The number of people with diabetes worldwide is set to more than double to 1.3 billion by 2050, a new study finds, a trend accelerated by widening inequities both between and within countries.
By 2050, about 1 in 10 people around the world are predicted to have the disease, representing a 60% surge in the prevalence of diabetes, according to the study, published Thursday in the Lancet as part of a wide-ranging series on global inequities in diabetes.
“Diabetes will be a defining disease of this century,” editors of the Lancet wrote in an editorial for the series. “How the health community deals with diabetes in the next two decades will shape population health and life expectancy for the next 80 years. The world has failed to understand the social nature of diabetes and underestimated the true scale and threat the disease poses.”
Rising rates will be driven by type 2 diabetes, which made up 96% of diabetes cases worldwide in 2021, and type 2 diabetes cases will in large part be driven by obesity, a primary risk factor for the disease. While the authors attribute about half of the rise in diabetes over the next three decades to demographic shifts such as aging populations, they attribute the remaining half to surging obesity rates.
Diabetes has traditionally been thought of as a disease that occurs in high-income countries, but along with obesity, it’s increasingly affecting low- and middle-income countries as well. These regions are rapidly shifting to industrialized lifestyles consisting of diets made up of processed foods and reduced physical activity, while also experiencing limited health spending and inadequate treatments, the authors said.
Even though new, highly effective drugs for obesity and diabetes have emerged — such as the class of GLP-1 drugs that include Ozempic, Wegovy and Mounjaro — addressing diabetes worldwide requires not only medical interventions, but also broad changes to the environments people live in, the Lancet editors wrote.
“The excitement and utility surrounding GLP-1 agonists and newer drug combinations that help to control blood sugar as well as reduce body weight is understandable,” they said. But, “the solution to unhealthy and unfair societies is not more pills but to re-evaluate and re-imagine our lives to provide opportunities to tackle racism and injustice, and to prevent the major social drivers of disease.”
“Addressing structural racism must become a core component of preventive strategies and health promotion — areas that invariably receive too little investment,” they added.
Earlier studies found that more than three-quarters of people with diabetes are predicted to live in low- and middle-income countries by 2045, but less than 10% of people with diabetes in those countries have received comprehensive diabetes care. This new study digs deeper into specific regions around the world.
In every country and territory in three regions — North Africa and the Middle East, Central Latin America and Oceania — the diabetes rate is set to exceed 10% by 2050, the study found. And in 10 out of 21 countries in North Africa and the Middle East and in 13 out of 18 countries in Oceania, the diabetes prevalence is set to exceed 20%.
Overall, across the world, there are no countries where diabetes rates are expected to decrease, the authors said.
“For a disease where there is a significant amount of financial investment — certain countries spend a lot of money and there are definitely industries that spend a lot of effort and energy — it seems like something is amiss,” said Liane Ong, first author of the study and a lead research scientist at the Institute for Health Metrics and Evaluation. “The way that we’ve been trying to tackle this condition maybe needs to be re-thought of and reframed.”
The Lancet series looked not only at inequities across countries but also within countries. In Australia for example, authors note that indigenous people experienced greater than four times higher rates of diabetes-related death and hospitalization than non-indigenous Australians. The authors trace these differences in outcomes to longstanding issues that indigenous groups face, like food insecurity and inadequate housing.
In the U.S., the authors note that Native and Black Americans experience a greater burden of diabetes, and attribute the disparities to consequences of historical events like displacement of Native communities and redlining that discriminated against Black populations.
“Structural inequities really lie at the heart of the global diabetes crisis that we have and for generations to come,” said Shivani Agarwal, lead author of the Lancet series and an associate professor of medicine at the Albert Einstein College of Medicine. If people don’t pay attention now, “we will be in a really tough spot for our ourselves and for our children and their children.”