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. 2024 Nov 23;404(10467):2077-2093.
doi: 10.1016/S0140-6736(24)02317-1. Epub 2024 Nov 13.

Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants

NCD Risk Factor Collaboration (NCD-RisC)
Collaborators

Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants

NCD Risk Factor Collaboration (NCD-RisC). Lancet. .

Erratum in

  • Department of Error.
    [No authors listed] [No authors listed] Lancet. 2025 Apr 5;405(10485):1146. doi: 10.1016/S0140-6736(25)00620-8. Lancet. 2025. PMID: 40187842 No abstract available.

Abstract

Background: Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories.

Methods: We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment.

Findings: In 2022, an estimated 828 million (95% credible interval [CrI] 757-908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554-713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries 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 or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and 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 coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait).

Interpretation: In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

Funding: UK Medical Research Council, UK Research and Innovation (Research England), and US Centers for Disease Control and Prevention.

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Conflict of interest statement

Declaration of interests JES reports consulting fees from GSK, AstraZeneca, Sanofi, Novo Nordisk, Eli Lilly, Roche, and Abbott; payments for lectures from AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Roche, Zuellig Pharmaceutical, and Eli Lilly; and payments for programme committee from AstraZeneca, outside the submitted work. ANW reports an honorarium from Sanofi for serving as a panel member at an educational event on thyroid cancer; support from Novo Nordisk for attendance at a continuing medical education event, and from Fogarty International Centre, National Institutes of Health Emerging Global Leader Award; and membership for the Diabetes Guidelines Committee, the Global Endocrine Leadership Coalition, the Society for Endocrinology, Metabolism and Diabetes of South Africa, and Endocrine Society-Member for the Research Affairs Core Committee, outside the submitted work. CJP reports holding stocks in Pfizer, outside the submitted work. All other authors declare no competing interests.

