Key Issues

  • The WHO estimated that the number of people with Diabetes in the Americas was 62 million in 2012.
  • According to the Diabetes Atlas, the number of people with diabetes will reach the 109 million mark by 2040.
  • In 2015 Health Expenditures for diabetes in the Americas were estimated at $382.6 billion (or 12-14% of health budget) and this number will increase to $445.6 billion by 2040.
  • Poorly controlled Diabetes increases the chances of premature mortality as well as chronic complications such as cardiovascular diseases, blindness, nephropathy, foot
  • ulcers and amputations.
  • In addition, people with diabetes are at higher risk of presenting tuberculosis, especially those with poor glycemic control.
  • The risk of dying from cardiovascular disease (CVD) and all causes is between two and three times higher among people with diabetes than among their peers without diabetes.
  • The cost of health care for people affected by diabetes is between two and three times higher than among peers without diabetes.
  • While diabetes and its complications are largely preventable, lack of access to quality health care services and lack of knowledge of preventive measures are widespread.
  • Studies have demonstrated that approximately one-third of people with type 2 diabetes are undiagnosed, and already present complications at the time of diagnosis.
  • People at risk for diabetes should be recommended daily consumption of fruit and vegetables 30-minute physical activity per day and maintaining a healthy weight.
  • People with diabetes should adhere to a healthy lifestyle and medication, if indicated by health provider, to ensure an adequate control of blood glucose.

What is diabetes?

Diabetes is a serious, chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

There are three major types of diabetes: type 1 diabetes which is the most frequent among children and adolescents; type 2 diabetes which is the most frequent among adults and it is linked to obesity or overweight, lack of physical activity and poor nutrition; and gestational diabetes which is a complication of pregnancy that affects an estimated 10% of pregnancies globally.

Key Actions

  1. Promote universal access to care - Universal access to health care to ensure diabetes prevention and control programs reach all sectors of the population especially those with limited resources and increased risk of type 2 diabetes.
  2. Primary Prevention of Type 2 Diabetes - Primary prevention at the population and individual level through activities such as health promotion, creation of healthy public policies focused on food, diet and physical activity, and creation of healthy environments. Make diabetes screening and prevention programs available at the first level of care so people at risk can be detected and provide guidance to prevention programs.
  3. Screening for type 2 diabetes and Impaired Fasting Glucose/Impaired Glucose Tolerance - Identification of people at risk for diabetes (with two or more risk factors for type 2 diabetes (such as a family history of diabetes, high blood pressure, a history of hyperglycemia or gestational diabetes, or overweight) where preventive services are available.
  4. Improving the management of diabetes - Standards for care and management of obesity and diabetes should be developed and implemented at the primary care level. The chronic care model is a framework to identify gaps in care with the aim of designing strategies for quality improvement. The creation of community programs within the civil society can provide additional support to people with obesity and diabetes.
  5. Secondary prevention of complications - Strategies include patient and provider education, efforts aimed at smoking cessation, increased physical activity, and healthy eating. A number of clinically proven strategies are available for the secondary prevention of complications such as CVD, nephropathy, retinopathy, blindness and amputations. The WHO package of Essential NCD Interventions in Primary Health Care (WHO — PEN) provides treatment protocols, referral criteria, an affordable list of essential medicines and technologies and templates for record keeping in primary health care.
  6. Surveillance and monitoring - Various sources of information can be used for the surveillance of diabetes and obesity in populations, including periodical population-based surveys using the WHO Steps method, health service statistics, school-based surveys and routinely collected vital statistics.
  7. Health Policies - Use fiscal, regulatory and other government powers to create environments that make the healthy choice the easier choice to make. This includes, for example, increasing taxes to reduce consumption of sugar-sweetened soda; banning advertising of unhealthy foods to children along with the sale of these foods in schools; and promoting public transportation and recreational spaces to encourage urban residents to be more physically active.

Key Actions by PAHO

PAHO is working with Member States and other partners to increase people's access to quality integrated diabetes care, including:

  • PAHO's Health Technology Manual includes a series of actions that can be taken at the first level of care to prevent or better control diabetes.
  • The Passport for Healthy Lifestyle is tool for the improvement of the management of diabetes and other chronic diseases and it is available in English, Spanish andPortuguese.
  • Implementing diabetes education courses for health professionals and people with diabetes in the PAHO Virtual Campus (currently available only in Spanish).
  • Providing training in the implementation of the integrated management of chronic diseases.
  • Providing advice and training on the implementation of patient centered care by providing self-management support.
  • Support the implementation of evidence based diabetes guidelines and protocols such as those from the Latin American Diabetes Association, and the American Diabetes Association.