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Background: WHO launched the Global Diabetes Compact in 2021 to improve worldwide diabetes outcomes by scaling up access to comprehensive, affordable, and high-quality care. This initiative established population diabetes metrics and targets for countries to attain by 2030, namely, 80% of all people with diabetes are diagnosed; and, among people with diagnosed diabetes, 80% have good glycaemic control (HbA1c <8·0%), 80% have good blood pressure control (<140/90 mm Hg), and 60% of people older than 40 years use statins. We aimed to estimate attainment of global diabetes targets worldwide and across country and individual characteristics in 2021.
Methods: We analysed pooled, individual participant data from nationally representative household health surveys done in 100 low-income, middle-income, and high-income countries between 2010 and 2023. The sample included non-pregnant adults aged 30-69 years. Diabetes was defined as use of glucose-lowering medications or biochemical evidence of diabetes (fasting plasma glucose ≥7·0 mmol/L or HbA1c ≥6·5% [48 mmol/mol]). The primary outcomes were the proportion of people attaining each diabetes metric. We analysed data using hierarchical Bayesian logistic regression models with the survey year set to 2021. We estimated the age-standardised proportion attaining each metric across the pooled dataset, by country-level characteristics such as World Bank income group, by country, and by individual-level characteristics including age, sex, educational attainment, and BMI.
Findings: In 2021, across the pooled dataset, the age-standardised proportion of people with diabetes who had been diagnosed was 63·2% (95% CI 61·8-64·6). Among those diagnosed, 63·2% (62·1-64·4) achieved glycaemic control (HbA1c <8·0%), 70·8% (69·8-71·9) achieved blood pressure control (<140/90 mm Hg), and 31·8% (30·4-33·2) were using statins. Of the 100 included countries, eight met the target for diabetes diagnosis, seven met the target for glycaemic control, 15 met the target for blood pressure control, and eight met the target for statin use. By country income group, the age-standardised proportion of people with diabetes who had been diagnosed ranged from 35·3% (33·5-37·1) in low-income countries to 69·9% (68·3-71·5) in high-income countries. Among those with diagnosed diabetes, glycaemic control ranged from 56·0% (54·2-57·8) in lower-middle-income countries to 73·7% (72·7-74·6) in high-income countries; blood pressure control ranged from 58·3% (57·3-59·4) in lower-middle-income countries to 82·4% (81·4-83·4) in high-income countries; and statin use ranged from 9·7% (8·0-11·4) in low-income countries to 58·7% (57·4-59·9) in high-income countries. Across individual-level characteristics, patterns of inequities were observed in the attainment of each metric.
Interpretation: There are pronounced inequities at multiple levels in the attainment of global diabetes metrics. Substantial progress is needed to reduce inequities and to achieve the 2030 targets.
Research in context: - Evidence before this study: We searched PubMed and Google Scholar on March 21, 2025, without language or date restrictions, using search terms in four categories: diabetes; diabetes-related metrics (control, treatment, management, care, or burden); geographical scope (cross-country, cross-national, multiple countries, worldwide, or global); and method (cross-sectional, population-representative, meta-analysis, or pooled studies and surveys). Our literature search identified previous global analyses that have estimated diabetes-related outcomes including prevalence, diagnosis, treatment, and burden. We also identified the study launching the WHO Global Diabetes Compact, which proposed population-based metrics with country-level targets to be achieved by 2030 for diabetes diagnosis, glycaemic control, blood pressure control, and statin use. Target levels were set to align with levels in the top 85th to 100th percentile of countries. To date, however, evidence on attainment of the global diabetes metrics has been based on summary estimates from previous published studies. - Added value of this study: To our knowledge, this study provides the most granular, comprehensive, and equity-focused evidence on attainment of the WHO global diabetes metrics. We directly estimated outcomes for the year 2021 using individual participant data from nationally representative health surveys in 100 countries, representing more than 75% of the global population. Several key findings emerge. First, our use of individual-level data illuminates within-country inequities that summary-level data alone cannot capture. Second, by analysing pooled data across countries, we quantify profound between-country inequities by characteristics such as World Bank income group. Third, our findings identify diagnosis and statin use as metrics with the most variation between countries. Finally, our study supports the 2030 targets as ambitious, as we found that between 7% and 15% of countries had attained each target in 2021. - Implications of all the available evidence: Rate of attainment of diabetes targets is low with marked inequities at multiple levels. Our study highlights the scale of missed opportunities and underscores the need to strengthen health systems to deliver equitable care addressing multiple risk factors (glycaemia, blood pressure, and cholesterol) for people with diabetes. These findings serve as a baseline for monitoring progress and a call to action to close global inequities in diabetes care.