Figures

Figure 1
Figure 1. Age-standardised diabetes prevalence from 1990 to 2022 by country, for women and men aged 18 years or older
The shaded areas around the lines show the 95% credible intervals of the estimates. Countries are labelled using their International Organization for Standardization 3166–1 α-3 codes. The numbers in brackets after each country’s label show the total number of data sources and the number of nationally representative data sources, respectively. See the appendix (pp 90–91) for the results for both sexes combined. AFG=Afghanistan. AGO=Angola. ALB=Albania. AND=Andorra. ARE=United Arab Emirates. ARG=Argentina. ARM=Armenia. ASM=American Samoa. ATG=Antigua and Barbuda. AUS=Australia. AUT=Austria. AZE=Azerbaijan. BDI=Burundi. BEL=Belgium. BEN=Benin. BFA=Burkina Faso. BGD=Bangladesh. BGR=Bulgaria. BHR=Bahrain. BHS=The Bahamas. BIH=Bosnia and Herzegovina. BLR=Belarus. BLZ=Belize. BMU=Bermuda. BOL=Bolivia. BRA=Brazil. BRB=Barbados. BRN=Brunei. BTN=Bhutan. BWA=Botswana. CAF=Central African Republic. CAN=Canada. CHE=Switzerland. CHL=Chile. CHN=China. CIV=Côte d’Ivoire. CMR=Cameroon. COD=DR Congo. COG=Congo (Brazzaville). COK=Cook Islands. COL=Colombia. COM=Comoros. CPV=Cabo Verde. CRI=Costa Rica. CUB=Cuba. CYP=Cyprus. CZE=Czechia. DEU=Germany. DJI=Djibouti. DMA=Dominica. DNK=Denmark. DOM=Dominican Republic. DZA=Algeria. ECU=Ecuador. EGY=Egypt. ERI=Eritrea. ESP=Spain. EST=Estonia. ETH=Ethiopia. FIN=Finland. FJI=Fiji. FRA=France. FSM=Federated States of Micronesia. GAB=Gabon. GBR=UK. GEO=Georgia. GHA=Ghana. GIN=Guinea. GMB=The Gambia. GNB=Guinea-Bissau. GNQ=Equatorial Guinea. GRC=Greece. GRD=Grenada. GRL=Greenland. GTM=Guatemala. GUY=Guyana. HND=Honduras. HRV=Croatia. HTI=Haiti. HUN=Hungary. IDN=Indonesia. IND=India. IRL=Ireland. IRN=Iran. IRQ=Iraq. ISL=Iceland. ISR=Israel. ITA=Italy. JAM=Jamaica. JOR=Jordan. JPN=Japan. KAZ=Kazakhstan. KEN=Kenya. KGZ=Kyrgyzstan. KHM=Cambodia. KIR=Kiribati. KNA=Saint Kitts and Nevis. KOR=South Korea. KWT=Kuwait. LAO=Laos. LBN=Lebanon. LBR=Liberia. LBY=Libya. LCA=Saint Lucia. LKA=Sri Lanka. LSO=Lesotho. LTU=Lithuania. LUX=Luxembourg. LVA=Latvia. MAR=Morocco. MDA=Moldova. MDG=Madagascar. MDV=Maldives. MEX=Mexico. MHL=Marshall Islands. MKD=North Macedonia. MLI=Mali. MLT=Malta. MMR=Myanmar. MNE=Montenegro. MNG=Mongolia. MOZ=Mozambique. MRT=Mauritania. MUS=Mauritius. MWI=Malawi. MYS=Malaysia. NAM=Namibia. NER=Niger. NGA=Nigeria. NIC=Nicaragua. NIU=Niue. NLD=Netherlands. NOR=Norway. NPL=Nepal. NRU=Nauru. NZL=New Zealand. OMN=Oman. PAK=Pakistan. PAN=Panama. PER=Peru. PHL=Philippines. PLW=Palau. PNG=Papua New Guinea. POL=Poland. PRI=Puerto Rico. PRK=North Korea. PRT=Portugal. PRY=Paraguay. PSE=Palestine. PYF=French Polynesia. QAT=Qatar. ROU=Romania. RUS=Russia. RWA=Rwanda. SAU=Saudi Arabia. SDN=Sudan. SEN=Senegal. SGP=Singapore. SLB=Solomon Islands. SLE=Sierra Leone. SLV=El Salvador. SOM=Somalia. SRB=Serbia. SSD=South Sudan. STP=São Tomé and Príncipe. SUR=Suriname. SVK=Slovakia. SVN=Slovenia. SWE=Sweden. SWZ=Eswatini. SYC=Seychelles. SYR=Syria. TCD=Chad. TGO=Togo. THA=Thailand. TJK=Tajikistan. TKL=Tokelau. TKM=Turkmenistan. TLS=Timor-Leste. TON=Tonga. TTO=Trinidad and Tobago. TUN=Tunisia. TUR=Türkiye. TUV=Tuvalu. TWN=Taiwan. TZA=Tanzania. UGA=Uganda. UKR=Ukraine. URY=Uruguay. USA=USA. UZB=Uzbekistan. VCT=Saint Vincent and the Grenadines. VEN=Venezuela. VNM=Viet Nam. VUT=Vanuatu. WSM=Samoa. YEM=Yemen. ZAF=South Africa. ZMB=Zambia. ZWE=Zimbabwe.
Figure 1
Figure 1. Age-standardised diabetes prevalence from 1990 to 2022 by country, for women and men aged 18 years or older
The shaded areas around the lines show the 95% credible intervals of the estimates. Countries are labelled using their International Organization for Standardization 3166–1 α-3 codes. The numbers in brackets after each country’s label show the total number of data sources and the number of nationally representative data sources, respectively. See the appendix (pp 90–91) for the results for both sexes combined. AFG=Afghanistan. AGO=Angola. ALB=Albania. AND=Andorra. ARE=United Arab Emirates. ARG=Argentina. ARM=Armenia. ASM=American Samoa. ATG=Antigua and Barbuda. AUS=Australia. AUT=Austria. AZE=Azerbaijan. BDI=Burundi. BEL=Belgium. BEN=Benin. BFA=Burkina Faso. BGD=Bangladesh. BGR=Bulgaria. BHR=Bahrain. BHS=The Bahamas. BIH=Bosnia and Herzegovina. BLR=Belarus. BLZ=Belize. BMU=Bermuda. BOL=Bolivia. BRA=Brazil. BRB=Barbados. BRN=Brunei. BTN=Bhutan. BWA=Botswana. CAF=Central African Republic. CAN=Canada. CHE=Switzerland. CHL=Chile. CHN=China. CIV=Côte d’Ivoire. CMR=Cameroon. COD=DR Congo. COG=Congo (Brazzaville). COK=Cook Islands. COL=Colombia. COM=Comoros. CPV=Cabo Verde. CRI=Costa Rica. CUB=Cuba. CYP=Cyprus. CZE=Czechia. DEU=Germany. DJI=Djibouti. DMA=Dominica. DNK=Denmark. DOM=Dominican