The Global Diabetes Compact: a promising first year

One year ago, the World Health Organization (WHO), together with the Government of Canada, launched the Global Diabetes Compact – an ambitious new initiative to galvanize efforts around the world to both reduce the risk of diabetes, and ensure that all people diagnosed with diabetes have access to equitable, comprehensive, affordable and quality treatment and care.

Those responsible for the conception of the Compact were under no illusions about the immensity of the challenge.

“The fact that 100 years after the discovery of insulin, a life-saver for many people with diabetes, the treatment was still out of reach for millions of people who needed it, was a clear signal that ’business as usual’ was no longer an option,” said Dr Bente Mikkelsen, Director of the Department of Noncommunicable Diseases at the World Health Organization. “The enthusiasm that we saw among political leaders at the highest levels for the Global Diabetes Compact showed us that the motivation for a radical scale-up of efforts was widely supported.”

A World Health Assembly Resolution: an important milestone

The critical nature of scaling-up efforts to prevent and treat diabetes was made clear by the adoption by WHO Member States of a historic resolution on diabetes at the World Health Assembly in May. The Resolution recommends the integration of prevention and treatment of diabetes into primary health services, the development of pathways for a substantial increase in access to insulin, the promotion of convergence and harmonization of regulatory requirements for diabetes medicines and technologies and improved diabetes monitoring and surveillance. Furthermore, it asks WHO to advise Member States on how to ensure the uninterrupted treatment of people living with diabetes in humanitarian emergencies. This important milestone provides a global mandate for diabetes efforts for the next decade.

Meanwhile work was underway to ensure that WHO had access to leading experts to provide technical advice on matters relating to WHO’s work on diabetes. The result was the establishment of a Technical Advisory Group on Diabetes in August. The Group, chaired by Professor Amanda Adler, Professor of Diabetic Medicine and Health Policy at Oxford University, met for the first time in September 2021.

The importance of engaging a broader community beyond technical experts was very clear when the Compact was established, and in November, the first Global Diabetes Compact Forum was held. With more than 50 participants from nongovernmental organizations, academic institutions, philanthropic foundations and business associations, the Forum provided an opportunity for the exchange of information on ongoing and future activities and the sharing of ideas on future endeavours that could be organized collectively for greater impact.

Learning from people with lived experience

Hearing from and learning from people living with diabetes will help ensure that work undertaken through the Compact is focused on areas where action is most needed. Focus groups hosted by WHO brought together more than 50 individuals with lived experience early in the year for an exchange of knowledge and information to help direct WHO’s diabetes efforts. The event featured the expertise and passion of people with lived experience from over 20 countries, from Africa to the Americas to Asia, including Australia, Bosnia and Herzegovina, Brazil, Canada, Costa Rica, Ghana, India, Indonesia, Kenya, Mexico, Netherlands, Nigeria, occupied Palestinian territory, South Africa, Sweden, Tunisia,  and the United States of America. During the event, facilitated by people with lived experience from Australia, Bosnia and Herzogovina, Costa Rica, India, Mexico and the United States of America. Insights were shared on access to and the affordability of diabetes care, medicine and technologies; diabetes risk reduction and education; mental health and the stigma associated with diabetes; and research and innovation.

New report recommends key actions for better accessibility of insulin

A new report published by WHO in the lead-up to World Diabetes Day in November highlighted the alarming state of global access to insulin and diabetes care, finding that high prices, low availability of human insulin, few producers dominating the insulin market and weak health systems are the main barriers to universal access.

Recommendations made in the report for addressing these issues included boosting human insulin production, introducing pooled procurement mechanisms to bring down prices and improving transparency in price-setting. As part of efforts to address these and other issues relating to the insulin market, WHO has embarked on dialogues with the private sector on medicines and technologies for diabetes care, the last of which was held in September 2021. While these early discussions have served as a basis for setting out goals and potential activities to reach them, WHO will continue to encourage and ask the private sector for commitments and contributions with the aim of dramatically improving access to insulin and health technologies in low- and middle-income countries, as well as in humanitarian emergencies.

Making a difference at country level

The establishment of the Compact and its associated coordination activities have given added impetus to diabetes efforts within ministries of health around the world.

WHO regional and country office staff have used the opportunity to support countries in their efforts, providing technical guidance and support for advocacy efforts.

World Diabetes Day in November, when there is focused attention from media and the public health community on the topic, provided an opportunity to highlight new and ongoing initiatives.

In a special ceremony at UN City in Copenhagen the day after World Diabetes Day, the World Diabetes Foundation signed an agreement granting WHO more than US$ 900 000 for a 3-year project in support of efforts for the prevention and control of noncommunicable diseases in primary care in Kyrgyzstan and Uzbekistan. The main beneficiaries of this project will be people with diabetes and their families and carers, particularly those most in need.

Also in November, at a national conference in Ljubljana, Slovenia presented its National Programme of Diabetes Control and Management 2020–2030. Detailed action plans will be developed every two years, with reporting required at the end of each period.

In Africa, WHO has been working hard to integrate diabetes into primary care, using the WHO Package of Essential Noncommunicable disease interventions (PEN) toolkit. Seven countries  ̶  Burkina Faso, Mali, Niger, Senegal, Uganda, United Republic of Tanzania and Zimbabwe  ̶  are implementing the HEARTS package. In Mali, the training of health-care workers on managing diabetes is underway. There are ongoing projects with partners such as the International Diabetes Federation, Africa Region and Santé Diabète.

In South-East Asia, WHO’s technical guidance on diagnosis and management of type 2 diabetes, HEARTS-D, was adapted into an online training module for use by programme managers responsible for planning diabetes services and facility managers and primary care staff involved in clinical care.

Also in South-East Asia, donations of insulin were provided to Bhutan, Maldives, Nepal, Sri Lanka and Timor-Leste during 2021. While donations are not a sustainable solution to meeting population needs for diabetes medicines, they have enabled countries to meet at least some of their needs during a year when supply continued to be disrupted by the COVID-19 pandemic.

Looking ahead

Reflecting on the year since the launch of the Compact and looking ahead, Dr Bente Mikkelsen said: “In the past twelve months we have established the foundations that will enable us to collectively work towards the goals of the Global Diabetes Compact. But this is just the start. We look forward to building on the achievements of this first year with our partners around the world to make a real difference to the lives of people with diabetes. They are counting on us.”