- The number of people with diabetes rose from 108 million in 1980 to 422 million in 2014.
- The global prevalence of diabetes* among adults over 18 years of age rose from 4.7% in 1980 to 8.5% in 2014 (1).
- Between 2000 and 2016, there was a 5% increase in premature mortality from diabetes.
- Diabetes prevalence has been rising more rapidly in low- and middle-income countries than in high-income countries.
- Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
- In 2016, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012.
- Almost half of all deaths attributable to high blood glucose occur before the age of 70 years. WHO estimates that diabetes was the seventh leading cause of death in 2016.
- A healthy diet, regular physical activity, maintaining normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes.
- Diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycaemia, or raised blood sugar, is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body’s systems, especially the nerves and blood vessels.
In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2016, diabetes was the direct cause of 1.6 million deaths and in 2012 high blood glucose was the cause of another 2.2 million deaths.
Between 2000 and 2016, there was a 5% increase in premature mortality from diabetes. In high-income countries, the premature mortality rate due to diabetes decreased from 2000 to 2010 but then increased in 2010-2016. In lower-middle-income countries, the premature mortality rate due to diabetes increased across both periods.
By contrast, the probability of dying from any one of the four main non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases or diabetes) between the ages of 30 and 70 decreased by 18% globally between 2000 and 2016.
Type 2 diabetes
Type 2 diabetes (formerly called non-insulin-dependent, or adult-onset) results from the body’s ineffective use of insulin. The majority of people with diabetes have type 2 diabetes. This type of diabetes is largely the result of excess body weight and physical inactivity.
Symptoms may be similar to those of type 1 diabetes but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen.
Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly frequently in children.
Type 1 diabetes
Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. Neither the cause of Type 1 diabetes nor the means to prevent it are known.
Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. These symptoms may occur suddenly.
Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes. Gestational diabetes occurs during pregnancy
Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. These women and possibly their children are also at increased risk of type 2 diabetes in the future.
Gestational diabetes is diagnosed through prenatal screening, rather than through reported symptoms.
Impaired glucose tolerance and impaired fasting glycaemia
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) are intermediate conditions in the transition between normality and diabetes. People with IGT or IFG are at high risk of progressing to type 2 diabetes, although this is not inevitable.
Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.
- Adults with diabetes have a two- to three-fold increased risk of heart attacks and strokes(1).
- Combined with reduced blood flow, neuropathy (nerve damage) in the feet increases the chance of foot ulcers, infection and the eventual need for limb amputation.
- Diabetic retinopathy is an important cause of blindness and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. Diabetes is the cause of 2.6% of global blindness(2).
- Diabetes is among the leading causes of kidney failure(3).
Simple lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:
- achieve and maintain healthy body weight;
- be physically active – doing at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;
- eat a healthy diet, avoiding sugar and saturated fats; and
- avoid tobacco use – smoking increases the risk of diabetes and cardiovascular disease.
Diagnosis and treatment
Early diagnosis can be accomplished through relatively inexpensive testing of blood sugar.
Treatment of diabetes involves diet and physical activity along with the lowering of blood glucose and the levels of other known risk factors that damage blood vessels. Tobacco use cessation is also important to avoid complications.
Interventions that are both cost-saving and feasible in low- and middle-income countries include:
- blood glucose control, particularly in type 1 diabetes. People with type 1 diabetes require insulin, people with type 2 diabetes can be treated with oral medication, but may also require insulin;
- blood pressure control; and
- foot care (patient self-care by maintaining foot hygiene; wearing appropriate footwear; seeking professional care for ulcer management; and regular examination of feet by health professionals).
Other cost-saving interventions include:
- screening and treatment for retinopathy (which causes blindness);
- blood lipid control (to regulate cholesterol levels);
- screening for early signs of diabetes-related kidney disease and treatment.
WHO aims to stimulate and support the adoption of effective measures for the surveillance, prevention and control of diabetes and its complications, particularly in low- and middle-income countries. To this end, WHO:
- provides scientific guidelines for the prevention of major non-communicable diseases including diabetes;
- develops norms and standards for diabetes diagnosis and care;
- builds awareness on the global epidemic of diabetes, marking World Diabetes Day (14 November); and
- conducts surveillance of diabetes and its risk factors.
The WHO “Global report on diabetes” provides an overview of the diabetes burden, interventions available to prevent and manage diabetes, and recommendations for governments, individuals, the civil society and the private sector.
The WHO “Global strategy on diet, physical activity and health” complements WHO’s diabetes work by focusing on population-wide approaches to promote a healthy diet and regular physical activity, thereby reducing the growing global problem of overweight and obesity.
The WHO module on diagnosis and management of type 2 diabetes brings together guidance on diagnosis, classification and management of type 2 diabetes in one document. The module will be useful to policymakers who plan service delivery of diabetes care, national programme managers responsible for training, planning and monitoring service delivery, and facility managers and primary care staff involved in clinical care and monitoring processes and outcomes of diabetes care.