More Than 800 Million People Worldwide Have Diabetes

TOPLINE:

Since 1990, the largest increase in diabetes prevalence has occurred in low-income and middle-income countries, whereas improvements in treatment have been greatest in high-income and industrialized nations and some emerging economies, especially in Latin America. These trends have widened the global gap in diabetes prevalence and treatment, with an increasing share of people with diabetes, especially with untreated diabetes, living in low-income and middle-income countries.

METHODOLOGY:

• In what is believed to be the first global analysis of trends in both diabetes prevalence and treatment coverage over all countries, the investigators analyzed and pooled 1108 population-representative studies with measures of glycemic biomarkers and data on diabetes treatment for a total 141 million adult participants.

TAKEAWAY:

• In 2022, age-standardized diabetes prevalence in the world was 13.9% for women and 14.3% for men.
• An estimated 828 million adults (420 women, 408 men) had diabetes in 2022, an increase of 630 million since 1990.
• India (212 million) and China (148 million) accounted for the largest proportions with diabetes, followed by the United States, Pakistan, Indonesia, and Brazil.
• In 1990, age-standardized diabetes treatment coverage was less than 50% in all except 11 countries for women and one for men, increasing in 2022 to 118 countries (59%) for women and 98 (49%) for men.
• In 2022 a total of 445 million adults aged ≥ 30 years with diabetes were not treated with oral hypoglycemic drugs nor insulin, 3.5 times the number in 1990 (129 million).
• Nearly a third (30%) of those with untreated diabetes (133 million) were in India, more than 50% greater than the next largest number of people with untreated diabetes in China (78 million).
• The number of people with untreated diabetes increased in every super-region from 1990 to 2022, with the largest contributor to this rise being the increase in size and age of population, since diabetes is more prevalent in older age groups.

IN PRACTICE:

“Our results show an expanding inequity of diabetes in the world: The largest increases in prevalence have occurred in low-income and middle-income countries, whereas the improvements in treatment were largest in high-income and industrialized nations in Europe, north America, Australasia, and the Pacific, and some well performing middle-income nations and emerging economies, especially those in Latin America. These trends have widened the global gap in diabetes prevalence and treatment, with an increasing share of people with diabetes, especially with untreated diabetes, living in low income and middle-income countries,” the authors wrote, adding “Given the disabling and fatal consequences of diabetes, preventing its onset and delaying its complications through improving diet and treatment are essential for better population health throughout the world.”

SOURCE:

The study was conducted by the Noncommunicable Disease Risk Factor Collaboration (NCD-RisC) and published on November 13 in The Lancet.

LIMITATIONS:

Limitations include variation in data collection and health survey participation across countries, differences in glucose assessment methods, and differences in populations with blood factors (eg, hemoglobinopathies) that affect A1c measurement. Moreover, most surveys didn’t distinguish by diabetes type. Another constraint was the potential impact of the COVID-19 pandemic, including on survey implementation, diabetes prevalence rates, and treatment coverage.

DISCLOSURES:

This study was funded by the UK Medical Research Council, the UK Research and Innovation (Research England Policy Support Fund), and the US Centers for Disease Control and Prevention. One author is supported by a fellowship from the Abdul Latif Jameel Institute for Disease and Emergency Analytics at Imperial College London, funded by a donation from Community Jameel.

Another author reports consulting fees from GlaxoSmithKline, AstraZeneca, Sanofi, Novo Nordisk, Eli Lilly, Roche, and Abbott; payments for lectures from AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Roche, Zuellig Pharmaceutical, and Eli Lilly; and payments for programme committee from AstraZeneca, outside the submitted work.

A third reported an honorarium from Sanofi for serving as a panel member at an educational event on thyroid cancer; support from Novo Nordisk for attendance at a continuing medical education event, and from Fogarty International Centre, National Institutes of Health Emerging Global Leader Award; and membership for the Diabetes Guidelines Committee, the Global Endocrine Leadership Coalition, the Society for Endocrinology, Metabolism and Diabetes of South Africa, and Endocrine Society-Member for the Research Affairs Core Committee, outside the submitted work.

A fourth author reported holding stocks in Pfizer, outside the submitted work.

The other authors declared no competing interests.