Indians account for quarter of world’s adult diabetes patients: Lancet study

About a quarter of the 828 million adults globally living with diabetes — either type 1 or 2 — are in India, a paper published in The Lancet said on Wednesday.

About a quarter of the 828 million adults globally living with diabetes — either type 1 or 2 — are in India, a paper published in The Lancet said on Wednesday.

133 million diabetic adults were living without treatment in India, the report said. (Shutterstock)

Apart from the 212 million patients in India, other high disease burden countries include China with 148 million adults, followed by the USA (42 million), Pakistan (36 million), Indonesia (25 million) and Brazil (22 million), the report said.

The report flagged a lack of access to treatment, with 445 million adults aged 30 years and older (59%) globally being deprived of proper care in 2022. The number of such adults in India stood at 133 million, which is a staggering 30% of the diabetics living without treatment.

The researchers compared data between1990 to 2022, and found that the current prevalence is at least four times more than what it was in 1990, and three and a half times the number in 1990 of those who were living without treatment.

“Our study highlights widening global inequalities in diabetes, with treatment rates stagnating in many low- and middle-income countries where numbers of adults with diabetes are drastically increasing. This is especially concerning as people with diabetes tend to be younger in low-income countries and, in the absence of effective treatment, are at risk of life-long complications — including amputation, heart disease, kidney damage or vision loss - or in some cases, premature death,” said senior author, Majid Ezzati, of Imperial College London, in a statement.

The study, conducted by the NCD Risk Factor Collaboration (NCD-RisC), in collaboration with the World Health Organization (WHO), is the first global analysis of trends in both diabetes rates and treatment which includes all countries. Researchers used data from over 140 million people aged 18 years or older from more than 1,000 studies in populations of different countries.

From 1990 to 2022, global diabetes rates doubled in both men (6.8% in 1990 to 14.3% in 2022) and women (6.9% to 13.9%). With the additional impact of population growth and ageing, this equates to an estimated 828 million adults with diabetes in 2022, an increase of approximately 630 million people from 1990, when roughly 198 million adults were estimated to have the disease.

The countries with the lowest rates of diabetes in 2022 were in western Europe and east Africa for both sexes, and in Japan and Canada for women. For example, diabetes rates in 2022 were as low as 2-4% for women in France, Denmark, Spain, Switzerland, and Sweden, and 3-5% for men in Denmark, France, Uganda, Kenya, Malawi, Spain, and Rwanda.

By contrast, countries with the highest rates, according to the paper, where 25% or more of the population had diabetes for both men and women, were the Pacific island nations and those located in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. Among high-income industrialised nations, diabetes rates in 2022 were highest in the USA (11.4% amongst in women and 13.6% in men).

The researchers attributed the rise in type 2 diabetes rates, and its variation across countries, to obesity and poor diets. Diabetes rate was either already high or increased more in some of the regions where obesity was or became prevalent between 1990 to 2022, compared to many high-income countries, especially those in the Pacific and western Europe, where, in general, obesity and diabetes rates did not rise or rose by a relatively small amount.

“Given the disabling and potentially fatal consequences of diabetes, preventing diabetes through healthy diet and exercise is essential for better health throughout the world. Our findings highlight the need to see more ambitious policies, especially in lower-income regions of the world, that restrict unhealthy foods, make healthy foods affordable and improve opportunities to exercise through measures such as subsidies for healthy foods and free healthy school meals as well as promoting safe places for walking and exercising including free entrance to public parks and fitness centres,” said Dr Ranjit Mohan Anjana, Madras Diabetes Research Foundation, India, in a statement.

Three out of five (59%) of adults aged 30 years and older with diabetes, a total of 445 million, were not receiving medication for diabetes in 2022, three and half times the number in 1990 (129 million).  

Since 1990, some countries, including many in central and western Europe, Latin America and East Asia and the Pacific, as well as Canada and South Korea have seen vast improvements in treatment rates for diabetes resulting in more than 55% of people with diabetes in these countries receiving treatment in 2022. The highest treatment rates were estimated in Belgium, at 86% for women and 77% for men.

However, for many LMICs diabetes treatment coverage has stayed low and changed little over the previous three decades, with over 90% of people with diabetes not receiving treatment in some countries in both 1990 and 2022.

As a result of these trends, the gap between the countries with the highest and lowest treatment coverage for diabetes has widened since 1990 to 2022; from 56 to 78 percentage points in women and from 43 to 71 percentage points in men.

“Our findings suggest there is an increasing share of people with diabetes, especially with untreated diabetes, living in low- and middle-income countries. In 2022, only 5-10% of adults with diabetes in some sub-Saharan Africa countries received treatment for diabetes, leaving a huge number at risk of the serious health complications,” said Jean Claude Mbanya, University of Yaoundé 1, Cameroon.

In 2022, almost one third (133 million, 30%) of the 445 million adults aged 30 years or older with untreated diabetes lived in India, more than 50% greater than the next largest number which was in China (78 million) because treatment coverage was higher in China (45% for women and 41% for men) than in India (28% for women and 29% for men). Similarly, Pakistan (24 million) and Indonesia (18 million), the next two countries with the largest number of untreated diabetes, surpassed the USA (13 million), which had higher treatment coverage (65% for women and 67% for men).

“Most people with untreated diabetes will not have received a diagnosis, therefore increasing detection of diabetes must be an urgent priority in countries with low levels of treatment. Better diagnosis of diabetes requires innovations such as workplace and community screening programmes, extended or flexible healthcare hours to enable people to visit outside of standard working hours, integration with screening and care for diseases like HIV/AIDS and TB which have well-established programmes, and the use of trusted community healthcare providers,” added Mbanya.