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The Global Diabetes Compact is a WHO-driven initiative uniting stakeholders around
goals of reducing diabetes risk and ensuring that people with diabetes have equitable
access to comprehensive, affordable care and prevention. In this report we describe
the development and scientific basis for key health metrics, coverage, and treatment
targets accompanying the Compact. We considered metrics across four domains: factors
at a structural, system, or policy level; processes of care; behaviours and biomarkers
such as glycated haemoglobin (HbA1c); and health events and outcomes; and three risk
tiers (diagnosed diabetes, high risk, or whole population), and reviewed and prioritised
them according to their health importance, modifiability, data availability, and global
inequality.
LatviaRockvilleMarylandUnited-statesProsnitzMecklenburg-vorpommernGermanyUnited-kingdomHertenRegion-flamandeBelgiumBrazilThe COVID-19 pandemic has disproportionately affected certain groups, such as older
people (ie, >65 years), minority ethnic populations, and people with specific chronic
conditions including diabetes, cardiovascular disease, kidney disease, and some respiratory
diseases. There is now evidence of not only direct but also indirect adverse effects
of COVID-19 in people with diabetes. Recurrent lockdowns and public health measures
throughout the pandemic have restricted access to routine diabetes care, limiting
new diagnoses, and affecting self-management, routine follow-ups, and access to medications,
as well as affecting lifestyle behaviours and emotional wellbeing globally.
BrazilNew-yorkUnited-statesJapanCopenhagenKøavn-DenmarkHong-kongMotoshimaAkagawaUnited-kingdomSeiduA substantial proportion of the adult US population with type 2 diabetes (T2D) are undiagnosed, calling into question the comprehensiveness of current screening practices, which primarily rely on age, family history, and body mass index (BMI). We hypothesized that a polygenic score (PGS) may serve as a complementary tool to identify high-risk individuals. The T2D PGS maintained predictive utility after adjusting for family history and combining genetics with family history led to even more improved disease risk prediction. We observed that the PGS was meaningfully related to age of onset with implications for screening practices: there was a linear and statistically significant relationship between the PGS and T2D onset (-1.3 years per standard deviation of the PGS). Evaluation of U.S. Preventive Task Force and a simplified version of American Diabetes Association screening guidelines showed that addition of a screening criterion for those above the 90th percentile of the PGS provided a small increase the sensitivity of the screening algorithm. Among T2D-negative individuals, the T2D PGS was associated with prediabetes, where each standard deviation increase of the PGS was associated with a 23% increase in the odds of prediabetes diagnosis. Additionally, each standard deviation increase in the PGS corresponded to a 43% increase in the odds of incident T2D at one-year follow-up. Using complications and forms of clinical intervention (i.e., lifestyle modification, metformin treatment, or insulin treatment) as proxies for advanced illness we also found statistically significant associations between the T2D PGS and insulin treatment and diabetic neuropathy. Importantly, we were able to replicate many findings in a Hispanic/Latino cohort from our database, highlighting the value of the T2D PGS as a clinical tool for individuals with ancestry other than European. In this group, the T2D PGS provided additional disease risk information beyond that offered by traditional screening methodologies. The T2D PGS also had predictive value for the age of onset and for prediabetes among T2D-negative Hispanic/Latino participants. These findings strengthen the notion that a T2D PGS could play a role in the clinical setting across multiple ancestries, potentially improving T2D screening practices, risk stratification, and disease management.
San-diegoCaliforniaUnited-statesTexasAmericaAmericanPattillo-smithJb-meigset-alAssociation-of-polygenic-risk-scoreUs-preventive-service-taskMe-personal-genome-serviceNational-institute-of-diabetes