The key to managing diabetes, one of the world’s most prevalent non-communicable diseases (NCDs), lies more in self-care skills than pills.  Leaders meeting at the United Nations next month to decide on how to address NCDs need to take note.

In 2022, the World Health Organization (WHO) reported that the number of people living with diabetes had reached a staggering 830 million globally. Of this demographic, around 80% are in low- and middle-income countries (LMICs) where getting diagnosed and accessing quality care, like medication, can be challenging. 

The lack of diagnosis can lead to inadequate diabetes control and the emergence of disease-related comorbidities. It is important to note that currently, less than 10% of patients in LMICs successfully manage their cholesterol, blood pressure, or blood glucose.

More urgently, of the four main NCDs, many of which are preventable, diabetes is the only condition where premature mortality rates are still rising. We need to turn the tide now.

Bridging the care gap 

To help address this challenge, the WHO established the Global Diabetes Compact in 2021. It operates with a clear mandate to ensure everyone living with diabetes gets accessible, equitable, comprehensive, and affordable care. 

One of the main workstreams is on prevention, health promotion and health literacy, including self-care. While strengthening health care systems and improving access to health care, diabetes medicines and technology remain a priority, it is critical that we amplify self-care as it enables people to make active and informed health decisions.

WHO recognizes health literacy as an asset for personal, social and cultural development. Health literacy is a social health determinant, an empowering capacity in health promotion strategies and a potential target of health equity initiatives and other health-related initiatives in groups experiencing social exclusion. 

Unfortunately, many people have poor health literacy, which limits their ability to engage in decisions regarding their own, their families’, and their communities’ health and well-being.

To elevate the levels of health literacy, WHO has developed a European roadmap for the implementation of health literacy initiatives through the life course and WHO Global recommendations to focus on improving self-care through improving health literacy.  Health literacy is a critical enabler of self-care as it empowers people and societies to improve their health in the context of everyday life.

Self-care is the ability of a person, family or community to promote and maintain their own health, helping prevent disease and manage illness, either independently or in the presence of a health worker. 

It is an integral and essential part of treatment for chronic conditions like diabetes and can lead to better health outcomes and improved quality of life. Currently underprioritized, health literacy, including self-care, has significant potential to advance person-centered care as it covers a broad spectrum from informal grassroots initiatives to therapeutic education carried out by trained health professionals and adapted to the needs of each individual.

Self-care models

Over the past couple of decades, the World Diabetes Foundation (WDF) has supported self-care models across a range of low- and middle-income contexts, notably with hyperglycemia in pregnancy, which affects 21 million mothers annually. In this area, we have seen that severe health risks to mother and offspring can be prevented if women receive tools to monitor and manage blood sugar levels from home, as well as guidance on observing a healthy diet.

Another example is the benefit of peer support. From Cambodia, through to Georgia and Mali, patient clubs, supported by WDF, are now spreading throughout local communities. These clubs provide a network for people living with diabetes to share their experiences, address challenges and organize physical activities like walking groups.

These experiences have taught us that self-care spreads through an individual to the people around them, who often play an important role in providing care and encouraging lifestyle changes. These benefits are most felt when the family is on-board to provide wide-ranging support from measuring out insulin doses for mothers with failing eyesight to checking the feet of fathers with neuropathy so they can avoid ulcers or amputation.

These examples also underscore the need for all partners to come together to strengthen self-care from the UN, NGOs, foundations and people with lived experience.

UN High-Level Meeting on NCDs

We have less than one month before heads of state and governments convene for the Fourth United Nations High-Level Meeting on NCDs and Mental Health on 25 September in New York to agree on a new Political Declaration.

Only a few weeks are left to accelerate action and influence policy to make sure people living with non-communicable diseases like diabetes are better supported and that empowerment starts to come into action. 

The WHO’s definition of self-care is “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health-care provider”. 

This, underpinned by the key principles of ethics and human rights, must come into force, be recognized and supported and be part of the Political Declaration. 

Self-care interventions can also strengthen national institutions with efficient use of domestic resources for health and improve primary healthcare, and contribute to achieving Universal Health Coverage.

We have the momentum and occasion to change the world of NCDs and mental health. Let’s advocate for health literacy and self-care to be recognized and prioritized as part of NCD reduction, prevention, and management strategies. 

This is our chance to make sure the power of people living with and affected by NCDs and mental health is no longer overlooked and that prevention and control for diabetes will be addressed at a national, regional, and global level. Self-care is not a luxury, nor an option; it is a must.

Dr Bente Mikkelsen is currently the director of global engagement strategies at St Jude Global, St Jude Children’s Research Hospital. She is also a board member of the World Diabetes Foundation. She was previously director of Non-Communicable Diseases at the World Health Organization Headquarters in Geneva, Switzerland, a post she had held since 2020. Before this appointment, Dr Mikkelsen was director of the Division of NCDs and Promoting Health through the Life course at the WHO Europe office, and headed the Secretariat for the Global Coordination Mechanism on the Prevention and Control of NCDs from its inception in 2014.

Sanne Frost Helt is the World Diabetes Foundation’s senior director of policy, programme, and partnerships. She has more than 20 years’ experience in international development cooperation and partnerships, including as Denmark’s representative to the Board of the World Bank and as Chief Advisor for Global Health at Denmark’s Ministry of Foreign Affairs.

Image Credits: Muhidin Issa Michuzi, World Diabetes Foundation.