Global Burden of Diabetes Mellitus

Key facts

Diabetes mellitus is a leading cause of mortality and reduced life expectancy. It 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. Overall, the global burden of diabetes had increased significantly since 1990. Both the trend and magnitude of diabetes-related disease burden varied substantially across regions and countries. The trend of global type 2 diabetes burden was like that of total diabetes (including type 1 diabetes and type 2 diabetes), while the global age-standardized rate of mortality and DALYs for type 1 diabetes declined. Globally, metabolic risks (high BMI) and behavioural factors (inappropriate diet, smoking, and low physical activity) contributed to the most attributable death and DALYs of diabetes. These estimations could be useful in policymaking, priority setting, and resource allocation in diabetes prevention and treatment. 

Source: IDF Diabetes Atlas - 9th Edition - 2019

Estimates and projections of diabetes prevalence

In 2000, the global estimate of diabetes prevalence in the 20-to-79-year age group was 151 million, which was close to the WHO estimate at the time. Estimates have since shown alarming increases, tripling to the 2019 estimate of 463 million adults aged 20-to-79-year age group worldwide (which means, around 9.3% of all adults in this age group) have diabetes. It is estimated that 79.4% live in low- and middle-income countries. Based on the 2019 estimates, by 2030 a projected 578.4 million, and by 2045, 700.2 million adults aged 20-to-79-year age group, will be living with diabetes. Projections for the future have indicated that the global impact of diabetes is likely to continue increasing considerably.

Global diabetes estimates and projections

Global Diabetes Estimates and Projections	2019	2030	2045
Total world population	7.7 billion	8.6 billion	9.5 billion
Adult population (20 to 79 years)	5.0 billion	5.7 billion	6.4 billion
Diabetes (20 to 79 years)
Global Prevalence	9.3%	10.2%	10.9%
Number of people with diabetes	463.0 million	578.4 million	700.02 million
Number of deaths due to diabetes	4.2 million	-	-
Total health expenditures for diabetes1	USD 760.3 billion	USD 824.7 billion	USD 845.0 billion
Hyperglycaemia in pregnancy (20 to 49 years)
The proportion of live births affected	15.8%	14.0%2	13.3%2
Number of live births affected	20.4 million	18.3 million	18.0 million
Impaired glucose tolerance (20 to 79 years)
Global prevalence	7.5%	8.0%	8.6%
Number of people with impaired glucose tolerance	373.9 million	453.8 million	548.4 million
Type 1 diabetes (0 to 19 years)
Number of children and adolescents with type 1 diabetes	1,110,100	-	-
Number of newly diagnosed cases each year	128,900	-	-
Source: IDF DIABETES ATLAS, Ninth edition 2019. International Diabetes Federation |
1Health expenditures for people with diabetes are assumed to be on average two-fold higher than people without diabetes. 2Age-adjusted prevalence

An estimated 463 million adults aged 20 to 79 years are currently living with diabetes. This represents 9.3% of the world’s population in this age group. The total number is predicted to rise to 578 million (10.2%) by 2030 and to 700 million (10.9%) by 2045. The estimated number of adults aged 20 to 79 years with impaired glucose tolerance is 374 million (7.5% of the world population in this age group). This is predicted to rise to 454 million (8.0%) by 2030 and 548 million (8.6%) by 2045. An estimated 1.1 million children and adolescents (aged under 20 years) have type 1 diabetes. It is currently not possible to estimate the number of children and adolescents with type 2 diabetes. The number of deaths resulting from diabetes and its complications in 2019 is estimated to be 4.2 million. An estimated 15.8% (20.4 million) of live births are affected by hyperglycaemia in pregnancy in 2019. Annual global health expenditure on diabetes is estimated to be USD 760 billion. It is projected that expenditure will reach USD 825 billion by 2030 and USD 845 billion by 2045.

Number of adults (20 to 79 years) with diabetes

Number of adults (20 to 79 years) with diabetes per World Bank income classification in 2019, 2030 and 2045
	2019		2030		2045
World Bank income classification	Prevalence of diabetes (%)	No. of people with diabetes (millions)	Prevalence of diabetes (%)	No. of people with diabetes (millions)	Prevalence of diabetes (%)	No. of people with diabetes (millions)
High-income countries	10.4 (8.6 – 13.3)1	95.2 (78.7 – 120.9)	11..4 (9.4 – 14.3)	107.0 (88.3 – 134.4)	11.9 (9.8 – 14.8)	112.4 (92.2 – 139.2)
Middle-income countries	9.5 (7.6 – 12.3)	353.3 (280.1 – 455.3)	10.7 (8.4 – 13.7)	449.6 (353.0 – 576.7)	11.8 (9.0 – 15.0)	551.2 (422.7 – 705.2)
Low-income countries	4.0 (2.8 – 6.7)	14.5 (10.0 – 24.3)	4.3 (3.0 – 7.1)	21.9 (15.2 – 36.4)	4.7 (3.3 – 7.8)	36.5 (25.8 – 60.2)
1 95% confidence intervals are reported in brackets. | Source: IDF DIABETES ATLAS, Ninth edition 2019. International Diabetes Federation

