Pan American Health Organization · 1st edition, 2022
Regional epidemiological report on diabetes burden, risk factors, complications, and national response capacity for clinicians and public-health professionals.
- Issuer
- Pan American Health Organization
- Edition
- 1st edition, 2022
- Audience
- Clinicians, public health professionals, policymakers, NCD programme managers
- Evidence
- Compiled from WHO Global Health Estimates (2000–2019), NCD Country Capacity Survey (2021), population-based surveys, published literature
- Reviewed
- 18 Oct 2026 · GMJ
What this guideline says
GMJ summary
The Panorama of Diabetes in the Americas presents comprehensive data on the diabetes epidemic across the Region. In 2019, diabetes caused 284,049 deaths (age-standardized mortality rate 20.9 per 100,000 population) and is the second leading cause of disability-adjusted life-years (DALYs) in the Americas. The age-standardized prevalence of raised fasting glucose/diabetes reached 8.3% in 2014, with projections showing continued increases through 2025. The report reveals striking geographic disparities: the highest mortality rates occur in Guyana (82.6 per 100,000), Mexico (71.8 per 100,000), and Trinidad and Tobago (69.6 per 100,000), while the lowest are in Canada (7.2 per 100,000), Cuba (8.5 per 100,000), and Colombia (9.1 per 100,000).
The Americas faces the highest global prevalence of diabetes risk factors. Overweight and obesity prevalence reached 62.5% in adults (2016), with a 17.3% increase since 2000. Among adolescents aged 10–19 years, 31.7% are overweight—nearly double the global rate—and obesity prevalence increased 60% between 2000 and 2016. Nearly 40% of the adult population is insufficiently physically active, and among adolescents this reaches 80.7%. Raised blood pressure affects 17.6% of adults. These risk factor trends explain the projected continued rise in diabetes prevalence across all countries.
The report documents national capacity for diabetes prevention and control based on the 2021 NCD Country Capacity Survey. While 33 of 35 countries reported having a national NCD policy including diabetes, only 19 (54%) have operational plans, and only 7 countries have specific diabetes policies. Essential medicines are generally available: 100% of countries reported metformin availability, 97% sulfonylureas, and 91% insulin in public pharmacies. However, only 12 countries (34%) reported having all six basic technologies for diabetes management available in 50% or more of public facilities. Population-based surveys with blood glucose measurement in the past five years were conducted in only 13 countries (37%). The report highlights diabetes complications (retinopathy, nephropathy, neuropathy), comorbidities (cardiovascular disease, tuberculosis, COVID-19), and the particularly high burden in indigenous populations.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Diabetes prevalence (raised fasting glucose ≥7.0 mmol/L or on treatment) is 8.3% age-standardized (2014), ranging from 5.5% (Canada) to 14.5% (Saint Kitts and Nevis, Saint Lucia), with all countries showing increases from 2000 to 2014
- Diabetes mortality: 284,049 deaths in 2019, age-standardized rate 20.9 per 100,000 population (male 23.1, female 18.9), with highest rates in Guyana (82.6), Mexico (71.8), and Trinidad and Tobago (69.6 per 100,000)
- Overweight/obesity (BMI >25 kg/m²) prevalence is 62.5% in adults (2016), with 31.7% of adolescents aged 10–19 years overweight (nearly double the global rate)
- Insufficient physical activity affects 39.3% of adults and 80.7% of adolescents aged 13–15 years in the Americas
- Raised blood pressure (SBP ≥140 or DBP ≥90 mmHg) prevalence is 17.6% in adults (2015), ranging from 12.9% (United States) to 27.1% (Saint Lucia)
- Essential diabetes medicines generally available in public sector: metformin in 100% of countries, sulfonylureas in 97%, insulin in 91%, but only 34% of countries have all six basic technologies (blood glucose equipment, oral glucose tolerance test, HbA1c test, fundus examination, tuning fork, urine test strips) in ≥50% of facilities
- Diabetic retinopathy prevalence is 34.6% globally in people with diabetes, with proliferative retinopathy in 6.96% and diabetic macular edema in 6.81%; prevalence in Mexican Americans reaches 48%
- People with diabetes have 2–5 times higher risk of cardiovascular disease mortality and twice the odds of severe COVID-19 disease
Examples of diabetes policies, strategies, or operational plans in countries of the Region of the Americas, 2021
Table extracted from the guideline
| Country | Document title | Electronic reference |
|---|---|---|
