The global gap in diabetes prevalence and treatment has widened since 1990

Since 1990, rising diabetes rates in lower-income countries have outpaced improvements in care, while wealthier nations have seen the most progress in treatment, widening the global diabetes gap.

A recent study published in The Lancet examined global trends in diabetes prevalence and treatment coverage between 1990 and 2022 to gain insights into the changing burden of diabetes and identify treatment gaps and disparities between low- and high-income areas.

The findings highlighted the stark discrepancy between increases in diabetes prevalence and improvements in diagnosis and treatment options in middle- and low-income countries.

Background

Diabetes has become a major global health problem and is associated with serious complications such as cardiovascular disease, kidney failure and vision loss. Managing diabetes requires early detection and effective treatments, such as oral medications and insulin, that can reduce the risk of long-term health problems.

In recent decades, diabetes incidence rates have increased in many regions, mainly due to the increase in obesity, especially in low- and middle-income countries. Although affordable, generic drugs such as metformin are widely available, access to these diabetes drugs is uneven.

High-income states have generally seen improvements in diabetes care, while many low-resource areas face limited access to treatment options, resulting in an untreated and often undiagnosed diabetes patient population at significant risk for complications. Furthermore, despite previous studies of diabetes prevalence and care, global data on changes in diabetes prevalence and treatment coverage have so far been insufficient to understand trends and differences in diabetes management worldwide.

About the study

In the present study, researchers used data from 1108 population-based studies consisting of more than 141 million participants over the age of 18 to examine trends in diabetes prevalence and treatment between 1990 and 2022 in 200 countries. They collected data on fasting glucose and glycated hemoglobin or HbA1c levels, as well as diabetes medication use.

The researchers used data on fasting plasma glucose (FPG) and HbA1c levels to define diabetes as having an FPG of 7.0 millimoles per liter or higher, HbA1c equal to or greater than 6.5%, or current use of diabetes medication.

Treatment coverage trends were assessed by analyzing changes over time in both prevalence and age-standardized treatment rates, which provided researchers with insights into health care system responses worldwide. Regional data were grouped into 20 regions and eight super-regions, such as high-income Western countries, South Asia and sub-Saharan Africa, allowing more detailed comparisons between economically and geographically diverse regions.

Important findings

The study found that the prevalence of diabetes had increased significantly worldwide between 1990 and 2022, with low- and middle-income countries, with South Asia, the Middle East and parts of Africa showing a notable increase.

In 2022, an estimated 828 million adults worldwide had diabetes, which was a significant increase from 198 million in 1990. The highest age-standardized prevalence was seen in regions such as Micronesia and Polynesia, parts of the Caribbean, North Africa and the Middle East. In contrast, prevalence remained comparatively low in Western Europe and East Africa. While the prevalence of diabetes increased in most countries, several high-income countries, including Japan and France, saw stable or declining trends in diabetes rates.

Furthermore, despite the increasing prevalence of diabetes worldwide, improvements in treatment coverage have been uneven. By 2022, 445 million adults with diabetes were untreated, three times the number seen in 1990. The highest treatment coverage was in South Korea, several high-income Western countries, and some countries in Latin America and the Middle East East.

In contrast, treatment coverage was particularly low in sub-Saharan Africa and South Asia, with some African nations having treatment rates below 10%. This disparity suggests that low-resource areas are increasingly burdened by untreated diabetes, which further increases the risk of cardiovascular disease and other complications. T

The study also highlighted that many of the untreated diabetes cases in low-income areas came from undiagnosed cases, highlighting the need for improved screening and access to health care.

conclusions

Overall, the findings highlighted the growing global burden of diabetes, particularly in low-income areas with limited access to treatment. Expanding health care coverage and diabetes management programs, especially in high-burden areas, is necessary to reduce complications and improve health outcomes for people with diabetes worldwide, the researchers said.