Diabetes prevalence is skyrocketing globally, leaving millions of people untreated

Global research shows that the total number of adults living with type 1 or type 2 diabetes exceeds 800 million worldwide, more than four times the total number in 1990. Analysis published ahead of World Diabetes Day lancet. Furthermore, by 2022, 445 million (59%) adults aged 30 and older with diabetes will not be receiving treatment, an increase of 3.5 times as many as in 1990.

Of the 828 million adults with diabetes in 2022, more than a quarter (212 million) will live in India, followed by China with an additional 148 million, followed by the United States (42 million). , Pakistan (36 million), Indonesia (25 million), and Brazil (22 million).

Although this study could not distinguish between type 1 and type 2 diabetes in adults, evidence to date suggests that the majority of diabetes cases in adults are type 2.

Lead author Professor Majid Ezzati from Imperial College London said: “Our study shows that in many low- and middle-income countries, where the number of adults with diabetes is increasing significantly, treatment rates have stagnated and “This highlights the growing global inequality in the world.” This is of particular concern person with diabetes They tend to be younger in low-income countries and, without effective treatment, are at risk of lifelong complications such as amputation, heart disease, kidney damage, vision loss, and even early death. ”

Global research using global data

This new study, conducted by the NCD Risk Factors Collaboration (NCD-RisC) in collaboration with the World Health Organization (WHO), examines trends in both diabetes prevalence and treatment across all countries. This is the first time that it has been analyzed on a global scale. The researchers used data from more than 140 million people aged 18 and older from more than 1,000 studies in different countries' populations.

The authors used statistical tools to compile all data from different years, ages, and countries to estimate diabetes prevalence and treatment in a way that is comparable across countries.

Diabetes was defined as fasting plasma glucose (FPG) of 7.0 mmol/L or higher and glycated hemoglobin (HbA1c) of 6.5% or higher (two commonly used diagnostic criteria options for diabetes according to current guidelines). ), or taking medication for diabetes. Diabetes. Treatment was defined as taking diabetes medication.

Most previous studies examining diabetes rates relied on high FPG as a single measure of diabetes and did not consider people with high HbA1c. Diabetes rates are therefore likely to be underestimated, especially in South Asia, where using FPG alone would miss more diabetes cases than in other countries. other areas.

Global diabetes incidence has doubled in the past 20 years

From 1990 to 2022, global diabetes rates doubled in both 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 translates to an estimated 828 million adults with diabetes in 2022, and around 198 million adults estimated to have diabetes. This is an increase of approximately 630 million people compared to 1990, when

Changes in diabetes rates from 1990 to 2022 varied widely across countries, with LMICs primarily experiencing the largest increases (e.g. diabetes rates among Pakistani women rose from 9.0% in 1990 to 30.9% in 2022). , the largest increase of any country). . Meanwhile, in Japan, Canada, and some other high-income countries, Western European countries (such as France, Spain, and Denmark) have seen no change or even a slight decline in diabetes rates over the past 20 years.

Diabetes incidence rate in 2022 will change significantly worldwide

The countries with the lowest diabetes rates in 2022 were Western Europe and East Africa for both men and women, and Japan and Canada for women. For example, diabetes rates in 2022 were low at 2-4% for women in France, Denmark, Spain, Switzerland, and Sweden, and 3-5% for men in Denmark, France, Uganda, Kenya, Malawi, and Spain. Rwanda.

In contrast, the countries with the highest prevalence of diabetes in at least 25% of the population for both men and women were Pacific island nations, countries in the Caribbean, the Middle East, and North Africa, Pakistan, and Malaysia. . Among high-income developed countries, the United States had the highest diabetes rate in 2022 (11.4% for women and 13.6% for men).

Important factors contributing to the rising prevalence of type 2 diabetes and its variation across countries are obesity and poor dietary habits. In some regions where obesity was prevalent or began to become prevalent between 1990 and 2022, diabetes rates were already high or were increasing. This is compared to many high-income countries, especially those in the Pacific region and Western Europe, where obesity and diabetes are common. Interest rates either did not rise, or the rise was relatively small.

Given the disabling and sometimes fatal consequences of diabetes, preventing diabetes through a healthy diet and exercise is essential to improving health worldwide. Our findings support efforts to limit unhealthy foods and make healthy foods more affordable, including subsidies for healthy foods and free healthy school meals, especially in low-income regions of the world. highlights the need for more ambitious policies to improve opportunities for physical activity through measures such as: Promote safe places for walking and exercise, such as free admission to public parks and fitness centers. ”

Dr. Ranjit Mohan Anjana, Madras Diabetes Research Foundation, India

Growing global inequalities in diabetes care

By 2022, three out of five (59%) adults aged 30 and over with diabetes, or 445 million people, will not be receiving treatment for diabetes, compared to 1990 (129 million people). It is 3.5 times that of

Since 1990, many countries in Central and Western Europe, Latin America, East Asia, and the Pacific region, as well as some countries such as Canada and South Korea, have significantly improved diabetes treatment rates, resulting in more than 55% of people have diabetes. These countries are receiving treatment in 2022. The following had the highest treatment rates: In Belgium, it is estimated that 86% are women and 77% are men.

However, in many LMICs, the prevalence of diabetes treatment has remained low and changed little over the past two decades, with more than 90% of people with diabetes receiving treatment in both 1990 and 2022 in some countries. Not yet.

As a result of these trends, from 1990 to 2022, the gap between countries with the highest and lowest diabetes treatment coverage widened. It ranges from 56 to 78 percentage points for women and from 43 to 71 percentage points for men.

“Our findings suggest that the proportion of people with diabetes living in low- and middle-income countries, especially those with untreated diabetes, is increasing. In some countries, only 5% to 10% of adults with diabetes receive treatment for their diabetes, leaving vast numbers at risk of serious health complications. Jean-Claude Mbanya, a professor at the University of Yaoundé I in Cameroon, said:

He continued, “Most people with untreated diabetes will not receive treatment. diagnosisTherefore, increasing detection of diabetes must be an urgent priority in countries with low levels of treatment. Better diagnosis of diabetes can be achieved through workplace and community screening programs, extended or flexible medical hours that allow for visits outside of standard working hours, and established programs to screen for diseases such as HIV/AIDS and tuberculosis. Innovations such as integration with care are needed. Using trusted communities healthcare provider. ”

By 2022, almost a third (133 million people, 30%) of the 445 million adults aged 30 years and older with untreated diabetes will live in India, with the second largest number of people living in India. More than 50% more people than China (78 million people). Coverage was higher in China (45% women and 41% men) than in India (28% women and 29% men). Similarly, the next two countries with the highest number of untreated diabetes patients, Pakistan (24 million people) and Indonesia (18 million people), have higher treatment penetration rates (65% for women and 67% for men) than the United States (65% for women and 67% for men). 13 million people). .

The authors acknowledge some limitations to their study, including that most survey data do not distinguish between type 1 and type 2 diabetes in adults. Furthermore, some countries for which estimates of diabetes prevalence and treatment were provided had little or, in some cases, no data, and their estimates were more strongly informed by data from other countries. Ta. This study included two diabetes measures: FPG and HbA1c. Studies that did not measure HbA1c predicted the prevalence of elevated HbA1c based on the relationship between HbA1c, FPG, and other predictors in studies that measured both, increasing the uncertainty in study estimates. I did.