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Worldwide, the number of people living with diabetes (PLWD) has increased from 108 million to 420 million in the last thirty years; 62 million people with diabetes are in the Region of the Americas. This number has increased over three-fold in the Region since 1980 and could be even higher since 40% of PLWD are unaware of their condition and undiagnosed.

The burden of disease associated with diabetes is enormous and growing: in just 20 years, mortality from diabetes has increased by 70% worldwide. In the Region of the Americas, it is the sixth leading cause of death and the seventh leading cause of years of life lost prematurely.

In the Region, diabetes (including diabetes-related kidney disease) causes the loss due to premature death of more than eight million years of life each year. Nearly half of premature deaths in the Americas are due to diabetes. In just 20 years, the number of disability-adjusted life years (DALYs) due to diabetes increased by 88%. This increase reaches 97% in men. Diabetes is currently the second leading cause of DALYs, preceded only by ischemic heart disease.

People living with diabetes are at higher risk of severe illness and death from other diseases:

• Diabetes is among the top five health-related risk factors for tuberculosis.
• Diabetes is the leading cause of blindness in people ages 40 to 74 years.
• Depression is twice as common in PLWD than in those without diabetes.
• The stress and anxiety produced by living with diabetes negatively impact the disease's evolution due to insufficient self-care, lack of adherence to treatment, and episodes of hypo or hyperglycemia.
• People living with diabetes have up to three times the risk of dying from cardiovascular disease, kidney disease, or cancer.
• People living with diabetes have double the risk of developing a severe condition and of dying from COVID-19.

Keeping blood glucose levels well controlled lowers the risk of severe illness or death; unfortunately, 50% to 70% of PLWD have uncontrolled blood glucose levels.

The expansive increase in the diabetes epidemic goes hand in hand with the rise in its risk factors. The Americas is the most overweight/obese and physically inactive region in the world: 63 out of 100 adults are overweight or obese, and 39 out of 100 people have insufficient physical activity.

The increase in risk factors for diabetes is alarming in children and adolescents. Thirty-two out of 100 adolescents and 36 out of 100 children are overweight or obese, while 81 out of 100 adolescents engage in insufficient physical activity.

People living with diabetes face different barriers to accessing health care:

• Treatment for diabetes and its complications can be costly and often requires high out-of-pocket expenses.
• Insulin is crucial to sustaining the lives of people with type 1 diabetes and many with type 2 diabetes.  
• In many countries, diabetes care is not included in universal health coverage, and there are gaps in primary health care services and access to other care levels.

The COVID-19 pandemic has seriously affected access to diabetes health services. Despite the association between diabetes and COVID-19 and the need for continuous and uninterrupted care for people living with the disease, in many countries, COVID-19 preparedness and response plans do not include services for diabetes.

Halting the rise in diabetes is possible and goes hand in hand with implementing strategies such as:

• Prevention of diabetes and its risk factors, especially overweight/obesity and insufficient physical activity.
• Screening for diabetes in the general population and closely monitoring the population at risk.
• Improving the diagnostic capacity of health services for diabetes.
• Continuous monitoring of people living with diabetes.
• The capacity for referral and care at the secondary health care level.
• Access to quality diabetes education, which guarantees adequate training for the healthcare team, people living with diabetes, their immediate environment, their caregivers, and society in general.
• Access to essential diabetes medicines and technologies, including insulin.
• Information systems for data collection for monitoring and surveillance of diabetes.

The change caused by the COVID-19 pandemic makes it essential to integrate evidence-based digital solutions, such as telemedicine and educational and monitoring applications in diabetes health care.

Diabetes care should be part of preparedness and response to health emergencies. People living with diabetes must be guaranteed the uninterrupted availability of their medicines in situations of this type.

PAHO/WHO offers technical assistance and provides resources, including:

• The HEARTS–D technical package: Diagnosis and management of type 2 diabetes.
• The WHO package of essential noncommunicable (PEN) disease interventions for primary health care.
• The Health Technology Manual: Improving the Integrated Management of Chronic Diseases at the First Level of Health Care Services
• The Passport to Healthy Lifestyle.
• The technical document "Best buys" for the prevention and control of non-communicable diseases.
• The PAHO Strategic Fund can help countries increase access to and availability of essential medicines, including insulin and other diabetes medicines and technologies.

The Global Diabetes Compact aims to support countries in the development, implementation, and evaluation of cost-effective programs that reduce the risk of diabetes and guarantee that all people who require it have access to diabetes care that is quality, equitable, comprehensive, and affordable.