44% of People with Diabetes Don’t Know They Have It

In 2023, an estimated 561 million people were living with diabetes, most of whom had type 2 diabetes. Managing diabetes is a lifelong process that can help reduce the risk of serious complications like kidney disease, vision loss and even amputations. The process often involves making lifestyle changes, taking medications to control blood sugar and addressing other health issues like high blood pressure and cholesterol. 

Early diagnosis and treatment are key to reducing the risk of these complications.

To improve diabetes care, health systems use a method called the “cascade of care,” which examines the entire process of diagnosing, treating, and managing a disease to identify strengths and gaps. 

One recent study, published in The Lancet: Diabetes and Endocrinology, focuses on three critical steps: how many people with diabetes are diagnosed, how many of those diagnosed are receiving treatment and how many of those treated have their blood sugar under control. By analyzing these “cascade of care” steps globally and breaking down the findings by region, age and sex, the study provides a comprehensive picture of diabetes care and highlights areas where improvements are needed. Let’s break down what the researchers found.

How Was Study Conducted?

This study conducted a detailed global analysis of how diabetes is diagnosed, treated and managed using data from the Global Burden of Disease project and additional sources, like systematic reviews of PubMed. In total, 266 data sources from 119 countries, covering all 21 project regions and spanning the years 1988 to 2023, were analyzed. The study focused on individuals aged 15 and older who had completed blood sugar tests, using either fasting plasma glucose or glycated hemoglobin (HbA1c). 

Researchers categorized people into five groups: those undiagnosed, those diagnosed but untreated, those receiving treatment regardless of blood sugar control, those treated but with uncontrolled blood sugar levels and those treated with controlled blood sugar levels.

Using advanced statistical methods, the study modeled these groups by location, year, age and sex. Treatment was defined as the current use of insulin or other hypoglycaemic medication. The analysis spanned 204 countries and territories from 2000 to 2023, providing a comprehensive view of the diabetes cascade of care: the proportion of people diagnosed among those with diabetes, the proportion receiving treatment among those diagnosed and the proportion achieving optimal blood sugar control among those treated. 

What Did The Study Find?

In 2023, 55.8% of people with diabetes globally were diagnosed, meaning nearly half of those with the condition were unaware they had it. Among those diagnosed, more than 90% were receiving treatment, but only about 40% of those receiving treatment had their blood sugar levels under control. 

This means that, overall, just 21.2% of all people with diabetes worldwide had their blood sugar levels at optimal levels. In numbers, this translates to 313 million people diagnosed with diabetes, 286 million receiving treatment and only 119 million managing their blood sugar effectively. Alarmingly, 248 million people globally had undiagnosed diabetes, highlighting a major gap in early detection.

The study also found differences in care by gender, age, and region. Men were less likely to be diagnosed (51.8%) compared to women (59.8%). Diagnosis rates improved with age, as older adults were more likely to be diagnosed and have better blood sugar control compared to younger adults. 

However, the number of undiagnosed cases peaked in middle age due to the higher prevalence of diabetes in this group. Regionally, high-income areas like North America (82.9%), southern Latin America (79.9%), and western Europe (77.5%) had the highest diagnosis rates. In contrast, central sub-Saharan Africa had the lowest rates, with only 16.3% of people with diabetes diagnosed, and in some countries like Niger, this dropped to just 10.7%.

Over time, there has been progress in diabetes care, but the number of people with undiagnosed diabetes has risen from 143 million in 2000 to 248 million in 2023, partly due to the growing prevalence of diabetes. Improvements varied by region, with central Latin America seeing the largest increase in diagnosis rates, while southern sub-Saharan Africa saw little to no improvement. 

While progress has been made, the study highlights the urgent need to address gaps in diagnosis, treatment, and management, particularly in low-income regions, to improve outcomes for people living with diabetes worldwide.

There are some limitations to consider when considering this data. First, in countries where no specific data was available, estimates were based on regional data and factors like average body mass index and healthcare quality. This approach may not fully capture the unique circumstances of each country, and may not be fully accurate. Second, the studies used in this analysis relied on a single blood sugar measurement to determine diabetes status, while clinical guidelines typically require more than one abnormal test result to confirm a diagnosis. This reliance on a single test could slightly overestimate diabetes prevalence.

The analysis also didn’t include lifestyle changes, such as improved diet or exercise, which can lower blood sugar levels without medication. As a result, people who manage their diabetes through lifestyle changes alone may have been classified as untreated, potentially underestimating the number of people achieving good blood sugar control. 

How Does This Apply To Real Life?

This study sheds light on the global challenges of managing diabetes and what it means for individuals and communities. With more than half a billion people living with diabetes in 2023, the findings highlight the importance of early diagnosis and effective treatment to prevent serious complications like kidney disease, vision loss and amputations. Alarmingly, nearly half of people with diabetes worldwide remain undiagnosed, meaning they are at risk of developing these complications without even knowing it. 

So what does this mean for you? This data underscores the importance of regular health check-ups, especially if you have risk factors like family history, obesity or an inactive lifestyle. Early detection and treatment can make a significant difference in managing the condition and improving quality of life.

And if you want to take steps in your routine to support better blood sugar, we have some meal plans that can help you do just that. Start small with a weeklong plan that relies on lots of simple, 30-minute dinner recipes. If you’re up for a bigger challenge, 30-day plans like our Mediterranean Diet Meal Plan for Better Blood Sugar are great options, too.

On a broader scale, the study emphasizes the need for stronger healthcare systems, particularly in lower-income regions where diagnosis and treatment rates are critically low. For example, while higher-income regions like North America have diagnosis rates above 80%, some areas in sub-Saharan Africa have rates as low as 10%. This disparity shows that access to healthcare and resources like medications and blood sugar testing is not equal worldwide.

Advocating for better healthcare policies and supporting diabetes awareness campaigns around the world may help close these gaps. Whether it’s through personal action or community involvement, the study highlights that improving diabetes care is a shared responsibility that can lead to healthier lives for millions.

Our Expert Take

A new study published in The Lancet: Diabetes and Endocrinology gives a comprehensive look at how diabetes is diagnosed, treated and managed, revealing both progress and significant gaps in care. While over 90% of diagnosed individuals are receiving treatment in many regions, nearly half of people with diabetes worldwide remain undiagnosed, and only 21.2% of all people with diabetes have their blood sugar levels under control. These findings highlight the urgent need for better early detection, access to treatment, and support for managing diabetes effectively, especially in low-income regions where care gaps are most pronounced.

If you’re at higher risk for diabetes, seek out regular check-ups with a healthcare provider to help you keep an eye on your blood sugar levels.