Diabetes Is Exploding Worldwide — But Diagnosis and Treatment Lag Far Behind
- t2diabetesnetwork
- Apr 7
- 5 min read
Diabetes. It's a word we hear often, but do we truly grasp its impact? It's not just about managing blood sugar; it's a complex health crisis with far-reaching consequences.
Diabetes has become one of the most urgent health crises of our time.
Worldwide numbers
Over the last three decades, the global number of adults living with diabetes has skyrocketed from 226 million in 1990 to an alarming 529 million in 2021. To put this into perspective, this means that today, 1 in 10 adults worldwide is living with diabetes. Even more concerning, almost 45% of these cases remain undiagnosed, leaving millions at risk of severe complications without even knowing it.
Closer to home, CBC News interviewed Cardiologist/Epidemiologist Dr. Labos from Montreal. Here they discuss the Lancet study published in Sept 2024 that showed shocking results in not only the number of people with diabetes, but the percentage that is untreated and the factors affecting that - and how we are doing in Canada in comparison.
A Comprehensive Global Analysis
This Lancet study stands out as the most comprehensive analysis of global diabetes trends to date. Researchers pooled and harmonized data from over 1,100 studies across 175 countries, covering an extraordinary 98% of the world’s population. What sets this analysis apart is its rigorous approach: it relied solely on studies that directly measured blood glucose and HbA1c levels, bypassing the common pitfalls of self-reported data that often miss undiagnosed cases.
The study defined diabetes based on both fasting plasma glucose (FPG) and HbA1c criteria, aligning with modern clinical guidelines. This is crucial because previous estimates often overlooked people with elevated HbA1c but normal FPG—an oversight particularly common in low- and middle-income countries.
👉 This study captured complex patterns and disparities between younger and older adults.
Key Findings
🧩 In 2022, 828 million adults had diabetes, which is 630 million more than in 1990.
🧩 Most of the increase in diabetes is happening in poorer countries like Malaysia, Pakistan, Egypt, and Latin American countries like Jamaica and Costa Rica.
🧩 Some places like Western Europe, Canada, and East Africa have had the same amount of diabetes since 1990, and countries like Japan and Spain have actually seen fewer cases.
🧩 The highest rates of diabetes are in places like Polynesia, Micronesia, the Middle East, and South Asia (like Pakistan and Malaysia).
🧩 In 2022, 445 million adults with diabetes didn't get treatment, which is 3.5 times more than in 1990.
🧩 Poorer countries show lower treatment rates (less than 10%) than wealthier countries (more than 55%) for people with diabetes.
Stark Regional Inequalities
The findings reveal a deeply troubling geographic divide:
In South Asia, more than 1 in 4 adults over 45 years old is living with diabetes.
In Polynesia and Micronesia, nearly 1 in 5 adults has the disease.
In contrast, in countries like the UK and Ireland, prevalence rates are below 5%.
Alarmingly, regions already struggling with high obesity rates are also experiencing surges in diabetes. The study underscores that obesity is a major driver of the diabetes epidemic. Regions where obesity is rising—such as the Middle East and parts of South Asia—are also seeing sharp increases in diabetes prevalence.
Treatment Gaps and Missed Opportunities
Equally concerning is the stagnation in diabetes diagnosis and treatment worldwide:
Less than half of people with diabetes globally have been diagnosed.
Only 1 in 5 receives the recommended combination of treatments: glucose-lowering medications, blood pressure control, and statins to prevent complications.
This treatment gap is even wider in low- and middle-income countries, where healthcare access is often limited.
👉The study highlights the urgent need to expand primary care capacity and improve affordability and availability of essential medications.
Early Detection and Prevention
The article suggests that early identification and prevention of diabetes can be very effective, especially in countries with universal health insurance and strong primary care systems. In these regions, people at high risk of diabetes can be identified early and receive a combination of diet and lifestyle changes along with medications to delay or prevent the onset of diabetes.
However, in low-resourced health systems, where resources for diabetes screening are limited, this approach is not as common. Genetic factors and childhood nutrition also play a role in diabetes rates, with regions like South Asia showing higher rates of diabetes, especially when there is rapid weight gain.
"Early identification and intervention in high-risk individuals is crucial, particularly through strong primary care systems and universal health insurance."
Given the serious health risks associated with diabetes, the study emphasizes the importance of preventing diabetes onset and delaying complications. Diet improvement is central to this strategy, including focusing on healthier foods such as fresh fruits, vegetables, dairy, legumes, and fish, while reducing the intake of harmful foods like refined carbohydrates and processed foods.
The study also suggests the need for regulations and taxes to curb the intake of unhealthy foods and to improve access to healthy foods. Low-income families and marginalized communities particularly benefit from subsidies or vouchers for healthy foods, as well as access to sports facilities and active leisure. Targeted cash transfers could also help families afford healthier options. Additionally, providing free healthy school meals can have a significant impact on children’s long-term health.
For people at high risk of developing diabetes (including those with prediabetes), the key is early intervention with a combination of diet, exercise, and medications. Health systems need to identify these high-risk individuals, support them in making lifestyle changes, and provide access to effective medications and regular follow-ups with healthcare providers.
👉 Without effective prevention and treatment, the global burden of diabetes will continue to grow, leading to more heart attacks, strokes, kidney failure, and amputations.
Looking Ahead: Multi-Pronged Solutions Needed
The study’s authors call for a coordinated, multi-pronged strategy to combat the escalating diabetes epidemic. Key recommendations include:
🧩 Population-wide initiatives to reduce obesity and improve diets, such as implementing taxes on sugary drinks, regulating food marketing, and improving access to healthy foods and sports facilities.
🧩Targeted prevention programs for high-risk individuals, offering lifestyle counseling and preventive medications.
🧩Strengthening primary care systems to improve screening, ensure access to affordable treatments, and provide continuous monitoring.
🧩National diabetes programs that leverage universal insurance and primary care expansion to close the diagnosis and treatment gaps.
For people already living with diabetes, the priorities are clear: improve access to affordable medications, support treatment adherence through education and community programs, and guarantee regular follow-up care to manage blood sugar and prevent complications.
👉 Check out our T2D Network Project dashboard to see how we are working towards these solutions in British Columbia
Final Thoughts
The gap between high-income countries and the rest of the world risks widening further, exacerbating health inequalities. However, with the right mix of public health policies, early detection, and equitable healthcare access, this trend is not inevitable.
As new and effective therapies emerge, there is a window of opportunity to transform diabetes care and prevention worldwide. Now is the time to act.
The IHME Global Burden of Disease Interactive Data Tool is an easy-to-use online tool that lets you explore health data from around the world. It shows trends in diseases, causes of death, and health risks by country, age, and gender. It's a helpful resource for anyone wanting to understand global health issues and track progress in fighting diseases.
What Can You Do?
So, where do we go from here? This isn't just a problem for doctors and policymakers to solve. It's something that affects all of us.
We need to start having open conversations about diabetes in our communities.
✅ What are the biggest challenges you see?
✅ What innovative solutions have you heard about?
✅ How can technology help us tackle this crisis?
✅ Share your thoughts in the comments below – let's learn from each other. Whether you’re a healthcare provider on the front lines or someone concerned about the health of your community, your voice matters.
👉 Get involved -- Join us and support T2D in British Columbia
The Lancet study acknowledges several limitations, including limited data from some countries, reliance on single-visit surveys instead of clinical diagnosis, potential inaccuracies in HbA1c measurements, and the lack of distinction between type 1 and type 2 diabetes. Additionally, the 2-hour postprandial glucose test was not included due to its limited use in population studies.
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