World Diabetes Day (WDD) on 14 November 2021 marks the beginning of a year-long campaign to raise awareness that people with diabetes need access to medicines and care that enable them to enjoy a good quality of life and avoid early death, loss of sight and amputations – and that many of them are not getting the care they need.
The number of people with diabetes in the WHO European Region is estimated to be over 60 million. Although the average incidence in the Region is 7.3% of the population, in some countries over 10% have the condition, straining economies and health systems.
Many people with diabetes are not diagnosed early enough to avoid complications, many struggle to get help with managing their condition, and many millions are not diagnosed at all. Yet exactly 100 years have passed since the invention of insulin. While there have been many advances in diabetes treatment and care, many people lack access to them.
WHO/Europe and partners are highlighting the huge gap between those who have access to insulin, other medications and support for self-management to control their diabetes, as well as essential technologies such as blood glucose meters and test strips – and those who do not.
This year’s WDD takes place as the world continues to live through the COVID-19 pandemic, which has resulted in severe disruptions to diabetes services and a high proportion of people with diabetes being hospitalized with COVID-19.
Dr Hans Henri P. Kluge, WHO Regional Director for Europe, said, “In the past 2 years, people with diabetes have experienced not only the fear of being vulnerable to hospitalization and severe outcomes of COVID-19, but also the fear of not getting the treatment, care, medicine and technologies they are used to. To many people, this fear is not even new. In some countries in our Region, there are people who have never received the care they are entitled to – and many remain undiagnosed. That has to change. We know what’s needed and we are working with partners on the Global Diabetes Compact.”
WHO’s Global Diabetes Compact was launched at the Global Diabetes Summit in April 2021 to boost efforts to reduce diabetes risk and bring equitable, comprehensive, affordable and good-quality treatment and care to all who need it. It aims specifically to decrease inequity in access to diagnosis and treatment in primary care.
The WDD campaign will highlight the direct experience of people with diabetes and their struggles for better access to patient-centred, quality care. It seeks to raise awareness among governments, key global health actors and donors of the urgent challenge before them, of the opportunities to improve access to diabetes medicines and diagnostics, and of the action needed to improve prevention, diagnosis and management through the Global Diabetes Compact.
Increasing access to diagnosis and treatment in primary care
Increasingly, countries are scrutinizing how they can best prevent diabetes, diagnose it earlier and improve the care that people with diabetes receive.
On 9 November 2021 at a national conference in Ljubljana, Slovenia presented its National Programme of Diabetes Control and Management 2020–2030. Its implementation will be ensured and monitored by detailed action plans every 2 years, which will report back on action points and guide the next 2 years. This model was established in the National Programme 2010–2020.
WHO/Europe has given its support since the early stages of the first National Programme. At the conference, representatives shared information on further support available and spoke about effective screening for diabetic retinopathy.
As well as covering essential areas such as data, monitoring, care, diagnosis, management and research, Slovenia’s new National Programme emphasizes the importance of empowerment, patient literacy and experience. It states: “On average, a person with diabetes thinks about their disease every 20 minutes, every day, for the rest of their life. Diabetes is therefore a huge burden and affects your quality of life.”
The National Programme stresses the impact of this burden: “Every day, a person with diabetes makes decisions and wonders about things that affect the outcome of treatment: which food to choose and in what quantity, how to get as much exercise as possible, whether to give up smoking and how, what is the body weight, has she taken the pill on time, whether any of them might be causing problems, whether they know how to use a blood sugar meter correctly, whether they have measured their blood sugar, what the blood sugar value means, what dose and type of insulin to use, how to adjust their insulin dose because they plan to walk faster, how to avoid too-low blood sugar values and many other questions.”
It concludes, “When a person is empowered to manage their diabetes holistically, it means that they are in control of their life.”
Global resolve at a time of disruption
It has been an intensive year for global advocacy for diabetes. In May 2021, the World Health Assembly endorsed a resolution, led by the Russian Federation, urging Member States to raise the priority given to the prevention, diagnosis and control of diabetes, as well as to the prevention and management of risk factors such as obesity.
WHO was also requested to develop recommendations and provide support for strengthening diabetes monitoring and surveillance within national noncommunicable disease programmes and to consider potential targets. WHO has been consulting with all partners on these issues. Draft recommendations and coverage targets were submitted on 1 October 2021 for consideration by the Executive Board in January 2022, and WHO will report back in May 2022.