North America and the Caribbean (NAC) is a region of significant ecological, linguistic and societal diversity, with a mix of high-, middle- and low-income countries, varied economic structures, and unique health challenges, including a rising burden of non-communicable diseases like diabetes. Despite an outward appearance of innovation and sophisticated healthcare systems, it has the second-highest diabetes prevalence among International Diabetes Federation (IDF) Regions at 14% and the second-highest number of children and adolescents with type 1 diabetes at 193,000.
The two largest economies in the region are Canada and the United States, both with differing political systems, economic structures and cultural influences. The Caribbean, an expansive archipelago of over 7,000 islands, mirrors the contrasts of North America with major nations like Jamaica, Haiti and the Bahamas, along with smaller island states such as Barbados, Saint Lucia, and Trinidad and Tobago.
The NAC Region has the second-highest diabetes prevalence among IDF Regions at 14% and the second-highest number of children and adolescents with type 1 diabetes at 193,000.
The value of universal healthcare
In the face of income disparities, the economic burden of chronic conditions like diabetes can be overwhelming. Globally, an estimated USD 966 billion was spent on diabetes-related healthcare in 2021. The IDF NAC Region has the highest diabetes-related expenditure at USD 415 billion, which accounts for 43% of global spending.
This expense underscores the need for government policy to promote early screening, prevention and the implementation of Universal Health Care (UHC) systems. Already on this path, almost all the countries in the NAC region have some form of UHC to ensure health coverage for their citizens. The only outliers are the United States and Haiti.
The US, the largest and richest economy globally, relies on private insurance, with public programmes to provide coverage. However, many Americans remain uninsured or underinsured. Meanwhile, Haiti, the region’s lowest-income country, has a fragmented healthcare system and relies on NGOs, charities or private clinics.
The IDF NAC Region has the highest diabetes-related expenditure at USD 415 billion, which accounts for 43% of global spending, underscoring the need for government policy to promote early screening, prevention and the implementation of Universal Health Care (UHC) systems.
Early screening and prevention: a shared imperative
While Universal Health Care systems provide access to affordable, quality and equitable healthcare, early screening and prevention programmes associated with UHC contribute to early diagnosis of diabetes and diabetes-related complications, ultimately improving health outcomes, reducing treatment costs and saving lives. Moreover, promoting healthier lifestyles through public health well-being campaigns focused on diet, exercise and mental health can help prevent many of these conditions from developing in the first place.
The National Diabetes Surveillance System (NDSS) was established in Canada in 1999 to track diabetes prevalence, with some provinces offering free screenings through public health initiatives. The NDSS evolved to become the Canadian Chronic Disease Surveillance System (CCDSS), to provide information on 20 chronic conditions.
Caribbean nations such as the Bahamas, Barbados, Trinidad and Tobago and Jamaica have government-backed diabetes screening programmes integrated into public health clinics and community outreach initiatives. Smaller nations like Antigua and Barbuda, Saint Kitts and Nevis, Saint Vincent and the Grenadines also provide free screenings through health campaigns. However, Haiti, Grenada, Saint Lucia and Dominica lack comprehensive national screening programmes, relying on NGOs and limited government efforts.
In 2023, countries in the Caribbean region collaborated to launch initiatives on diabetes awareness and promote health education. A key project undertook early detection to reduce amputations caused by diabetes-related nerve complications. Supplies were procured and distributed to participating countries in Dominica, St. Kitts and Antigua, where teams met to develop and implement a strategy. Podiatrists from the Bahamas and Barbados, as well as the Head of the Diabetic Foot Centre in Guyana, offered technical guidance.
Despite some exceptions, the NAC region has the lowest proportion of undiagnosed diabetes among IDF regions, at 24%. This is largely due to regular screening for diabetes and diabetes awareness-raising activities.
Despite some exceptions, the NAC region has the lowest proportion of undiagnosed diabetes among IDF regions, at 24%, due largely to regular screening for diabetes and diabetes awareness-raising activities.
