Of the 828 million adults with diabetes in 2022, more than a quarter (212 million) lived in India and 148 million in China, followed by the United States (42 million), Pakistan (36 million), Indonesia (25 million) and Brazil (22 million).
The study could not distinguish type 1 diabetes from type 2 diabetes in adults. However, previous evidence suggests that the vast majority of cases of diabetes in adults are type 2.
Lead author Professor Majid Ezzati, from Imperial College London, said: “Our study highlights growing global inequalities in diabetes, with stagnant treatment rates in many low- and low-income countries. intermediate where the number of adults with diabetes increases considerably. 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 vision loss – or in some cases. cases, premature death.
A global study with global data
The new study, led by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), is the first global analysis of trends in diabetes rates and treatment that includes all countries . The researchers used data from more than 140 million people aged 18 or older from more than 1,000 studies of populations in different countries.
The authors used statistical tools to bring together all the data across different years, ages and countries, and estimate diabetes rates and treatment in a way that allows comparisons between countries.
Diabetes was defined as fasting plasma glucose (FPG) of 7.0 mmol/L or more, glycated hemoglobin (HbA1c) of 6.5% or more (two commonly used diagnostic criteria for diabetes according to guidelines modern) or taking medications for diabetes. diabetes. Treatment was defined as taking medication for diabetes.
Most previous studies looking at diabetes rates relied on high FPG as the sole measure of diabetes and did not take into account people with high HbA1c, likely leading to underestimates. rates, particularly in South Asia, where FPG use alone missed more cases of diabetes than in South Asia. other regions.
Global diabetes rates have doubled in the past two decades
From 1990 to 2022, global diabetes rates doubled among men (from 6.8% in 1990 to 14.3% in 2022) and women (from 6.9% to 13.9%). With the added impact of population growth and aging, this equates to approximately 828 million adults with diabetes in 2022, an increase of approximately 630 million people from 1990, when approximately 198 million adults were affected. of the disease.
Changes in the rate of diabetes between 1990 and 2022 varied considerably between different countries, with most LMICs experiencing the largest increases (for example, the rate of diabetes among women in Pakistan increased from 9.0% in 1990 to 30.9% in 2022, the largest increase in any country). . While some higher income countries, such as Japan, Canada and some
Substantial global changes in diabetes rates in 2022
The countries with the lowest rates of diabetes in 2022 were in Western Europe and East Africa for both sexes, and Japan and Canada for women. For example, diabetes rates in 2022 were as low as 2-4% for women in France, Denmark, Spain, Switzerland and Sweden, and between 3-5% for men in Denmark, France, in Uganda, Kenya, Malawi, Spain and Sweden. Rwanda.
In contrast, the countries with the highest rates, where 25% or more of the population had diabetes in both men and women, were the Pacific island nations and those located in the Caribbean, Middle East and North Africa, as well as Pakistan and Malaysia. . Among high-income industrialized countries, diabetes rates in 2022 were highest in the United States (11.4% among women and 13.6% among men).
Obesity and poor diet are a significant factor in the increasing rates of type 2 diabetes and its variation across countries. The rate of diabetes was already high or increased further in some regions where obesity was or became prevalent between 1990 and 2022, compared to many high-income countries, particularly those in the Pacific and Western Europe, where, in general, obesity and diabetes rates have not increased or have increased to a relatively small extent.
Given the disabling and life-threatening consequences of diabetes, preventing diabetes through healthy diet and exercise is essential for better health everywhere. Our findings highlight the need for more ambitious policies, particularly in low-income parts of the world, that limit unhealthy foods, make healthy foods affordable, and improve exercise opportunities through measures such as subsidies for healthy food and free healthy school meals. as well as promoting safe places for walking and exercising, including free entry to public parks and fitness centers.
Dr Ranjit Mohan Anjana, Madras Diabetes Research Foundation, Inde
Increasing global inequalities in diabetes treatment
Three in five (59%) adults with diabetes aged 30 and older, a total of 445 million, were not receiving diabetes medication in 2022, three and a half times the number in 1990 (129 million).
Since 1990, some countries, including many in Central and Western Europe, Latin America, East Asia and the Pacific, as well as Canada and South Korea, have experienced large improvements in diabetes treatment rates, resulting in more than 55% of people with diabetes in these countries receiving treatment in 2022. The highest treatment rates were
However, in many LMICs, diabetes treatment coverage has remained low and changed little over the previous two decades, with more than 90% of people with diabetes not receiving treatment in some countries in 1990 and 2022.
As a result of these trends, the gap between countries with the highest and lowest treatment coverage for diabetes has widened between 1990 and 2022; from 56 to 78 percentage points among women and from 43 to 71 percentage points among men.
“Our findings suggest that a growing proportion of people with diabetes, particularly those who are untreated, live in low- and middle-income countries. In 2022, only 5-10% of adults with diabetes in some sub-Saharan African countries have received treatment for diabetes, putting many at risk of serious health complications.
He continues: “Most people with untreated diabetes will not have been diagnosed, so increased screening for diabetes must be an urgent priority in countries where treatment levels are low. Better diagnosis of diabetes requires innovations such as workplace and community screening programs, expanded or flexible healthcare hours to allow people to visit outside of normal working hours, integration of testing and care for diseases such as HIV/AIDS and tuberculosis, for which programs are well established. and the use of a trusted community
In 2022, almost a third (133 million, 30%) of the 445 million adults aged 30 or older with untreated diabetes lived in India, more than 50% more than the next largest number who was in China (78 million), because treatment coverage was higher in China (45% for women and 41% for men) than in India (28% for women and 29% for men). Similarly, Pakistan (24 million) and Indonesia (18 million), the next two countries with the highest number of untreated diabetics, overtook the United States (13 million), which had higher treatment coverage (65% for women and 67% for men). .
The authors acknowledge some limitations to their study, including the fact that most survey data do not distinguish type 1 diabetes from type 2 diabetes in adults. Additionally, some countries where estimates were provided on diabetes rates and treatment had very little or in some cases no data and their estimates were more informed by data from other countries. The study included two diabetes measures: FPG and HbA1c. In studies that did not measure HbA1c, the prevalence of elevated HbA1c was predicted based on the relationship between HbA1c, FPG, and other predictors in studies that measured both, increasing the uncertainty of the study estimates.
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