Diabetes in the world 2021

Diabetes is a serious, chronic condition that occurs when the body cannot produce enough insulin or it cannot effectively use the insulin it does produce [1, p.10].

Organisations such as the International Diabetes Federation (IDF) and the World Health Organization (WHO) agree that diabetes is “one of the fastest growing global health emergencies of the 21st century” [1, p.5] — a global health concern that is on the rise worldwide [2].

But how many people are currently living with diabetes around the world? What is the breakdown of who is affected and why? And where are we headed?

In this article, we present statistical data from 2021 that provides some answers to these questions. We also look at which countries are most affected, which groups of people are most at risk, and some of the changes we can make to try to prevent this condition.

Diabetes: the global situation in 2021

In 2021, it was estimated that over half a billion adults — 537 million — between the ages of 20 and 79 years were living with diabetes worldwide [1, p.30]. This is a staggering 10.5% of the world’s population in this age group [1, p.30]. 

The vast majority of these cases — over 90% — are cases of type 2 diabetes [1, p.10]. There is evidence that type 2 diabetes may be prevented or delayed [1, p.10], which means that a number of these global cases of diabetes could potentially be avoided.

In addition, 541 million people are estimated to have impaired glucose tolerance (IGT) in 2021 [1, p.50], and a further 319 million have impaired fasting glucose (IFT) [1, p.50]. 

IGT and IFG are conditions where blood glucose levels are raised above the normal range (though below the diabetes diagnostic threshold) [1, p15]. ‘Prediabetes’ is a term used increasingly to describe people with impaired glucose tolerance and/or impaired fasting glucose [1, p10]. Prediabetes might put you at a higher risk of developing type 2 diabetes and diabetes-related complications [1, p10]. 

Mortality from diabetes is also high. Globally, it was estimated that over 6.7 million people between the ages of 20 and 79 years would die due to diabetes and diabetes-related complications in 2021 [1, p.33].

Age, gender, location: which groups are most at risk?

A person’s age, gender, and where they live may influence the likelihood of having diabetes [1].

• Age: 2021 diabetes estimates show an increasing prevalence of diabetes by age. The lowest rates among adults are found in people aged 20–24 years [1, p.35]. On the other hand, those between the ages of 55 and 59 were the most likely to have diabetes in 2021 [1, p. 35].
• Gender: generally, men tend to be more likely to develop diabetes than women [1, p. 36]. In 2021, there were 17.7 million more men living with diabetes than women [1, p. 35].
• Urban vs rural location: In 2021, 360 million people with diabetes lived in urban areas, compared with 176.6 million in rural areas [1, p 36].
• Region: globally, certain regions of the world are more affected by diabetes than others. The Middle East and North Africa, for example, had the highest comparative prevalence of diabetes in people aged 20–79 years in 2021 [1, p. 36]. This estimate is expected to increase in the future [1, p.36].

Diabetes numbers by region

Diabetes does not affect each country or geographical region equally. The 10 countries with the highest numbers of adults living with diabetes are [1, p. 37]:

• China
• India
• Pakistan
• The United States (U.S.)
• Indonesia
• Brazil
• Mexico
• Bangladesh
• Japan
• Egypt

The five countries with the highest numbers of deaths from diabetes are [1, p. 55]:

• China
• U.S. 
• India 
• Pakistan
• Japan

Some of these countries — such as China, the U.S., or India — may also have a higher prevalence of diabetes because their population is larger [1, p 55]. Proportionally, the countries with the highest number of total deaths associated with diabetes are Singapore (29%) and Pakistan (29%) [1, p 55].

It’s worth noting that in areas such as Africa, South-East Asia, and the Western Pacific, more than half of the people with diabetes are undiagnosed [1, p.30].

Income disparities

Diabetes affects low- and middle-income countries to a disproportionate degree. Over three in four people with diabetes globally are from low and middle-income countries [3].

Nearly 90% of people who have diabetes globally but do not know they have it live in lower-income countries [1, p30].

Diabetes in children

In 2021, over 1.2 million children and teenagers were living with type 1 diabetes, and 54% of these were under 15 years old [1, p.30].

Type 1 diabetes is the most common form of diabetes in kids and teenagers [1, p.43]. Globally, 1,211,900 children and adolescents under 20 have type 1 diabetes [1, p.43].

Europe has the highest number of children and teenagers with type 1 diabetes — 295,000 in total [1, p.72]. 

Although representative epidemiologic data of youth-onset type 2 diabetes is lacking in many regions, type 2 diabetes is increasingly recognised as an emerging chronic disease in children and adolescents [1, p.26].