| Argentina | (a) National Law 23.753/89; (b) Resolution 301/99. National Diabetes Program (PRONADIA) | (a) https://bancos.salud.gob.ar/…/ley-nacional-diabetes-23753.pdf; (b) http://servicios.infoleg.gob.ar/…/57326/norma.htm |
| Brazil | Law 13.895 Establishes the National Policy for Diabetes Prevention and Comprehensive Assistance to Diabetic Persons | http://www.planalto.gov.br/ccivil_03/_ato2019-2022/2019/lei/L13895.htm |
| Cuba | National Diabetes Program | https://extranet.who.int/ncdccs/Data/CUB_B6_Programa%20Nacional%20de%20Diabetes%20Cuba..pdf |
| Ecuador | Law 32 for the prevention, protection and comprehensive care of people suffering from diabetes | https://www.salud.gob.ec/wp-content/uploads/downloads/2014/09/Normativa-Ley-de-Prevención-Protección-y-Atención-de-la-Diabetes.pdf |
| Mexico | Official Mexican STANDARD NOM-015-SSA2-2010, For the prevention, treatment and control of diabetes mellitus | http://www.dof.gob.mx/normasOficiales/4215/salud/salud.htm |
| Peru | (a) Law 28553. General law for the protection of people with diabetes; (b) Decree 009-2008-SA. Regulation of the general law | (a) https://docs.peru.justia.com/federales/leyes/28553-jun-17-2005.pdf; (b) https://www.gob.pe/institucion/minsa/normas-legales/248268-009-2008-sa |
| United States | Healthy People 2030: Diabetes | https://health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes |
Source: Pan American Health Organization, Panorama of Diabetes in the Americas. Reproduced in summary form.
From the guideline
Verbatim
“In the Americas, the situation is more serious than at the global level. In 2016, the prevalence of overweight in adolescents of both sexes reached 31.7%, almost double that observed worldwide.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute of Georgia, I find this report particularly relevant for our region because it demonstrates the critical link between economic transition and cardiometabolic disease that we are witnessing in Georgia and neighbouring countries. The most actionable recommendation for Georgian clinicians is ensuring availability of the six basic diabetes technologies—blood glucose measurement, oral glucose tolerance tests, HbA1c testing, fundus examination, tuning fork testing, and urine test strips—in primary care facilities, as the report shows only 34% of countries in the Americas achieve this standard. Georgia's Universal Health Care programme, established in 2013, provides a framework for systematic implementation, but we must prioritize these essential diagnostics alongside medicines. The report's documentation that 80.7% of adolescents in the Americas are insufficiently physically active, with obesity prevalence increasing 60% between 2000 and 2016, should inform our school-based prevention programmes and urban planning policies. One implementation caveat is that population-based surveys with blood glucose measurement—conducted in only 37% of Americas countries in the past five years—require sustained funding and laboratory capacity that must be built systematically rather than through one-off surveys.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 18 Oct 2026
Applicability
Georgia and the South Caucasus
Georgia and the South Caucasus face similar diabetes challenges to those documented in the Americas. The Region of the Americas shows that countries with rapid economic transition experience sharp increases in overweight/obesity and diabetes prevalence, a pattern relevant to Georgia, Armenia, and Azerbaijan. The report’s finding that only 34% of countries have all six basic technologies for diabetes management in ≥50% of public facilities highlights the importance of strengthening primary care capacity—a priority aligned with Georgia’s Universal Health Care programme established in 2013. The documented relationship between diabetes and tuberculosis is particularly relevant for the South Caucasus, where tuberculosis incidence remains elevated. National diabetes programmes should consider the report’s evidence that population-based surveys with blood glucose measurement (conducted in only 37% of Americas countries in the past five years) are essential for monitoring trends and evaluating interventions. The high burden in indigenous populations underscores the need for health equity approaches in ethnically diverse regions. Georgia’s public health system would benefit from implementing the six basic diabetes technologies systematically: blood glucose measurement equipment, oral glucose tolerance tests, HbA1c testing, fundus examinations, tuning fork for neuropathy screening, and urine test strips—ensuring availability in primary care facilities nationwide.