High cost of insulin and treatment
Insulin underpins diabetes treatment for approximately 8.4 million people worldwide living with type 1 diabetes. For more than 60 million people living with type 2 diabetes, insulin is essential to reduce the risk of diabetes-related complications like chronic kidney disease (CKD), cardiovascular disease (CVD), retinopathy and nerve disease.
The US has some of the highest insulin prices in the world. A single vial of insulin can cost over USD 300 without health insurance. This exorbitant cost forces some people to ration insulin, leading to dangerous health consequences such as diabetic ketoacidosis (DKA), which can be fatal. Although efforts have been made in the past eight years to cap the price of insulin, the cost is still not accessible to everyone. Meanwhile, in many Caribbean nations, access to insulin is often limited, and public healthcare systems struggle with supply shortages, leaving people with diabetes reliant on inconsistent imports or expensive private options.
Several countries in the Caribbean region have established free or low-cost insulin distribution programmes to improve access for people with diabetes. Furthermore, the Organization of Eastern Caribbean States (OECS) has implemented the Diabetes Prevention and Care Project, which focuses on diabetes prevention, reducing diabetes-related complications, and supporting the development of a regional diabetes registry. Beneficiary countries include Antigua and Barbuda, Dominica, Grenada, Saint Lucia, and Saint Vincent and the Grenadines.
Similarly, in Haiti, IDF partner Direct Relief, in collaboration with the Haiti Health Network, has elaborated transportation channels to ensure the delivery of insulin and supplies in difficult-to-reach areas in the north of the island.
Additionally, the WHO Global Diabetes Compact works to improve global insulin access by collaborating with governments to lower costs and expand distribution efforts, ensuring that more people in LMICs receive essential diabetes care.
Beyond insulin, people with diabetes use glucose monitors, test strips, insulin pumps and continuous glucose monitors (CGMs) to manage their condition. However, these essential devices can be prohibitively expensive without health insurance. A CGM can cost over USD 1,200 per year out-of-pocket, making it inaccessible for many people in low-income environments.
With diabetes management supplies scarce in some Caribbean nations, people rely on methods predating technological advancements, such as manual blood glucose testing. Although considered innovative for its time, this can lead to less effective monitoring and increased risk for complications.
The exorbitant cost of insulin in the US or the difficulty in obtaining insulin in other countries forces some people to ration insulin, leading to dangerous health consequences such as diabetic ketoacidosis (DKA), which can be fatal.
Populations at risk for diabetes
In the NAC region, populations with origins in the global south face a higher risk of developing type 2 diabetes due to genetic, socioeconomic and lifestyle factors.
In Canada and the United States, people of African and Latina origins are more likely to live with diabetes. Latino Americans have a 50% higher risk of type 2 diabetes, while African Americans are 60% more likely to be diagnosed. Indigenous/First Nations People face the highest risk, with rates three to five times higher than the other populations.
Looking towards the Caribbean, Afro-Caribbean communities have a greater predisposition to diabetes, often accompanied by complications such as hypertension and cardiovascular disease.
Difficulties accessing healthcare, healthy food and diabetes education are all factors contributing to the diabetes risk in low-income communities. In addition to food insecurity, many people consume processed foods and sugary drinks, sometimes missing routine screenings, all of which leads to higher rates of undiagnosed diabetes.
The NAC region may face fewer health challenges than other regions, but the rising prevalence of diabetes places an immense strain on economies and health budgets. Early screening has reduced the number of people living undiagnosed with diabetes. This success, combined with diabetes prevention initiatives and lifestyle interventions, can lead to better health outcomes and reduce healthcare costs.
While Universal Health Care systems in most countries provide a pathway to early detection and more equitable access to care, better access to healthcare and affordability of insulin and supplies are still needed. As the rate of diabetes soars globally, the NAC region needs to step up to fight the diabetes burden through policies that promote diabetes awareness, education and prevention.
