London [UK]: More than half a billion people live with diabetes worldwide. The disease affects men, women and children of all ages in every country.
A new study, published Thursday, June 22 in The Lancet, predicts the number of people with diabetes will rise to 1.3 billion in the next 30 years in every country and territory in the world.
"The new study presents a sobering fact that global figures for type two diabetes will increase. These new figures surpass many of the predictions we had before," said Stephen Lawrence, a diabetes primary care expert at the University of Warwick, UK.
Diabetes a global health concern
The study used information from the Global Burden of Disease (GBD) 2021 study, where researchers examined the prevalence, morbidity, and mortality of diabetes in 204 countries and territories between 1990 and 2021 and forecast the prevalence of diabetes to 2050.
"They've used very accurate modeling studies, so it isn't just someone putting their finger in the wind and making a guess," Lawrence told DW.
Overall, they found that 529 million people around the world were living with diabetes in 2021, with a global prevalence of 6.1%.
By 2050, the study predicts, 43.6% of 204 countries will have diabetes prevalence greater than 10%, and more than 1.3 billion people will be diagnosed with type 1 or type 2 diabetes.
Diabetes rates were highest in North Africa and the Middle East, where 8.7% to 9.9% of people have diabetes, but 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%.
Qatar had the highest age-specific prevalence of diabetes, with 76% of individuals between the age of 75-79 living with the disease in 2021.
Type 2 diabetes behind the rise
The study found that type 2 diabetes is much more prevalent than type 1, accounting for 96% of total diabetes cases.
Type 1 diabetes is an autoimmune problem where the immune system attacks beta cells in the pancreas, reducing insulin production. Insulin is a vital hormone for regulating blood sugar levels, allowing sugar (glucose) to enter cells. No insulin means the cells can't take up the glucose needed to produce energy.
"Type 1 diabetes is in a very difficult situation, because without insulin over a period of weeks, they will potentially die," said Lawrence.
Type 2 diabetes is different — it can develop over time due to a variety of factors like diet, body mass and age. In 2021, 52% of type 2 diabetes cases were linked to high body mass index (BMI).
What is causing diabetes rates to rise?
There are multiple causes for the global rise in type 2 diabetes rates, but changes in the food industry and lifestyles are the major factors.
For Lawrence, consumption of hyper-calorific foods, increasingly so in lower-income countries, is the big elephant in the room.
"Our genes just sadly aren't made to cope with that. It takes a combined effort of the individual and the environment to develop type 2 diabetes. It takes a good ten years of sedentary living and the excess consumption of refined carbohydrates," said Lawrence.
It's the increased consumption of cheap, ultra-processed foods that's caused the increased prevalence in lower income countries too.
"In low- and middle-income countries, as countries move away from traditional food and activity cultures towards more industrialization and more fast foods or ready meals, then the combination leads to more diabetes," said Naveed Sattar, a metabolic health expert at the University of Glasgow, UK.
People are living longer with diabetes
According to Lawrence, another major reason for the rise in numbers is a success story of science.
"Over the years, we've become more adept at diagnosing diabetes, and credit has to be given to primary care throughout the world. Patients have also become more aware, and testing options are far better than they were a decade ago," said Lawrence.
Sattar also pointed out that the biggest driver of the rise in diabetes is actually better survival in people with diabetes due to lower death rates, especially in higher and middle-income countries.
"The prevalence of diabetes in the UK has risen from 1 in 100 to 1 in 12 people over the last 35 years. Part of this is because people are living longer. Diabetes becomes more common as you age, and we're better at treating diabetes so people aren't dying prematurely of it," Sattar told DW.
Sattar also pointed to differences between ethnic groups in diabetes rates.
"In lower and higher income countries, every ethnic group outside whites has higher risks of diabetes. South Asians for example, carry higher percentage of body fat in tissues like the liver compared with white European people," said Sattar.
Sattar's research suggests there isn't a clear genetic contribution, but it could instead be due to nutrition.
"When south Asians move abroad, they get taller and leaner, especially in their children. This suggests to me it's not genetic, but more to do with epigenetics and nutrition," said Sattar.
Societal changes needed to reduce diabetes rates
Diabetes is a huge burden on healthcare systems around the world. In the US, a quarter of all healthcare is spent caring for people with diabetes — $327 billion (€301 billion). And that's to say nothing about the unquantifiable personal burden of living with diabetes.
What can the world do to try and avoid a climb in diabetes rates, or even reduce rates? It's a tough question with no one answer.
For Sattar, it comes down to food culture. Changing this is a societal issue, not just a medical issue.
"It's a consequence of raising people from poverty and giving them better life qualities. Type two diabetes was more common in wealthy people 50 years ago. Now it's more common in poor people, so it's linked to deprivation and poor food quality. Part of that is moving away from cheaper and high processed foods," said Sattar.
Lawrence is optimistic societies can achieve this, most likely through smaller changes that need to be properly designed, focusing primarily on the most at risk.
"Look at the tobacco industry. Forty years ago people said how can we reduce smoking when it contributes so much to the tax economy? But we've done it. Governments can make decisions about the food industry just as they did around laws for smoking and seat belts," said Lawrence.