Diabetes

We discuss new findings on diabetes worldwide with researchers Dr. Liane Ong and Lauryn Stafford.

• More people are living with diabetes now than ever before, and we expect numbers to continue increasing, with 1.3 billion cases in 2050.
• Why? Risk factors like high BMI, diet, and physical activity, plus aging and population growth. 
  • About 50% of the burden due to type 2 diabetes can be attributed to high body mass index. 
  • About 50% of the increase in total diabetes cases will be from population growth and aging.
• North Africa & the Middle East and Oceania are expected to have the greatest increases in diabetes. By 2050, about 1 in 5 people in those regions will be living with diabetes.
• What are our policy recommendations?
  • Strengthen health systems to detect diabetes early and help individuals develop healthy habits from an early age. 
  • Implement social and structural changes that encourage healthy lifestyles like access to grocery stores and physical activity. 
  • Think about holistic approaches to tackling diabetes that will work long-term for generations.

Read the research

This transcript has been lightly edited for clarity.

PAULINE CHIOU: Welcome to this episode of Global Health Insights at the Institute for Health Metrics and Evaluation. I’m Pauline Chiou in Media Relations. In this podcast, we’ll be discussing the latest research on diabetes. Dr. Liane Ong is lead research scientist and first author of a new study that’s published in The Lancet. And Lauryn Stafford is the second author of the same paper.

Thank you, both of you, for being with us for this discussion. Diabetes affects so many people, and your research unveils some really staggering statistics. Dr. Ong, let me start with you. This is the most comprehensive study of diabetes available today, and it looks at the past 30 years as well as projects into the next three decades. What would you say the main findings are of this research?

DR. LIANE ONG: Well, first of all, thank you, Pauline. I think that the main findings are that we’re expecting to see diabetes continue to increase. We’ve seen an increase over the past 30 years, and we’re going to continue to see it increase to the point that we’re expecting to see about 1.3 billion people have diabetes by 2050.

PAULINE CHIOU: So 1.3 billion. And what is causing this surge that we’re expected to see in the next 30 years? 

DR. LIANE ONG: It’s actually a combination of multiple factors and multiple things. And so it is a combination of modifiable risk factors, things like high BMI, diet, physical activity, but it’s also things like aging and population growth that are all contributing toward that increase that we’re going to observe.

PAULINE CHIOU: In fact, your paper says that no country will see a decrease in diabetes, which is quite a staggering projection. Lauryn, let me bring you into the conversation. You really focus on different regions as you’re looking at where diabetes will surge and you’re paying special attention to North Africa, the Middle East, as well as certain islands in the Pacific.

Can you tell us what’s going on in these regions? 

LAURYN STAFFORD: Yeah. Thank you, Pauline. Like you said, the two hardest-hit regions we expect by 2050 are North Africa and the Middle East, and then Oceania, which includes a lot of the smaller Pacific island nations like American Samoa and Fiji. And like Dr. Ong said, we think that will be largely driven by a high body mass index or BMI.

We’ve seen that in 2021, about 50% of the burden due to type 2 diabetes can be attributed to high body mass index. So that’s definitely a really big driver. And in those regions, North Africa and the Middle East and the small Pacific island nations, by 2050, we expect that about one in five people will be living with type 2 diabetes, which is pretty alarming and significant.

PAULINE CHIOU: So Dr. Ong, Lauryn mentioned high BMI or obesity, and this is to some extent preventable. When you talk about type 2 diabetes, if obesity is one of the main drivers, is this an issue of better diet and exercise? And then we may not see these projections that the numbers surge so much? 

DR. LIANE ONG: I think that that is a pretty simplistic way of looking at the problem.

There is going to be some component of that for sure. But I don’t think that we know yet that it will completely solve the increases that we’re seeing. We also know that not everyone who has a higher BMI will develop diabetes, and not everybody with diabetes has a high BMI. So it’s a bit of what we know, strong risk factors.

And so it can’t hurt, but it’s hard to know how much of a difference that will make. We can make some educated guesses, but that’s not what this paper did. It was just to quantify the relationship between the two. 

PAULINE CHIOU: Okay. And not only obesity, but 15 other risk factors that you looked at as well. Can you talk about them? Because they range from air pollution to low physical activity to obesity.

DR. LIANE ONG: Yes. So we looked at 16 risk factors. They include high BMI, as mentioned, physical activity, a series of different dietary factors. So high-sugar beverages, low vegetable, red meat. They also included things like environmental and occupational exposure. So like you mentioned, air pollution. It also included things like tobacco and alcohol.

These are all risk factors that have been associated with type 2 diabetes in the literature. So there have been previous studies that have looked at the relationship between each of these risk factors and the development of diabetes. 

PAULINE CHIOU: Okay. So you’re looking at all of these risk factors. Let’s put it together. If we know what these risk factors are and we are anticipating this huge surge of more than 1 billion people with diabetes in 2050. I mean, what can be done right now? 

DR. LIANE ONG: If we solved all risk factors, the most that we would help control diabetes is about 50%. If everybody was 100% correct and this was everything. But we know that about 50% of the diabetes increase that we’re expected to see is also going to be contributed by population growth and aging.

And that’s actually really going to steer us toward thinking about health systems and health infrastructure and are countries going to prepare because the reality is that oftentimes people with diabetes don’t realize that they have diabetes until they have caused irreversible damage to themselves. In some ways that you can call diabetes silent in that way if it doesn’t manifest itself until it’s too late.

