Diabetes inequities persist worldwide, especially for low-, middle-income countries
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Key takeaways:
- Diabetes prevalence rose from 1990 to 2022, with the largest increases in low- and middle-income countries.
- More adults were untreated in 2022 vs. 1990, especially in some African and South Asian countries.
From 1990 to 2022, diabetes prevalence rose greatly, but for the most part, treatment did not increase at all or sufficiently, especially in low- and middle-income countries, researchers reported in The Lancet.
“To our knowledge, this is the first global analysis that estimated diabetes treatment coverage for all countries in the world. This is also the first global analysis that estimated diabetes rates based on both fasting glucose and glycated hemoglobin, so that the definition of diabetes in global studies that estimate the burden of diabetes is consistent with contemporary clinical guidelines,” Bin Zhou, PhD, research fellow in health analytics and machine learning at the Abdul Latif Jameel Institute for Disease and Emergency Analytics and the WHO Collaborating Centre on NCD Surveillance, Epidemiology and Modeling at the MRC Centre for Environment and Health at the School of Public Health at Imperial College London, told Healio. “The main motivation for such analysis is to address a major evidence gap to enhance global prevention and management of diabetes and other noncommunicable diseases.”
Zhou and colleagues conducted a pooled analysis using data from 1,108 population-representative studies with 141 million participants aged 18 years and older. All participants had fasting glucose and HbA1c measurements and data on diabetes treatment. Diabetes was defined as a fasting plasma glucose of 7 mmol/L or higher, HbA1c of 6.5% or higher or taking diabetes medications. Treatment was defined as the proportion of individuals with diabetes taking diabetes medications.
Diabetes prevalence
An estimated 828 million adults (95% credible interval, 757,000,000-908,000,000) had diabetes in 2022, which was an increase of 630 million (95% credible interval, 554,000,000-713,000,000) since 1990. India and China accounted for the largest proportion of adults with diabetes, followed by the U.S., Pakistan, Indonesia and Brazil. Age-standardized diabetes prevalence rose in 131 countries for women and in 155 for men from 1990 to 2022, with a posterior probability of more than 0.8.
Researchers observed the largest diabetes prevalence increases ranging from 15 to 22 percentage points in low- and middle-income countries in Southeast Asia, South Asia, the Middle East, North Africa, Latin America and the Caribbean. Diabetes prevalence did not rise nor fall with a posterior probability of more than 0.8 in some western and central European, sub-Saharan African, East Asian, Pacific, Canadian and Pacific Island nations countries where prevalence remained high since 1990, Zhou and colleagues wrote. Conversely, diabetes prevalence decreased with a posterior probability of more than 0.8 for women in Japan, Spain and France and for men in Nauru.
In 2022, the lowest diabetes prevalence globally was in western Europe and East Africa for both men and women and in Japan and Canada for women, the researchers found. The highest diabetes prevalence globally in 2022 was observed in some countries in:
- Polynesia;
- Micronesia;
- the Caribbean;
- the Middle East;
- North Africa;
- Pakistan; and
- Malaysia.
Diabetes treatment coverage
The researchers reported that 59% of adults aged 30 years or older with diabetes did not receive treatment in 2022, which was more than three times higher vs. 1990 (445 million vs. 129 million). Of untreated adults, 30% were in India. Diabetes treatment coverage increased in 118 countries for women and 98 for men, with a posterior probability of more than 0.8.
In 1990, diabetes treatment coverage was less than 50% in all but 11 countries for women and one for men.
Researchers observed the largest diabetes treatment coverage increases ranging from 25 to 37 percentage points in Latin America, central and western Europe, Canada, South Korea, Russia, Seychelles and Jordan. Most countries in sub-Saharan Africa, the Caribbean, Pacific Island nations and South, Southeast and Central Asia demonstrated no increase in diabetes treatment coverage.
Gaps between countries with the highest and lowest diabetes treatment coverage rose from 56 percentage points in women and 43 percentage points in men in 1990 to 78 percentage points and 71 percentage points in 2022, respectively.
Age-standardized diabetes treatment coverage was lowest in sub-Saharan African and South Asian countries in 2022, with less than 10% coverage in some African countries. In contrast, South Korea, many high-income Western countries, some countries in central and eastern Europe, Latin America, the Middle East and North Africa had diabetes treatment coverage of 55% or higher. The highest aged-standardized diabetes treatment coverage was in Belgium, with 86% for women and 77% for men, the researchers wrote.
“Most people with untreated diabetes in low- and middle-income countries have not received a diagnosis, therefore increasing detection of diabetes must be an urgent priority in countries with low levels of treatment,” Zhou said in an interview. “Better diagnosis of diabetes requires innovations such as workplace and community screening programs, extended or flexible health care hours to enable people to visit outside of standard working hours, integration with screening and care for diseases like HIV/AIDS and tuberculosis, which have well-established programs, and the use of trusted community health care providers.”
For more information:
Bin Zhou, PhD, can be reached at b.zhou13@imperial.ac.uk.
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