New estimates predicted that the number of people with diabetes worldwide could double from 529 million in 2021 to more than 1.3 billion in 2050 .
A linked series of studies, published in The Lancet and The Lancet Diabetes and Endocrinology journals suggested that in spite of efforts to tackle the burden, low- and middle-income countries were likely to experience the highest increases in diabetes rates, illness, and mortality, whilst "structural racism" meant minority ethnic groups were most at risk.
Experts warned that no country was expected to witness a decline in age-standardised diabetes rates over the next 3 decades.
Rates of type 1 and type 2 diabetes in young people up to 25 years were also rising globally, leading to "an exponential generational increase" in diabetes, the authors said.
The United Nations has separately predicted that the world's current population of around 7.6 billion is expected to reach 9.8 billion in 2050 . Nevertheless, the latest estimates in The Lancet series of articles predicted that between 2021 and 2050, the global age-standardised total diabetes prevalence would increase by 59.7%, from 6.1% to 9.8%, resulting in 1.31 billion people living with diabetes by the end of the period.
'Widening Inequity' Driving Rates Up
Of the predicted increase, 49.6% would be driven by rising rates of obesity, and the remaining 50.4% driven by demographic trends. However, even that inflated figure was likely to be exceeded in two 'super regions', with 11.3% rates of diabetes likely in Latin America and the Caribbean, and 16.8% in North Africa and the Middle East, according to estimates in The Lancet, aided by the latest analysis by the Global Burden of Diseases (GBD) collaborators. Every country in Oceania, North Africa and the Middle East, and central Latin America could expect to have a diabetes prevalence rate exceeding 10% by 2050. In total, 89 (43.6%) of 204 countries and territories would have an age-standardised rate greater than 10%, whilst for 24 countries (11.8%), it would exceed 20%, study results suggested.
The projected increase would be largely driven by type 2 diabetes, with global prevalence rising by 61.2, from 5.9% in 2021 to 9.5% in 2050, affecting more than 1.27 billion people. Age-standardised type 2 diabetes prevalence would increase by more than 70% in six regions: North Africa and the Middle East, East Asia, central sub-Saharan Africa, southern sub-Saharan Africa, central Latin America, and Australasia.
The new collection of papers also highlighted how diabetes rates were being fuelled by large-scale inequity in diabetes prevalence, illness, and death. Estimates indicated that adults living in low- to middle-income countries would account for more than three-quarters of diabetes cases by 2045, and fewer than 1 in 10 of those people would be receiving guideline-based comprehensive diabetes care.
In high-income countries, such as the US, rates of diabetes were already 1.5 times higher among minority ethnic groups compared with White populations. The Lancet studies found that marginalised communities around the world were less likely to have access to essential medicines, including insulin and new treatments.
Findings published in The Lancet Diabetes and Endocrinology emphasised those race and ethnic trends. For example, Black people born in Africa or the Caribbean were 25% less likely to develop diabetes than Black people born in the US; and Asian, Black, and Hispanic individuals, and those on low incomes, were less likely to receive diabetes treatment with GLP1 receptor agonists than their White or wealthier counterparts.
The study authors said that strategies to curb the growth of diabetes, "threatening global health now and for generations to come", should be in line with recommendations from The Lancet Commission on Diabetes, in concert with World Health Organisation and United Nations sustainable development goals.
"Diabetes remains one of the biggest public health threats of our time and is set to grow aggressively over the coming three decades in every country, age group, and sex, posing a serious challenge to health-care systems worldwide," said Dr Shivani Agarwal, from Albert Einstein College of Medicine and Montefiore Health System in the US, and senior author of the multi-paper series.
She continued, "A central focus and understanding of inequity in diabetes is vital to achieve the UN's sustainable development goal to reduce non-communicable diseases by 30% in less than 7 years, and to curtail the increasingly negative effects on the health of marginalised populations and the strength of national economies for decades to come."
The study authors also called for more real-world research to develop and test interventions to boost equitable access to care for people with diabetes.
Concerted Action Urgently Needed
Commenting on the latest research, Chris Askew, chief executive of Diabetes UK, said : "This important study underlines the sheer scale of the diabetes crisis we're facing, both in the UK and around the world.
"We already know that, in the UK, type 2 diabetes does not affect everyone equally. Your ethnicity, where you live and your income all affect your chances of getting type 2 diabetes, the care you receive and your long-term health, and these are all interlinked.
"The need for concerted cross-government action to address inequalities in diabetes prevalence and outcomes – as well as the underlying conditions of ill health, such as poverty and living with obesity – has never been greater or more urgent."