Diabetes explosion forecast worldwide

Researchers are forecasting a massive increase in the number of people worldwide affected by diabetes.

More than half a billion people are living with diabetes worldwide, and that number is projected to more than double to 1.3 billion people in the next 30 years, with every country seeing an increase, according to a new report in the influential British medical journal The Lancet.

It says the current global prevalence rate is 6.1%, making diabetes one of the top 10 leading causes of death and disability.

The highest rate is 9.3% in North Africa and the Middle East, and that number is projected to jump to 16.8% by 2050. The rate in Latin America and the Caribbean is projected to increase to 11.3%.

Diabetes Australia (DA) predicts incidence in this country will rise above 8%.

“In the past 20 years, the numbers have dramatically increased from 459,678 people living with the condition in 2000 to more than 1.47 million in 2022, an increase of around 220%,” DA says in Change the Future, a report calling for health care reform.

“If the growth rates of the past decade continue, there will be more than 3.1 million Australians, around 8.3% of the projected population, living with diabetes by 2050. The annual cost of the condition is forecast to grow to about $45 billion per annum in this time.”

The Lancet says diabetes was especially evident in people 65 and older in every country and recorded a prevalence rate of more than 20% for that demographic worldwide. The highest rate was 24.4% for those between ages 75 and 79. Examining the data by super-region, North Africa and the Middle East had the highest rate at 39.4% in this age group, while Central Europe, Eastern Europe, and Central Asia had the lowest rate at 19.8%.

Almost all global cases (96%) are Type 2 diabetes (T2D).

DA says Type 2 diabetes develops over a long period of time (years). During this time insulin resistance starts, because the insulin is increasingly ineffective at managing blood glucose levels. The pancreas responds by producing greater amounts of insulin, to try and achieve some degree of management of blood glucose.

As insulin overproduction occurs over a very long period of time, the insulin-producing cells in the pancreas wear themselves out, so that by the time someone is diagnosed with T2D, they have lost 50–70% of their insulin-producing cells.

Initially, T2D can often be managed with healthy eating and regular physical activity.

DA says many people with T2D have no symptoms, and as the disease is commonly (but not always) diagnosed at a later age, sometimes signs are dismissed as a part of “getting older”. In some cases, by the time T2D is diagnosed, its long-term complications may already be present.

Diabetes Australia and leading specialists late last year called on the Australian Government to implement the 2021–2023 National Diabetes Strategy.

CEO Justine Cain describes the problem as “an epidemic”.

“It is one of the largest and most complex health challenges Australia has faced,” Cain says in the Change the Future report. “We have a major challenge in front of us but doing nothing is not an option. Without action, diabetes will continue to have an unacceptable impact on the physical, emotional and financial wellbeing of Australians as well as our health system.”

Dr Liane Ong, Lead Research Scientist at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine, writing as lead author in The Lancet report says: “The rapid rate at which diabetes is growing is not only alarming but also challenging for every health system in the world, especially given how the disease also increases the risk for ischemic heart disease and stroke.”

Lauryn Stafford, second author and Post-Bachelor Fellow at IHME, says some people might be quick to focus on one or a few risk factors.

“But that approach doesn’t take into account the conditions in which people are born and live that create disparities worldwide.

“Those inequities ultimately impact people’s access to screening and treatment and the availability of health services.”

The Lancet report says Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course.

“However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.”