disease, an inherited red blood cell disorder in which red blood cells are crescent or “sickle” shaped and do not bend or flow easily. These sickle-shaped cells block blood flow to the rest of the body and cause repeated infections and sporadic painful episodes.
Some A1C testing methods for blood glucose may produce unreliable results for people with the sickle cell gene. Falsely high outcomes can lead to the prescription of more aggressive treatments, resulting in increased episodes of hypoglycaemia. Conversely, falsely low outcomes can lead to the undertreatment of diabetes.
Genetics make Afro-descendants susceptible to sickle cell disease. Some A1C testing methods for blood glucose may produce unreliable results for people with the sickle cell gene.
Among some of the highest consumers of sugar-sweetened beverages (SSBs) in the world, the SACA region has seen a rise in obesity and diabetes, contributing to almost a quarter (24%) of new type 2 diabetes diagnoses in 2020. The prevalence of diabetes and obesity in South America is closely linked to dietary habits, particularly the consumption of sugary drinks. The highest impact is in Colombia, where sugary drinks are responsible for almost half (48%) of all new diabetes diagnoses. Additionally, healthcare costs associated with diabetes and CVD, both linked to SSB consumption, amount to billions of dollars annually.
In response, several countries in the region have implemented measures such as taxation on sugary drinks, marketing regulations and public health campaigns. For example, Chile implemented comprehensive regulations, including front-of-package warning labels and marketing restrictions, resulting in decreased SSB consumption.
Many people with diabetes in the region live undiagnosed. Estimates suggest that around 32% of adults with diabetes are unaware of their condition in the absence of screening. Early diagnosis and intervention underpin effective diabetes management, leading to timely treatment and reducing the risk of diabetes complications and strained healthcare systems.
Diabetes research in the SACA region has largely contributed to understanding these challenges and developing targeted interventions. The region also relies heavily on the 37 IDF Member organisations to lead public diabetes awareness and advocacy. In 2023 alone, 22 Member Associations carried out 360 activities and initiatives ranging from prevention campaigns to diabetes education for healthcare professionals to community support programmes for diabetes management and mental well-being.
As the diabetes epidemic grows, we need to adapt strategies and lifestyle interventions to match changing and diverse populations. Concerted advocacy efforts in prevention, management, and access to healthcare can improve outcomes for people living with diabetes.
