Despite recent global efforts to address the diabetes pandemic, the number of people living with diabetes is at an all-time high, reaching an estimated 537 million people in 2021. The projections are stark, with most countries off-track to achieve the World Health Organization (WHO) target of 0% increase in diabetes prevalence by 2025.
To accelerate progress on diabetes and other non-communicable diseases (NCDs), WHO has developed an Implementation Roadmap that includes diabetes recommendations and a set of diabetes coverage targets for the period 2023-30. The targets were adopted at the 75th World Health Assembly (23-29 May, 2022) and will guide Member State action on diabetes in the coming years.
The WHO targets are:
- Target 1: 80% of people with diabetes are diagnosed
- Target 2: 80% of people diagnosed have a good control of glycaemia
- Target 3: 80% of people diagnosed have a good control of blood pressure
- Target 4: 60% of people with diabetes over 40 years receive statins
- Target 5: 100% of people with T1D have access to affordable insulin treatment and blood glucose self-monitoring
We spoke with Prof Stephen Colagiuri, Vice-President of the International Diabetes Federation (IDF), about the potential of these targets to improve the lives of people living with diabetes over the next decade.
In 2013, WHO adopted some NCD-related targets, including 0% increase in obesity and type 2 diabetes and 80% access to essential medicines and technologies. Have Member States done enough to address diabetes and improve access to care over the last decade?
In recent years we have seen increasing political interest in diabetes, due to its growing human and economic impact. However, progress on halting the rising prevalence of the condition and improving care has been limited and uneven. The vast majority of countries are off-track to achieve the target of 0% increase in type 2 diabetes prevalence – and most of those that are on-track (8 for diabetes in men, and 19 for diabetes in women) are in Europe.
When it comes to access to diabetes medication and devices, we know that many people with diabetes do not have reliable and affordable access – particularly in low- and middle-income countries. We estimate that over 30 million people with type 2 diabetes and thousands of people with type 1 diabetes do not have access to the insulin they need to manage their condition. We can therefore conclude that while we welcome the efforts of Member States, unfortunately they have not been sufficient to meet the 2013 WHO targets.
Why has WHO developed these diabetes coverage targets now and how did they come up with them?
The diabetes coverage targets were developed after consultation with experts in the field and civil society organisations, including IDF. They were developed as part of the WHO Implementation Roadmap 2023-2030 for the Global Action Plan for NCDs Prevention and Control, and are a core component of the WHO Global Diabetes Compact, a framework launched in 2021 to mark the centenary of the discovery of therapeutic insulin. The Compact aims to reduce the number of people affected by type 2 diabetes and ensure that all people diagnosed with diabetes have access to equitable, comprehensive, affordable and quality treatment and care.
Are the targets realistic and does IDF agree with them?
Yes, the experts who worked on modelling the targets concluded that achieving them is completely feasible, provided that Member States dedicate sufficient human and financial resources to act on diabetes and monitor progress.
IDF agrees with the targets and believes they provide a great opportunity to improve the lives of the more than half a billion people currently living with diabetes worldwide. However, IDF encourages countries with the capacity to go beyond these targets to do so – particularly with regard to diagnosing diabetes. The 80% diabetes diagnosis target falls short of expectations when it comes to people living with type 1 diabetes, where the target should be 100% diagnosis to ensure timely access to life-saving insulin treatment.
What will be needed to achieve the targets by 2030?
Member States need to start acting on diabetes now if the targets are to be achieved by 2030. This will require dedicating sufficient resources to raise awareness of diabetes, so that their populations can understand how to recognise the symptoms and risk factors and when to consult a healthcare professional. They also need to invest in the training of healthcare professionals to improve diabetes diagnosis rates and provide the best available treatment and care. Global action is also required to address barriers to access to affordable medicines, including insulin. It is hard to believe that 100 years after the discovery of therapeutic insulin, millions of people with diabetes across the world do not have access to affordable insulin and that children and adolescents with type 1 diabetes are dying from a lack of life-saving insulin. This is a humanitarian crisis that could be solved with concerted action from all public and private players involved in the insulin production and supply chain.
What does achieving these targets potentially mean for the global diabetes community?
Achieving the targets on diagnosis, blood glucose and blood pressure control, and access to statins would reduce the prevalence of diabetes-related complications. This would result in improved quality of life for many of the 640 million people that IDF estimates will be living with the condition in 2030. In addition, this would have a significant economic impact on individuals, their families and the broader community. Efforts to achieve the target of 100% access to affordable insulin and blood-glucose self-monitoring will help avoid preventable deaths resulting from insufficient access to the essential care that people with type 1 diabetes need.
