Twenty years later, in 2009, it was stated in an editorial in the British Journal of Diabetes and Vascular Disease that 'despite the progress made following the St. Vincent Declaration and the UN Resolution, significant gaps still exist and urgent action is needed to stem this rising epidemic'.
[10] Such progress has been supported by the development of DIABCARE (and its analogue QUALIDIAB as it is known in French and Spanish), an integrated information system to monitor diabetes care, according to the “gold standards” of the St Vincent Declaration Action Program.
[19] The St Vincent’s, Western Pacific and Africa initiatives remain fully in force, but DOTA was discontinued as a joint venture of PAHO/WHO and IDF after two 5 year planning and implementation periods.
[20] Since then, PAHO has built instead on the CARMEN network of integrated national NCD initiatives, conceived in 1995[21] and implemented in 1997,[22] and the Pan American Forum for Action on NCDs (PAFNCDs), launched in 2009.
Useful lessons emerged: the relevance of process-related targets to achieve short to medium term success; the value of broadly based participation in gaining recognition of a major cause of disease burden at national health policy level; wide acceptance of an integrated program model; and the critical role of having a Ministry staff member designated in each country as a managerial focal point.