Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1,108 population-representative studies with 141 million participants

Abstract

Background: Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of mortality and complications. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment coverage for 200 countries and territories. Methods: We used data from 1,108 population-representative studies with 141 million participants aged 18 years and older with measurement of fasting glucose and HbA1c, and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7.0 mmol/L or higher, having a glycated haemoglobin (HbA1c) of 6.5% or higher, or taking medications for diabetes. We defined diabetes treatment as the proportion of people with diabetes who used oral hypoglycaemic drugs or insulin. We pooled and analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment. We calculated the number of people with diabetes and the number of people with untreated diabetes by multiplying age-specific prevalence by the corresponding age-specific population. Results: In 2022, an estimated 828 million (95% credible interval (CrI) 757-908) adults had diabetes, an increase of 630 million (554-713) from 1990. From 1990 to 2022, age-standardised prevalence of diabetes increased with a posterior probability (PP) >0.80 in 134 countries for women and by 2-18 percentage points in 156 countries for men. The largest increases were in low- and middle-income countries in southeast Asia (e.g., Malaysia), south Asia (e.g., Pakistan), the Middle East and north Africa (e.g., Egypt), and Latin America and the Caribbean (e.g., Jamaica, Trinidad and Tobago, Costa Rica). Age-standardised prevalence neither increased nor decreased with a PP >0.80 in some countries in western and central Europe, sub-Saharan Africa and east Asia and the Pacific, Canada, as well as some Pacific island nations where prevalence was already high in 1990; it decreased with a PP >0.80 in women in Japan, Spain and France, and men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and central and east Africa for both sexes, and in Japan and Canada for women. At the other extreme, age-standardised diabetes prevalence among women in 21 countries and men in 14 countries surpassed 25% in 2022. These included many countries in Polynesia and Micronesia, some in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401-496) adults aged 30+ years with diabetes did not receive treatment (59% of those with diabetes), 3.5 times of the number in 1990. From 1990 to 2022, diabetes treatment coverage increased with a PP >0.80 in 118 countries for women and 98 for men. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, Costa Rica), Canada, South Korea, Russia, Seychelles and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa, the Caribbean, Pacific island nations, and south, southeast and central Asia. In 2022, age-standardised treatment was lowest in countries in sub-Saharan Africa and south Asia, below 10% in some African countries. Treatment was ≥55% in South Korea, many high-income western countries, and some countries in central and eastern Europe (e.g., Poland, Czechia, Russia), Latin America (e.g., Costa Rica, Chile, Mexico), and the Middle East and north Africa (Jordan, Qatar, Kuwait). Interpretation: In the majority of countries, especially in low- and middle-income countries, diabetes treatment has not increased at all or has expanded insufficiently in comparison with the rise in prevalence. Together with population increase and ageing, this has substantially increased the number of people with diabetes who lack treatment and are at risk of complications, with the burden of diabetes and untreated diabetes increasingly borne by low- and middle-income countries. Expansion of health insurance and primary healthcare should be accompanied with diabetes programmes that realign and resource health services to enhance early detection and effective treatment of diabetes. Funding: UK Medical Research Council; UK Research and Innovation (Research England); US Centres for Disease Control and Prevention