Research in context: - Evidence before this study: We searched PubMed and Google Scholar on March 21, 2025, without language or date restrictions, using search terms in four categories: diabetes; diabetes-related metrics (control, treatment, management, care, or burden); geographical scope (cross-country, cross-national, multiple countries, worldwide, or global); and method (cross-sectional, population-representative, meta-analysis, or pooled studies and surveys). Our literature search identified previous global analyses that have estimated diabetes-related outcomes including prevalence, diagnosis, treatment, and burden. We also identified the study launching the WHO Global Diabetes Compact, which proposed population-based metrics with country-level targets to be achieved by 2030 for diabetes diagnosis, glycaemic control, blood pressure control, and statin use. Target levels were set to align with levels in the top 85th to 100th percentile of countries. To date, however, evidence on attainment of the global diabetes metrics has been based on summary estimates from previous published studies. - Added value of this study: To our knowledge, this study provides the most granular, comprehensive, and equity-focused evidence on attainment of the WHO global diabetes metrics. We directly estimated outcomes for the year 2021 using individual participant data from nationally representative health surveys in 100 countries, representing more than 75% of the global population. Several key findings emerge. First, our use of individual-level data illuminates within-country inequities that summary-level data alone cannot capture. Second, by analysing pooled data across countries, we quantify profound between-country inequities by characteristics such as World Bank income group. Third, our findings identify diagnosis and statin use as metrics with the most variation between countries. Finally, our study supports the 2030 targets as ambitious, as we found that between 7% and 15% of countries had attained each target in 2021. - Implications of all the available evidence: Rate of attainment of diabetes targets is low with marked inequities at multiple levels. Our study highlights the scale of missed opportunities and underscores the need to strengthen health systems to deliver equitable care addressing multiple risk factors (glycaemia, blood pressure, and cholesterol) for people with diabetes. These findings serve as a baseline for monitoring progress and a call to action to close global inequities in diabetes care.
Descrição
Global Health and Population Project on Access to Care for Cardiometabolic Diseases Collaborators: Grace S Chung, Yajuan Si, Krishna Aryal, Silver Bahendeka, José R Banegas, Till Bärnighausen, Marta Barreto, Abdul Basit, Omar Yaxmehen Bello-Chavolla, Pascal Bovet, Luisa Cc Brant, Rodrigo M Carrillo-Larco, Babangida S Chori, Renata Cífková, Sarah Cuschieri, Albertino Damasceno, Maria Dorobantu, Farshad Farzadfar, Pascal Geldsetzer, Mongal Singh Gurung, David Guwatudde, Ian R Hambleton, Christin Heidemann, Dismand Houinato, Alpamys Issanov, Jutta J Rgensen, Khem Karki, Demetre Labadarios, Jinkook Lee, Zeyu Lou, Nuno Lunet, Konstantinos Makrilakis, Deborah C Malta, João S Martins, Kibachio Joseph Mwangi, Augustine N Odili, Binur Orazumbekova, Gastón Perman, Sarah Quesnel-Crooks, Hedley Knewjen Quitana, Timothy Raxworthy, Fernando Rodríguez-Artalejo, Sahar Saeedi Moghaddam, Antonio Sarria-Santamera, Ronel Sewpal, Abla Sibai, Xueling Sim, Mafalda Sousa-Uva, Lela Sturua, Mubarak A Sulola, Giota Touloumi, Jithin Sam Varghese, Kavita Venkataraman, Yuan S Zhang, Mingqian Zheng, Rifat Atun, Sebastian Vollmer, Maja E Marcus, Michaela Theilmann, Mohammed K Ali, Edward W Gregg, Justine Davies, Jennifer Manne Goehler, David Flood.
Global Health and Population Project on Access to Care for Cardiometabolic Diseases Collaborators: Marta Barreto (INSA).
Global Health and Population Project on Access to Care for Cardiometabolic Diseases Collaborators: Marta Barreto (INSA).
Palavras-chave
Diabetes Mellitus Epidemiology Global Health Diabetes Determinantes da Saúde Estados de Saúde e de Doença Cuidados de Saúde INSEF
Contexto Educativo
Citação
Lancet Glob Health. 2026 Jan;14(1):e21-e32. doi: 10.1016/S2214-109X(25)00393-6
Editora
Elsevier