Questions this guideline answers
Quick answers
What is the current diabetes prevalence in the Americas and how does it compare globally?
The age-standardized prevalence of raised fasting blood glucose/diabetes in the Americas was 8.3% in 2014 (the latest year for comparable estimates), similar to the global prevalence of 8.5%. However, the Americas has the second-highest burden of diabetes-related disability-adjusted life-years (DALYs) among all WHO regions. All countries in the Region showed increases in diabetes prevalence between 2000 and 2014, and projections indicate continued increases through at least 2025. Country-specific prevalence ranges from 5.5% (Canada) to 14.5% (Saint Kitts and Nevis, Saint Lucia). The Americas also has the highest global prevalence of key diabetes risk factors: overweight/obesity affects 62.5% of adults (versus lower global rates), and 39.3% of adults are insufficiently physically active.
Which essential medicines and technologies for diabetes management are available in the Americas?
Based on the 2021 NCD Country Capacity Survey of 35 countries, essential diabetes medicines are generally available in public sector pharmacies: metformin in 100% of countries, sulfonylureas in 97%, and insulin in 91%. However, availability of basic technologies for diabetes management and monitoring is inadequate: only 12 countries (34%) reported having all six basic technologies in 50% or more of public health facilities. The six basic technologies are: equipment for measuring blood glucose (94% of countries), oral glucose tolerance tests (69%), tests to measure HbA1c (54%), fundus examination equipment (51%), tuning fork for diabetic foot screening (51%), and urine test strips for glucose and ketones (57%). Additionally, 97% of countries (34 of 35) have evidence-based national guidelines for diabetes management, but only 74% report use in more than 50% of health facilities.
What are the main complications of diabetes and their prevalence?
Diabetes causes microvascular complications (diabetic retinopathy, nephropathy, neuropathy) and macrovascular complications (coronary heart disease, peripheral artery disease, stroke). Diabetic retinopathy: global prevalence of any retinopathy is 34.6% in people with diabetes, with 6.96% having proliferative retinopathy and 6.81% having diabetic macular edema; a study in Mexican Americans found 48% prevalence of diabetic retinopathy. Chronic kidney disease affects 12–55% of people with diabetes globally; in the United States, 36.9% of adults with diabetes had chronic kidney disease in 2018. Diabetic foot disease leads to lower extremity amputations at rates 10–20 times higher than in people without diabetes; in Costa Rica, the incidence of lower extremity amputations was 6.02 per 1,000 person-years. People with diabetes have 2–5 times higher cardiovascular disease mortality; in Mexico City, diabetes was associated with about four times the cardiovascular death rate.
How does diabetes interact with tuberculosis and COVID-19?
Diabetes and tuberculosis have a bidirectional relationship: diabetes increases susceptibility to tuberculosis infection, risk of latent infection progression, relapse, and death, while tuberculosis can trigger diabetes onset and worsen glycemic control. Globally, 350,000 incident tuberculosis cases were attributable to diabetes in 2019. In the Americas, 11,000 (4%) of new tuberculosis cases were associated with diabetes in 2018, with 28 countries reporting 21,135 (10.1%) of notified tuberculosis cases involving comorbid diabetes, ranging from 2.6% (Panama) to 40% (Puerto Rico). For COVID-19, people with diabetes have twice the odds of developing severe disease, are twice as likely to require intensive care and ventilators, and have twice the mortality risk. This increased risk persists even without other comorbidities and decreases with well-controlled blood glucose. The COVID-19 pandemic disrupted essential health services: 46% of evaluated services in the Americas reported disruptions, with more than 40% of countries reporting disruptions to NCD services including diabetes management.
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- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- 1st edition, 2022
- Status
- Current
- Published
- 2022-01-01
- Languages
- English, Spanish
- Scope
- Regional epidemiological report covering 35 countries in the Americas
- Audience
- Clinicians, public health professionals, policymakers, NCD programme managers
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-75-12633-2 (PDF)
- Evidence
- Compiled from WHO Global Health Estimates (2000–2019), NCD Country Capacity Survey (2021), population-based surveys, published literature
- Record history
- Created 18 Oct 2026 · updated 18 Oct 2026 · next check Apr 2027
Pan American Health Organization. Panorama of Diabetes in the Americas. Washington, DC: PAHO; 2022. Available from: https://doi.org/10.37774/9789275126332GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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