Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact

Abstract

The Global Diabetes Compact is a World Health Organization-driven initiative uniting stakeholders around goals of reducing diabetes risk and ensuring that those with diabetes have equitable access to comprehensive, affordable care and prevention. In this report we describe the development and scientific basis for key health metrics and coverage and treatment target levels accompanying the Compact. We considered metrics across four domains (structural, system- or policy-level factors; processes of care; biomarkers and behaviours; and health events and outcomes) and three risk tiers (diagnosed diabetes, high risk, or whole population) and reviewed and prioritized them according to their health importance, modifiability, data availability and global inequality. We reviewed global distributions of levels for each metric to set target levels for future attainment. This process led to 5 country-level core metrics and target levels for UN member states: 1) at least 80% of the persons with diabetes are diagnosed; 2) 80% of those with diagnosed diabetes having HbA1c levels below 8.0%; 3) 80% with diagnosed diabetes having blood pressure levels below 140/90 mmHg; 4) 60% with persons aged > 40 with diagnosed diabetes using statins, and, 5) 100% of persons with type 1 diabetes having continuous access to insulin, blood glucose meters and test strips. We also propose several complementary metrics that currently have limited global coverage but warrant scale-up in population based surveillance systems, including collection of data and estimation of cause-specific mortality, and incidence of end-stage kidney disease, lower-extremity amputations, and incidence of diabetes. Primary prevention of diabetes and integrated care to prevent long-term complications remain important areas to develop and validate new metrics. These metrics and targets are intended to drive multi-sectoral action applied to individuals, health systems, policies, and country-level health care access to achieve the goals of the Global Diabetes Compact. Although ambitious, their achievement can result in broad health benefits for the growing global population with diabetes.