TODAY is World Diabetes Day and it provides an opportunity to raise awareness of diabetes as a global public health issue and what needs to be done, collectively and individually, for better prevention, diagnosis and management of the condition.

Diabetes is the second-leading cause of death for Jamaicans under the age of 70 years. Locally the month of activities is being celebrated under the theme ‘Access to diabetes care… The time is now!’

The Jamaica Health and Lifestyle Survey III (2016-2017) indicates that one in every eight people, 15 years and older, has diabetes and four out of 10 people in Jamaica who have diabetes are not aware of their status

This year’s World Diabetes Day is taking place at the end of a year which has been intensive in terms of global advocacy for diabetes. World Health Organization (WHO) and partners have used the opportunity of the 100th anniversary of the discovery of insulin to highlight the huge gap between the people who need access to insulin to control their diabetes, as well as essential technologies such as blood glucose meters and test strips, and those who actually have access.

The day also comes at a time when the world continues to live through the novel coronavirus pandemic, which has not only resulted in a high proportion of people with diabetes among hospitalised patients with severe manifestations of COVID-19 and among those who have succumbed to the virus, but has also led to severe disruption of diabetes services.

The problems

We have greater knowledge than ever before about how to prevent and treat diabetes yet the number of people with diabetes is growing rapidly and the lack of access to diagnosis and treatment is causing unnecessary suffering and death, particularly in low- and middle-income countries.

More than 420 million people have diabetes. The number of people with diabetes has quadrupled since 1980 and is expected to rise beyond half a billion by the end of the decade.

The increasing prevalence of diabetes is largely caused by the increasing prevalence of obesity and physical inactivity. The prevalence of overweight and obesity among children and adolescents aged 5-19 rose dramatically from four per cent in 1975 to over 18 per cent in 2016.

Deaths from diabetes increased by 70 per cent globally between 2000 and 2019. The condition is also responsible for the largest rise in male deaths among the top 10 causes of death, with an 80 per cent increase since 2000.

Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. One in two adults with type 2 diabetes is unaware of their condition. Globally, health systems are failing to diagnose and care for people living with diabetes.

Despite the discovery of insulin 100 years ago, many children, adolescents and adults with type 1 diabetes struggle to access insulin, as well as basic technologies such as blood glucose meters and test strips.

Half of all adults with type 2 diabetes are undiagnosed. Those who are diagnosed are not guaranteed access to essential diabetes and related medicines and regular screening for complications.

A low number of manufacturers globally, due to factors including manufacturing complexity, intellectual property protection, and other practices such as regulatory and market exclusivities, has stifled market competition for insulin and delivery devices and contributed to higher prices.

The global cost of diabetes has been estimated at over US$1 trillion annually.

According to a recent WHO survey, the diabetes services in 62 per cent of WHO’s 194 member states have been partially or completely disrupted during the novel coronavirus pandemic.

This disruption serves to underscore the importance of ensuring that services for diabetes are available in primary health-care systems and can withstand disruptions such as those that have occurred during the pandemic.

The vulnerability of people with diabetes to other health complications has been highlighted by the novel coronavirus pandemic, which has resulted in a high proportion of people with diabetes among hospitalised patients with severe manifestations of COVID-19.

Diabetes is not being included sufficiently in universal health coverage packages, meaning that insulin, other diabetes medicines and associated technologies are unaffordable for many people who need them, particularly in low- and middle-income countries.

In general, primary health-care facilities in low-income countries do not have the basic technologies or essential medicines needed to diagnose and manage diabetes.

Globally, essential medicines for diabetes are reported to be generally available in about 80 per cent of facilities in the public and private health-care sectors. However, they are available in only about one-half of facilities in low- and lower middle-income countries.

Data on diabetes derived from monitoring and surveillance systems in most countries are sparse and inadequate.

Only 56 per cent of countries have recently conducted a diabetes prevalence survey, meaning that the reliability of information related to deaths from diabetes is doubtful.

The solutions

Actions for governments

Develop and strengthen monitoring systems to determine the disease and death resulting from diabetes, the diabetes treatment gap, and health system performance (capacity and interventions).

Set national diabetes monitoring and coverage targets.

Promote a healthy diet, regular physical activity and avoidance of tobacco and work with relevant sectors to address the barriers preventing a healthy lifestyle.

Include diagnosis of and treatment and care for diabetes within the primary health care system.

Strengthen referral systems between primary and other levels of care.

Strengthen health workforce and institutional capacity to detect early and manage diabetes.

Ensure that insulin is included in the national essential medicines list.

Include care for diabetes (including insulin and other medicines, insulin delivery devices and blood glucose monitoring devices) in national insurance packages.

Increase the meaningful engagement of people with diabetes on issues relating to treatment and care.

Actions for WHO

Expand efforts to promote a healthy diet, regular physical activity and avoid tobacco and work with relevant sectors to address the barriers preventing a healthy lifestyle.

Identify solutions to facilitate purchase by low- and middle-income countries of insulin, other diabetes medicines and monitoring and delivery devices; to increase the transparency of prices; and to facilitate regulation.

Provide guidance to national health authorities on inclusion of diagnosis of and care for diabetes within primary health-care systems and national insurance systems.

Actions for civil society

Maintain the visibility of diabetes on the global health and development agendas.

Monitor progress in meeting agreed targets relating to diabetes prevention and control.

Engage with processes to ensure that the voices of people with lived experience of diabetes are considered when decisions are made on policies and programming.

Source: World Health Organization and the Ministry of Health and Wellness