World Diabetes Day: New research cautions of alarming global prevalence and widening treatment gaps

In 2022, an estimated 828 million adults had diabetes worldwide, an increase of 630 million compared to 1990, according to a new study. More than half of diagnosed patients (59%) aged 30 or older did not receive treatment — 3.5 times the number in 1990. The researchers caution that the burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries, where treatment did not increase sufficiently at pace with surging diabetes prevalence.

The study published in The Lancet uses data from 1,108 studies, with 141 million participants over 18 from 175 countries. These studies included measurements of fasting glucose and glycated hemoglobin levels and treatment information. 

The WHO, which supported the research conducted by the NCD Risk Factor Collaboration, observes an “urgent need for stronger global action” to address rising rates and widening treatment gaps. 

“We have seen an alarming rise in diabetes over the past three decades, which reflects the increase in obesity, compounded by the impacts of the marketing of unhealthy food, a lack of physical activity and economic hardship,” says WHO director-general Dr. Tedros Adhanom Ghebreyesus. 

“To bring the global diabetes epidemic under control, countries must urgently take action. This starts with enacting policies that support healthy diets and physical activity, and, most importantly, health systems that provide prevention, early detection and treatment.”

According to the research, the age-standardized prevalence of diabetes increased for women in 131 countries and men in 155 countries. In 2022, an estimated 13.9% of women and 14.3% of men had diabetes.

Global prevalence rates

The study defines diabetes as a fasting glucose of at least 7.0 mmol/L, glycated hemoglobin of 6.5% or higher or taking diabetes medication, which the authors say is in line with contemporary clinical guidelines. 

They calculated age-standardized prevalence and treatment by taking a weighted average of age-specific estimate rates to compare statistical populations with different age profiles.

The WHO calls for urgent global action to address rising rates and widening treatment gaps.Low- and middle-income countries in Southeast Asia, South Asia, the Middle East and North Africa, Latin America and the Caribbean experienced the largest growth between 1990 and 2022. 

The countries with the highest diabetes prevalence were India (212 million people), China (148 million), US (42 million), Pakistan (36 million), Indonesia (25 million), Brazil (22 million) and Bangladesh (18 million). 

The lowest diabetes prevalence in 2022 was in Western Europe and East Africa for both sexes and in Japan and Canada for women. 

Treatment gaps

In 2022, 445 million adults over 30 with diabetes did not receive treatment with oral hypoglycemic drugs or insulin. Of this group, 30% (133 million) were in India, and 17% (78 million) in China, where treatment coverage is higher. 

Similarly, Pakistan and India both had a higher number of untreated diabetes patients than the US despite having lower diabetes prevalence rates than the US, which had a higher treatment coverage.  

Over the study period, diabetes treatment coverage increased in 118 countries for women and 98 countries for men. However, treatment coverage did not improve in most countries in sub-Saharan Africa, the Caribbean, Pacific Island nations and South, Southeast and Central Asia. 

The researchers estimate that the gap between countries with the highest and lowest coverage widened from 56 and 43 percentage points in women and men, respectively, in 1990 to 78 and 71 percentage points in women and men in 2022. 

Age-standardized treatment coverage was lowest in sub-Saharan Africa and South Asian countries. Only 5–10% of patients received treatment in some African countries, such as Burkina Faso, Angola, Niger, Liberia and Benin. At the same time, Belgium had the highest age-standardized coverage rate at 86% for women and 77% for men. 

The authors urge that health insurance and primary health care expansion be accompanied by diabetes programs that realign and resource health services to enhance early detection and effective diabetes treatment. 

Diabetes drivers

The authors stress that obesity is an important driver of the rise in diabetes prevalence and variation. In regions where obesity was or became prevalent, diabetes was high or increased more than in high-income countries where both conditions only grew slightly or not at all. 

In addition, specific foods or diets impact diabetes and metabolic health. For example, sugar restriction and limiting ultra-processed food intake can reduce diabetes risk, while low-carb diets may reduce medication dependence for type 2 diabetics. 

Access to affordable healthy foods, exercise, early diagnosis and diabetes treatment are key to reverse the trend, underscores the report.The study further suggests that in countries with universal health insurance and reasonable access to primary care, people at a high risk of diabetes may be identified early. It advises to use a combination of diet, lifestyle modifications and medicines to prevent or delay the onset of diabetes. 

However, this approach may be less widely used in low-resourced health systems with limited attention or resources for diabetes screening. 

The study authors add: “Genetic and phenotypic differences due to fetal and childhood nutrition and growth also influence worldwide variations, especially when accompanied with rapid weight gain — for example, the high diabetes prevalence in South Asia.” 

Reversing the trend

The study makes recommendations in policy and healthcare to help prevent diabetes, delay its onset and improve treatment access. 

“Curbing and reversing the rise in obesity, and improving the quality of diet, require both regulations and taxes to reduce the intake of foods such as refined carbohydrates that lead to weight gain, and improving financial and physical access to healthier foods, such as fresh fruits, vegetables, legumes, dairy and fish, and to sports and active leisure,” details the research. 

For example, previous research indicates that people with type 2 diabetes can put the disease into remission by following a targeted diet and support from healthcare professionals. 

Moreover, the study calls for improved diabetes detection to increase treatment coverage and universal insurance accompanied by expanded primary care, including access to medicines, information and support to adhere to treatment. 

“With new diabetes medicines and technologies such as continuous glucose monitoring now available in high-income countries, such actions are particularly essential to avoid widening the global inequalities in diabetes burden and treatment,” highlights the study. 

Today, the WHO has also launched a new global monitoring framework on diabetes to guide countries in measuring and evaluating diabetes prevention, care, outcomes and impacts. This framework tracks critical indicators such as glycemic control, hypertension and access to essential medicines so that countries can improve targeted interventions and policy initiatives.