The global population of adults living with diabetes has skyrocketed to over 800 million, more than four times the number recorded in 1990. This alarming increase was revealed in a comprehensive global analysis published in The Lancet ahead of World Diabetes Day. The study also highlighted that 445 million adults aged 30 and above with diabetes (59%) did not receive any treatment in 2022, which is three and a half times higher than the figure in 1990.
Diabetes Concentrated in Key Regions
Of the 828 million adults with diabetes in 2022, a significant portion were concentrated in just a few countries. India led with 212 million cases, followed by China with 148 million. The United States had 42 million, while Pakistan, Indonesia, and Brazil had 36 million, 25 million, and 22 million cases, respectively.
The study was unable to distinguish between type 1 and type 2 diabetes in its analysis, though existing evidence suggests that type 2 diabetes is predominant among adults.
Growing Inequality in Diabetes Treatment
Professor Majid Ezzati from Imperial College London, a senior author of the study, emphasized the widening gap in diabetes treatment across different regions. “Our study shows increasing global disparities in diabetes care, with stagnant treatment rates in many low- and middle-income countries where diabetes cases are rapidly growing. This is particularly troubling as people with diabetes in these countries are often younger, making them vulnerable to lifelong complications such as heart disease, kidney damage, or even early death if left untreated,” he said.
First-of-Its-Kind Global Analysis
This extensive research was conducted by the NCD Risk Factor Collaboration (NCD-RisC) in partnership with the World Health Organization (WHO). It marks the first global assessment that covers both diabetes prevalence and treatment across all nations. The study compiled data from over 140 million individuals aged 18 and older, utilizing more than 1,000 studies from various countries.
Researchers applied advanced statistical methods to harmonize data across different years, ages, and regions, enabling a comprehensive comparison of diabetes rates and treatment globally. The study defined diabetes as having either a fasting plasma glucose (FPG) of 7.0 mmol/L or higher, a glycated hemoglobin (HbA1c) of 6.5% or higher, or being on medication for diabetes.
Doubling of Global Diabetes Rates Since 1990
Diabetes rates have doubled globally over the past three decades. For men, rates increased from 6.8% in 1990 to 14.3% in 2022, while women saw an increase from 6.9% to 13.9%. This growth, combined with population increases and aging, resulted in approximately 828 million adults with diabetes in 2022—up by 630 million from the 198 million cases reported in 1990.
Significant variations were observed across different countries. Low- and middle-income countries (LMICs) saw the highest increases, with Pakistan’s diabetes rate among women jumping from 9% in 1990 to nearly 31% in 2022, the largest increase worldwide. In contrast, high-income countries like Japan, Canada, and parts of Western Europe saw little to no change, or even slight decreases, in diabetes rates.
Regional Disparities in Diabetes Prevalence
In 2022, the lowest diabetes rates were found in Western Europe and East Africa, with countries like France, Denmark, and Uganda reporting rates as low as 2-4% among women and 3-5% among men. Conversely, the highest rates were seen in Pacific island nations, the Caribbean, the Middle East, and North Africa, with some populations experiencing diabetes rates exceeding 25%. Among high-income nations, the United States had the highest rates, with 11.4% of women and 13.6% of men diagnosed with diabetes.
A major factor driving the rise in type 2 diabetes is the increase in obesity and poor dietary habits. Countries with significant obesity levels in recent decades, especially in the Pacific and parts of Western Europe, have seen corresponding rises in diabetes rates.
Treatment Gaps Widen in LMICs
A staggering 59% of adults aged 30 and older with diabetes were not receiving treatment in 2022. This equates to 445 million untreated cases, compared to just 129 million in 1990. While some countries in Latin America, East Asia, and Western Europe have improved diabetes treatment coverage—surpassing 55% treatment rates—LMICs have made little progress. In some nations, over 90% of adults with diabetes went untreated in both 1990 and 2022.
The gap in treatment coverage between the best and worst-performing countries widened significantly from 1990 to 2022, increasing from a 56 to 78 percentage point difference in women and from 43 to 71 points in men.
Professor Jean Claude Mbanya from the University of Yaoundé in Cameroon commented on the dire situation: “Our research indicates a growing number of people with untreated diabetes in LMICs. In 2022, only 5-10% of adults with diabetes in some sub-Saharan African countries received any form of treatment, putting them at severe risk of complications.”
He urged for urgent measures to increase diabetes detection and treatment, suggesting strategies like workplace and community screenings, flexible healthcare hours, and leveraging established programs for diseases like HIV/AIDS for diabetes care integration.
India and China Lead in Untreated Cases
India accounted for nearly a third (133 million) of the 445 million untreated diabetes cases among adults aged 30 and above, followed by China with 78 million. The treatment coverage in China was higher (45% for women and 41% for men) than in India (28% for women and 29% for men). Pakistan and Indonesia followed, with 24 million and 18 million untreated cases, respectively. The United States had higher treatment rates (65% for women and 67% for men), resulting in fewer untreated cases.
Study Limitations
The researchers noted some limitations in their findings, including the inability to differentiate between type 1 and type 2 diabetes in most datasets. Additionally, estimates for some countries relied heavily on data from other nations due to a lack of local data. The study’s methodology of combining FPG and HbA1c criteria aimed to provide a more accurate estimate but introduced some uncertainty.
This comprehensive study underscores the urgent need for global action to address diabetes, particularly in low- and middle-income countries where the burden of the disease is rapidly escalating.
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