Why have diabetes rates doubled over the past 30 years – and what can be done about it?

What is diabetes?

Diabetes is a chronic disease caused when the pancreas does not produce enough (or any) insulin (a hormone that regulates blood glucose) or the body cannot effectively use the insulin it produces. Uncontrolled diabetes can cause hyperglycaemia, or raised blood sugar, which over time can cause serious damage to many of the body’s systems, especially the nerves and blood vessels.

What’s the difference between type 1 and type 2 diabetes?

Type 1 diabetes is an autoimmune disease in which the body destroys the cells in the pancreas that produce insulin. Type 2 diabetes is a metabolic disorder which stops the body using insulin properly. More than 95% of people with diabetes have type 2 diabetes. Unlike type 1, type 2 diabetes can be prevented. Being overweight, eating unhealthily and not exercising enough, as well as genetic factors, can increase the risk of developing diabetes.

How many people have diabetes?

The Lancet study found that rates of diabetes in adults doubled from approximately 7% to about 14% between 1990 and 2022. In all, it calculated 828 million people over 18 have the condition, up approximately 630 million people over the three decades.

While India accounted for more than a quarter of all cases and has a diabetes rate of more than 20%, diabetes rates in the UK (8.8%) are second only to the US (12.5%) in the G7.

Why are cases of diabetes growing so much?

Growing levels of obesity are fuelling an epidemic in type 2 diabetes. According to the World Obesity Federation, nearly 1 billion adults and 159 million children are living with obesity. As you are more likely to develop diabetes as you get older, an ageing global society is also increasing the prevalence of the condition. A healthy lifestyle is unaffordable for some people. In many countries, unhealthy food is cheap, convenient and heavily advertised, while healthy food can be increasingly difficult to get and more expensive in the face of the droughts, floods and rising seas caused by climate change, according to the World Health Organization. Meanwhile, in some places, it is difficult to exercise safely.

How is diabetes treated?

People with type 1 diabetes need insulin injections or a pump to survive. While those with type 2 diabetes may need insulin or glucose-reducing medications; diet and lifestyle changes also help to manage blood sugar levels.

Why are so many people in lower and middle income countries not getting the medication they need?

Nearly 450 million people with diabetes are untreated, the Lancet study found, three-and-a-half times the number in 1990. Most of these people are undiagnosed. Despite the availability of effective glucose-lowering medication, millions of people with diabetes in low- and middle-income countries (LMICs) are untreated. According to Leif Fenger Jensen, managing director of the World Diabetes Foundation, “complex barriers to accessing health services” in lower and middle income countries make tackling diabetes more difficult. “These challenges lead to under-diagnosis and limited access to diabetes care, with major human and economic costs for both individuals and societies.”

What can be done about it?

Improving access to a doctor will make both prevention and getting diagnosis easier. Reducing the cost of diabetes drugs, especially in LMICs, would also make a difference. In addition, there is widespread consensus that more action is needed to reduce obesity.

A study published last month, found that reducing the sugar children receive in the womb and as toddlers can protect them against diabetes and high blood pressure in adulthood.

Johanna Ralston, chief executive of the World Obesity Forum, said countries should take a systematic approach “focusing on prevention, public health measures and policies that limit exposure to unhealthy food marketing, especially to children.”