The number of people with diabetes has doubled over the past 30 years to more than 800 million worldwide, according to an international study.
The global analysis published in the Lancet found that diabetes rates in adults doubled from 7% to 14% between 1990 and 2022, with the largest increase in low- and middle-income countries.
The study is the first global analysis of diabetes rates and treatment across countries. Scientists at NCD-RisC in collaboration with the World Health Organization used data from more than 140 million people aged 18 and over from more than 1,000 studies in different countries. They applied statistical tools to enable accurate comparisons of prevalence and treatment across countries and regions.
How is diabetes caused?
Diabetes is a chronic disease caused when the pancreas does not produce enough insulin or the body cannot effectively use the insulin it does produce. Uncontrolled diabetes can cause hyperglycemia, or high blood sugar, which over time can cause serious damage to many body systems, especially nerves and blood vessels.
Type 1 diabetes is an autoimmune disease in which the body destroys the cells in the pancreas that produce insulin. Type 2 diabetes is a metabolic disorder that prevents the body from using insulin properly. More than 95% of people with diabetes have type 2 diabetes. Unlike type 1, type 2 diabetes is largely preventable. Being overweight, eating unhealthy and not exercising enough, as well as genetic factors, can increase the risk of developing diabetes.
The study highlighted growing health inequalities. More than half of global diabetes cases were concentrated in four countries. Of the people with diabetes in 2022, more than a quarter (212 million) lived in India, 148 million were in China, 42 million were in the US and 36 million in Pakistan. Indonesia and Brazil accounted for another 25 million and 22 million cases respectively.
In some countries in the Pacific Islands, the Caribbean, the Middle East and North Africa, more than 25% of the female and male population have diabetes, the study found, while the US (12.5%) and the UK (8.8%) had diabetes .
In contrast, diabetes rates in 2022 were as low as 2-4% for women in France, Denmark, Spain, Switzerland and Sweden, and 3-5% for men in Denmark, France, Uganda, Kenya, Malawi, Spain and Rwanda.
The increase in obesity, together with the aging of the global population means that an increasing number of people are at greater risk of developing type 2 diabetes.
Dr Ranjit Mohan Anjana, joint first author and president of the Madras Diabetes Research Foundation in India, said: "Our findings highlight the need to look at more ambitious policies, particularly in lower-income regions of the world, that limit unhealthy foods, make healthy foods affordable and improve opportunities to exercise, through measures such as healthy food subsidies and free healthy school meals. and promoting safe places to walk and exercise, including free admission to public parks and fitness centers.”
Despite the availability of effective, off-patent glucose-lowering medications, the lack of treatment is also driving disparities, the study found. While many, often higher-income countries have seen large improvements in treatment rates, with more than 55% of diabetic adults receiving treatment in 2022, for many low- and middle-income countries the percentage receiving treatment has not improved.
As a result, more than half of adults with diabetes — 445 million (59%) — aged 30 and older did not receive treatment in 2022.
A senior author of the study, Prof Majid Ezzati, of Imperial College London, said: "Our study highlights growing global inequalities, with treatment rates lagging in many low- and middle-income countries, where the number of adults with diabetes is increasing dramatically. This is of particular concern as people with diabetes tend to be younger in low-income countries and, in the absence of effective treatment, are at risk of lifelong complications, including amputation, heart disease, kidney damage or loss of vision to some extent, premature death."
The researchers concluded that policymakers should adopt prevention strategies, expand access to screening, and support initiatives for better long-term management of this disease.
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