Diabetes in pregnancy

Approximately one in six pregnancies is affected by hyperglycaemia (high blood glucose levels) in pregnancy [1, p.5]. It has been estimated that most of these cases (between 75%–90%) occur due to gestational diabetes [1, p.15] — a condition in which a pregnant person develops high blood glucose that begins, or is first recognised, in pregnancy [1, p.130].

Gestational diabetes may lead to pregnancy and birth complications [1, p.10]. Pregnant women with gestational diabetes can have babies that are large for gestational age, increasing the risk of pregnancy and birth complications for both mother and baby [1, p.10].

Most cases of hyperglycaemia in pregnancy happen in low and middle-income countries, where antenatal care may not be as widely available [1, p.54]. 

Underdiagnosis

The figures for undiagnosed diabetes are particularly high — according to recent estimates, as many as 239.7 million people worldwide may be living with diabetes and not know it [1, p.38]. That is nearly one in two adults living with diabetes around the world [1, p.38].

It is fundamental to diagnose diabetes as early as possible [1, p.38]. Earlier diagnosis of diabetes can help to manage the condition, prevent or delay complications and improve quality of life [1, p.38].

Healthcare costs

Estimates show that in 2021, countries worldwide spent nearly one trillion USD in healthcare costs related to diabetes [1, p.57]. This is a 316% increase over the last 15 years [1, p.57].

However, not every country spends equally. For example, North America and the Caribbean countries make up 43% of the total global spending on diabetes and diabetes-related health problems [1, p72]. 

The top 10 countries that have spent the most of their GDP (gross domestic product) on diabetes and diabetes-related conditions are [1, p.59]:  

• United States 
• China
• Brazil
• Germany
• Japan
• United Kingdom
• France
• Mexico
• Spain
• Italy

At the other end of the spectrum, countries that spent the least in 2021 were Gambia (in West Africa) and Nauru (in the South-West Pacific Ocean) [1, p.58].

Overall, countries with the highest income tend to have the highest costs related to diabetes, and countries with a low income tend to have the least [1, p58]. 

Diabetes and COVID-19

The year 2021 has seen a global pandemic in full swing. Diabetes is one of the pre-existing conditions that raise a person’s risk of developing severe COVID-19 and being hospitalised for it [1, p69]. 

In fact, in the first wave of the pandemic, people with diabetes were 3.6 times more likely to be hospitalised with COVID-19 [1, p.64]. 

Of those who are hospitalised with the coronavirus infection, people with diabetes are 2.3 times more likely to die than people who do not have diabetes [1, p.68].

How have diabetes numbers changed over time?

Diabetes prevalence — meaning the total number of diabetes cases per population at any one time [1, p.22] — has risen sharply in the last few decades. 

In 1980, the total number of adults living with diabetes globally was estimated at 108 million [2]. In the year 2000, this increased an estimated 151 million — 4.6% of the global population at the time [1, p2].

Today, this number has reached an estimated 537 million — 10.5% of the global population [1, p2]. That’s a three-fold increase since 2000 [1, p2], and almost a five-fold increase since the 1980s. 

This rising number of people with diabetes is driven by multiple factors [1, p2]. It may be due to people with the condition living longer now due to better healthcare [1, p.41]. We also have higher quality data [1, p.2].

Future trends and predictions

Without sufficient action to address the situation, the number of people who will develop diabetes by 2030 is estimated to be 643 million, according to the IDF [1, p.2]. That’s over 11% of the world’s population [1, p.2].

If this current trend continues, the total number of people worldwide who will have diabetes is projected to be 783 million by 2045 — over 12% of the global population [1, p.2]. 

What can be done?

Reading about the escalating numbers of diabetes cases around the world can feel alarming. 

But healthcare policies that comprise aiming healthcare campaigns at those with increased risk of developing diabetes, as well as early diagnosis of diabetes and appropriate diabetes therapy can help to improve the current situation around diabetes [2].  

Preventing diabetes

Type 1 diabetes tends to occur in childhood but can develop at any age [1 p. 10]. It cannot be prevented [1 p. 10]. 

However, type 2 diabetes can generally be prevented [1 p. 10]. In the U.S., 9 in 10 cases of diabetes are considered preventable [4].

Individual behaviour and lifestyle changes can help to lower the risk of developing diabetes [4]. Some of the steps that individuals can take to lower their risk include [4]:

• Exercising more and sitting less
• Maintaining a healthy weight 
• Eating a healthy diet consisting of whole grains, healthy fats, limited red meat and no sugary drinks
• Not smoking
• Limiting alcohol intake

Beyond individual behaviour, the role of community, family, school, media, health policies and the food industry in preventing diabetes should not be underestimated [4]. These institutions must work together to make healthier choices easier for the individual [4].