Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact.
Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact.
复制标题
DOI：
10.1016/s0140-6736(23)00001-6
复制
发表时间：
2023-04-15
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
在糖尿病相关发病率造成巨大且日益严重的负担以及错失采用循证护理和预防的机会的背景下，世界卫生组织（WHO）启动了《全球糖尿病契约》，优先考虑循证干预措施、资源和目标制定，以减轻全球糖尿病负担。在本报告中，我们阐述了为《契约》的主要卫生目标和指标水平提出建议的科学依据。我们考虑了4个领域的指标（结构、系统或政策层面的因素;护理流程;生物标志物和行为;健康事件和结果）和风险等级（诊断的糖尿病、高风险或整个人群）。一个专家组根据指标的健康重要性、可修改性、数据可用性及其代表差距和全球不平等领域的程度，对指标进行了审查和优先排序。我们审查了每个感兴趣指标的全球水平分布，以设定未来实现的目标水平。这一过程为联合国会员国制定了5个国家级核心指标和目标水平：1）至少80%的糖尿病患者应被诊断; 2）80%的糖尿病诊断患者的HbA 1c水平低于8.0%; 3）80%的糖尿病诊断患者的血压水平低于140/90 mmHg; 4）60%的诊断为糖尿病的患者使用他汀类药物，5）100%的1型糖尿病患者持续使用胰岛素、血糖仪和试纸。此外，我们还提出了几个补充指标，目前全球覆盖范围有限，但值得监督规模扩大。其中包括，在糖尿病患者中，记录和例行收集全因和特定原因死亡率估计数，以及终末期肾病、下肢截肢和糖尿病发病率。我们还确定了仍然需要制定指标的重要领域，包括糖尿病的一级预防和综合护理。实现《全球糖尿病契约》的总体目标将需要多部门的努力，适用于个人、卫生系统、政策和国家一级的行动。
In the context of a large and growing burden of diabetes-related morbidity and missed opportunities to employ evidence-based care and prevention, the World Health Organization (WHO) has initiated the Global Diabetes Compact to prioritize evidence-based interventions, resources, and objective-setting to reduce the global burden of diabetes. In this report we describe the scientific basis that informed the recommendations of the key health objectives and target levels for the Compact. We considered metrics across 4 domains (structural, system- or policy-level factors; processes of care; biomarkers and behaviours; and health events and outcomes) and risk tiers (diagnosed diabetes, high risk, or whole population). An expert group reviewed and prioritized metrics according to their health importance, modifiability, data availability, and the degree to which they represent gaps and areas of global inequality. We reviewed global distributions of levels for each metric of interest to set target levels for future attainment. This process led to 5 country-level core metrics and target levels for UN member states: 1) at least 80% of the persons with diabetes should be diagnosed; 2) 80% of those with diagnosed diabetes having HbA1c levels below 8.0%; 3) 80% with diagnosed diabetes having blood pressure levels below 140/90 mmHg; 4) 60% with diagnosed diabetes using statins, and, 5) 100% of persons with type 1 diabetes having continuous access to insulin, blood glucose meters andtest strips. In addition, we propose several complementary metrics that currently have limited global coverage but warrant surveillance scale-up. These include, among persons with diabetes, documentation and routine collection of all-cause and cause-specific mortality estimates, and incidence of end-stage kidney disease, lower-extremity amputations, and incidence of diabetes. We also identified important areas for which the development of metrics is still required, including primary prevention of diabetes and integrated care. Achieving the overarching goals of the Global Diabetes Compact will require multi-sectoral efforts applied to individuals, health systems, policies, and country-level actions.