Republic. DZA=Algeria. ECU=Ecuador. EGY=Egypt. ERI=Eritrea. ESP=Spain. EST=Estonia. ETH=Ethiopia. FIN=Finland. FJI=Fiji. FRA=France. FSM=Federated States of Micronesia. GAB=Gabon. GBR=UK. GEO=Georgia. GHA=Ghana. GIN=Guinea. GMB=The Gambia. GNB=Guinea-Bissau. GNQ=Equatorial Guinea. GRC=Greece. GRD=Grenada. GRL=Greenland. GTM=Guatemala. GUY=Guyana. HND=Honduras. HRV=Croatia. HTI=Haiti. HUN=Hungary. IDN=Indonesia. IND=India. IRL=Ireland. IRN=Iran. IRQ=Iraq. ISL=Iceland. ISR=Israel. ITA=Italy. JAM=Jamaica. JOR=Jordan. JPN=Japan. KAZ=Kazakhstan. KEN=Kenya. KGZ=Kyrgyzstan. KHM=Cambodia. KIR=Kiribati. KNA=Saint Kitts and Nevis. KOR=South Korea. KWT=Kuwait. LAO=Laos. LBN=Lebanon. LBR=Liberia. LBY=Libya. LCA=Saint Lucia. LKA=Sri Lanka. LSO=Lesotho. LTU=Lithuania. LUX=Luxembourg. LVA=Latvia. MAR=Morocco. MDA=Moldova. MDG=Madagascar. MDV=Maldives. MEX=Mexico. MHL=Marshall Islands. MKD=North Macedonia. MLI=Mali. MLT=Malta. MMR=Myanmar. MNE=Montenegro. MNG=Mongolia. MOZ=Mozambique. MRT=Mauritania. MUS=Mauritius. MWI=Malawi. MYS=Malaysia. NAM=Namibia. NER=Niger. NGA=Nigeria. NIC=Nicaragua. NIU=Niue. NLD=Netherlands. NOR=Norway. NPL=Nepal. NRU=Nauru. NZL=New Zealand. OMN=Oman. PAK=Pakistan. PAN=Panama. PER=Peru. PHL=Philippines. PLW=Palau. PNG=Papua New Guinea. POL=Poland. PRI=Puerto Rico. PRK=North Korea. PRT=Portugal. PRY=Paraguay. PSE=Palestine. PYF=French Polynesia. QAT=Qatar. ROU=Romania. RUS=Russia. RWA=Rwanda. SAU=Saudi Arabia. SDN=Sudan. SEN=Senegal. SGP=Singapore. SLB=Solomon Islands. SLE=Sierra Leone. SLV=El Salvador. SOM=Somalia. SRB=Serbia. SSD=South Sudan. STP=São Tomé and Príncipe. SUR=Suriname. SVK=Slovakia. SVN=Slovenia. SWE=Sweden. SWZ=Eswatini. SYC=Seychelles. SYR=Syria. TCD=Chad. TGO=Togo. THA=Thailand. TJK=Tajikistan. TKL=Tokelau. TKM=Turkmenistan. TLS=Timor-Leste. TON=Tonga. TTO=Trinidad and Tobago. TUN=Tunisia. TUR=Türkiye. TUV=Tuvalu. TWN=Taiwan. TZA=Tanzania. UGA=Uganda. UKR=Ukraine. URY=Uruguay. USA=USA. UZB=Uzbekistan. VCT=Saint Vincent and the Grenadines. VEN=Venezuela. VNM=Viet Nam. VUT=Vanuatu. WSM=Samoa. YEM=Yemen. ZAF=South Africa. ZMB=Zambia. ZWE=Zimbabwe.
Figure 2
Figure 2. Age-standardised diabetes prevalence and treatment coverage in 2022 and change from 1990 to 2022
(A) Age-standardised diabetes prevalence in people aged 18 years or older. (B) Age-standardised treatment coverage in people aged 30 years or older. The density plot alongside each map shows the smoothed distribution of estimates across countries. The appendix (pp 78–81) shows the posterior probability of an estimated increase or decrease being a true increase or decrease. The appendix (pp 92–93) also shows the results for both sexes combined.
Figure 3
Figure 3. Number of people with (A) diabetes and (B) untreated diabetes in 2022
The number of people with diabetes is for people aged 18 years or older; the number of people with diabetes covering only those aged 30 years or older is shown in the appendix (p 70). The number of people with untreated diabetes is for people aged 30 years or older. The area of the circle is proportional to the number of people with diabetes or untreated diabetes in each country. Countries listed were the top 20 countries in 2022 in terms of number of people with diabetes or untreated diabetes, with their rankings shown by the numbers before their names. The numbers in brackets after each country name show the number of people with diabetes or untreated diabetes in that country, and its percentage of the global number (828 million for diabetes and 445 million for untreated diabetes).
Figure 4
Figure 4. Age-standardised treatment coverage for women and men aged 30 years or older in 1990 and 2022
Each line represents a country, with countries coloured by the super-region in which they fall. The black triangle shows the age-standardised treatment coverage for the world. The appendix (p 69) shows the countries in each super-region. The appendix (pp 94–95) also shows the results for both sexes combined.
Figure 5
Figure 5. Contributions of population growth and ageing, rise in diabetes prevalence, and improvement in treatment coverage to the change in the number of people with untreated diabetes from 1990 to 2022
The sum of all sections in each graph is the total number of people with untreated diabetes over time, also shown by the solid black line. The area above the solid black line and top of stacked sections, where it is present, equals the contribution of improvement in treatment (ie, the purple section) towards reducing the number of people with untreated diabetes—namely, the top of the stacked sections shows how many people would have had untreated diabetes had treatment coverage not improved. The appendix (p 69) describes the countries in each super-region.
See this image and copyright information in PMC

Comment in

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