The number of adults living with diabetes worldwide will more than double by 2050, according to research that blames rapidly rising obesity levels and widening health inequalities.
New estimates predict the number will rise from 529 million in 2021 to more than 1.3 billion in 2050. No country is expected to see a decline in its diabetes rate over the next 30 years. The findings were published in The Lancet and The Lancet Diabetes & Endocrinology journals.
Experts described the data as alarming, saying diabetes was outpacing most diseases globally, presenting a significant threat to people and health systems.
“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 healthcare systems worldwide,” said Dr Shivani Agarwal, of the Montefiore Health System and the Albert Einstein College of Medicine in New York.
Separately, the UN has predicted that by 2050 the world’s population will be about 9.8 billion. That suggests that by then between one in seven and one in eight people will be living with diabetes.
The research authors wrote: “Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors.”
Structural racism experienced by minority ethnic groups and “geographic inequity” were accelerating rates of diabetes, disease, illness and death around the world, the authors said.
People from marginalised communities are less likely to have access to essential medicines such as insulin, and have worse blood sugar control, a lower quality of life and reduced life expectancy.
The pandemic has amplified diabetes inequity globally. People with diabetes were twice as likely to develop severe infection with Covid-19 and to die compared with those without diabetes, especially among minority ethnic groups, the authors said.
The research outlines how the large-scale and deep-rooted effects of racism and inequity lead to unequal impacts on global diabetes prevalence, care and outcomes.
The negative impacts of public awareness and policy, economic development, access to high-quality care, innovations in management, and sociocultural norms were felt widely by marginalised populations and will be for generations to come, it found.
“Racist policies such as residential segregation affect where people live, their access to sufficient and healthy food and healthcare services,” said co-author Leonard Egede of the Medical College of Wisconsin. “This cascade of widening diabetes inequity leads to substantial gaps in care and clinical outcomes for people from historically disenfranchised racial and ethnic groups, including Black, Hispanic and Indigenous people.”
The structural conditions in the places people live and work have far-reaching, transgenerational negative effects on diabetes outcomes across the world, according to the research.
Dr Alisha Wade, a co-author and an associate professor at the University of the Witwatersrand in South Africa, said: “It is vital that the impact of social and economic factors on diabetes is acknowledged, understood and incorporated into efforts to curb the global diabetes crisis.”
The charity Diabetes UK has previously said that the high number of overweight or obese people – about 64% of adults in England – is translating into an increase in cases of type 2 cases.
The condition is becoming increasingly common among those under the age of 40 and in areas where there are higher levels of deprivation.
The charity said the risk factors of type 2 diabetes were “multiple and complex” and included age, family history, ethnicity and weight.
Chris Askew, the 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.
“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.”