And many health systems are not prepared, or they don’t proactively identify individuals that have high blood sugars until it’s too late. And so what happens is that health systems can actually intervene. If they can identify these individuals earlier, they can help them monitor their blood sugar better, they can monitor their systems like whether or not they’re developing neuropathy or vision loss. And when you can minimize the effect of high blood sugar, you can also decrease risk to other complications like heart disease and stroke that we know are also associated with high blood sugar.

So really, in my opinion, if we really want to tackle as much of 100% of the sources of the increase of diabetes, we would think about this not from a risk factor perspective. We would think about this from a health systems perspective. What can countries do to shore up their health systems that can also address modifiable risk factors, but also make sure that they can monitor and maintain individuals who are unfortunately going to develop diabetes because of the aging impacts, aging effect on population growth and other uncontrollable contributors toward the development of diabetes. 

PAULINE CHIOU: Okay. So early detection can be very helpful. 

DR. LIANE ONG: I was just going to say it’s early detection, but also proactive education. Proactive maintenance. Many of the risk factors that we talk about are behaviors that once they’re ingrained within individuals, they’re very hard to disentangle and to change.

So, if we can target these things from a societal point of view and think long term, we’ll be in a much better place to help generations of individuals. 

PAULINE CHIOU: Okay, So early detection and proactive maintenance, and what are some of the behaviors, Lauryn, that are very difficult to change that that you’re seeing when you look at the prevalence of diabetes?

LAURYN STAFFORD: So like we mentioned, some of the main risk factors have to do with diet and physical activity and smoking. And you know, those types of behaviors are very ingrained and sometimes it’s really hard to break those habits. Also I think there are a lot of different structural things at play as well. So whether people have access to healthy foods or grocery stores nearby and as well as foods that are affordable.

And if the environment that they live in is accessible and, you know, conducive to physical activity and those sorts of things. So we have to think about it, like Dr. Ong said, from behavior side, but also at the societal and structural level as well. 

PAULINE CHIOU: And Lauryn, let’s look at age, because your paper also looks at diabetes and different age groups, and diabetes is especially prevalent at age 65 and older – the highest rate that you found in 2021 was 24.4% between the ages of 75 and 79.

So why are those age groups particularly vulnerable?

LAURYN STAFFORD: Yeah, that’s a great question. I think naturally as the body ages, people tend to just have higher glucose levels. So that’s definitely a component. And we do see that it peaks in the 60s and 70s, although that varies geographically as well and also varies over time. But we do see that after those ages, people living with diabetes have a shorter survival than other people.

That’s why it peaks and then starts to decrease. But I think also we should make sure that we’re not just getting stuck on one age group or only older adults. Diabetes is really a condition that affects people of all ages. And some of our research shows the onset of diabetes is becoming earlier and earlier.

And so prevalence among younger adults is also increasing over time. So we also need to take that into consideration. 

PAULINE CHIOU: And Dr. Ong, what are your thoughts in terms of looking at the different age groups? Should we be compartmentalizing them that way or look at this issue as more of a lifetime issue?

DR. LIANE ONG: I think that we definitely need to look at it as a lifetime issue in terms of thinking about the impact of diabetes on society and our future.

I think that however, when we think about interventions and we think about policies and we think about how can we address the diabetes situation, we may need to think about it in terms of buckets just because of what the drivers are. You know, it’s hard to imagine, where physical activity, tobacco, these different modifiable risk factors, they impact different age groups differently.

It could be it’s a lot easier to perhaps shift someone’s behaviors on foods when they’re much younger than when they’re much older. Physical activity is going to be different in different age groups. Aging. Because of that, we know that their risk of diabetes is going to be different. So how we package the different policies and how we package our approach may need to vary by age groups, but it will just be the same components, but maybe in different weights or maybe in different strategies.

But they all are important. They all do need to play a role. It’s just unlikely that it will be a one-size-fits-all like pill that you could get to everybody from a 10-year-old to a 90-year-old and it causes the same change. 

PAULINE CHIOU: And Dr. Ong, finally, you spent so much time, you and Lauryn, on this research looking at diabetes data from more than 200 countries. What would your main message be to the public and would it be different from your message to policymakers?

DR. LIANE ONG: I think that my main message to the public would be that I think many people have heard of diabetes. It’s a very old disease. It’s not new. And I think that we’ve become complacent in diabetes perhaps from a public level.

And I think that what we’ve seen in this research is that it’s increasing every year and we know that it doesn’t need to increase like this everywhere. We know that it doesn’t need to be increasing in younger ages. And we know that maybe it doesn’t need to be increasing at the rate it’s increasing. And to have people be a little bit more understanding and thoughtful of the drivers of it, just because the drivers are so intertwined within your system and it’s intertwined in the choices we make today and so just to realize that and that more attention is being paid.

From a policy perspective, my main message to them would be that we can’t think about diabetes as a different segment, as a specific segment. So we can’t say we want to intervene with high BMI without thinking about all the other things that are happening. We can’t, if we do that and we don’t remember the impact of complications and the fact that  very few people are going to well, it’s more difficult to identify those who have diabetes earlier in the stage in many locations.

I think we need to think about this from a holistic perspective. All the layers get all the stakeholders on table and kind of think about this as a long-term kind of challenge and how are we going to tackle this for generations? 

PAULINE CHIOU: Well, the research is so layered and there’s so much context that you provided. Dr. Liane Ong and Lauryn Stafford, thank you so much for being with us on this podcast about diabetes.

DR. LIANE ONG: Thank you.

LAURYN STAFFORD: Thank you.