The table shows the total number of adults in the 20-to-79-year age group with diabetes per World Bank income classification in 2019, 2030, and 2045. There are currently 351.7 million people of working age (20 to 64 years) with diagnosed or undiagnosed diabetes in 2019. This number is expected to increase to 417.3 million by 2030 and 486.1 million by 2045. The largest increase will take place in regions where economies are moving from low- to middle-income status. Let us view the table shown in this slide.

Diabetes estimates in people older than 65 years

Global diabetes estimates in people older than 65 years in 2019, 2030 and 2045
	2019	2030	2045
Adult population (65 to 99 years)	704.4 million	995.2 million	1.4 billion
Prevalence (65 to 99 years)	19.3% (15.3 – 24.2%)1	19.6% (15.5 – 24.8%)	19.6% (15.2 – 25.4%)
Number of people older than 65 years with diabetes (65 to 99 years)	135.6 million (107.6 – 170.6)	195.2 million (154.7 – 247.1)	276.2 million (214.8 – 358.9)
1 95% confidence intervals are reported in brackets.

The table shows the global diabetes estimates in people older than 65 years in 2019, 2030, and 2045. Diabetes prevalence increases with age, so the highest estimated prevalence is in people older than 65. In 2019, the estimated number of people with diabetes aged 65 to 99 years is 135.6 million (19.3%). If this trend continues, the number of people above 65 years (from 65 to 99 years) with diabetes will be 195.2 million in 2030 and 276.2 million in 2045. These data point to a significant increase in the diabetes population of the ageing societies in the next 25 years and the inevitable public health and economic challenges this will bring.

Number of men & women (20 to 79 years) with diabetes

Number of men and women (20 to 79 years) with diabetes in 2019, 2030 and 2045
	2019		2030		2045
Gender	Prevalence of diabetes (%)	No. of people with diabetes (millions)	Prevalence of diabetes (%)	No. of people with diabetes (millions)	Prevalence of diabetes (%)	No. of people with diabetes (millions)
Men	9.6	240.1	10.4	296.7	11.1	357.7
Women	9.0	222.9	10.0	281.8	10.8	342.5
1 95% confidence intervals are reported in brackets. | Source: IDF DIABETES ATLAS, Ninth edition 2019. International Diabetes Federation

The table depicts the overall number of men and women in the 20-to-79-year age group with diabetes in 2019, 2030, and 2045. The estimated prevalence of diabetes in women aged 20 to 79 years is slightly lower than in men (9.0% vs 9.6%). In 2019, there are about 17.2 million more men than women living with diabetes. The prevalence of diabetes is expected to increase in both men and women by 2030 and 2045.

Prevalence of diabetes by age group

The table illustrates the prevalence of diabetes in the 20-to-79-year age group in 2019, 2030, and 2045. Diabetes estimates for 2019 show a typically increasing prevalence of diabetes by age. Similar trends are predicted for the years 2030 and 2045. Prevalence is lowest among adults aged 20 to 24 years (1.4% in 2019). Among adults aged 75 to 79 years diabetes prevalence is estimated to be 19.9% in 2019 and is predicted to rise to 20.4% and 20.5% in 2030, and 2045, respectively.

Top 5 countries for the number of adults (20 to 79 years) with diabetes

Top 5 countries for # of adults (20 to 79 years) with diabetes
2019			2030			2045
Rank	Country or territory	No. of people with diabetes (millions)	Rank	Country or territory	No. of people with diabetes (millions)	Rank	Country or territory	No. of people with diabetes (millions)
1	China	116.4 (108.6 – 145.7)	1	China	140.5 (130.3 – 172.3)	1	China	147.2 (134.7 – 176.2)
2	India	77.0 (62.4 – 96.4)	2	India	101.0 (81.6 – 125.6)	2	India	134.2 (108.5 – 165.7)
3	USA	31.0 (26.7 – 35.8)	3	USA	34.4 (29.7 – 39.8)	3	Pakistan	37.1 (15.8 – 58.5)
4	Pakistan	19.4 (7.9 – 30.4)	4	Pakistan	26.2 (10.9 – 41.4)	4	USA	36.0 (31.0 – 41.6)
5	Brazil	16.8 (15.0 – 18.7)	5	Brazil	21.5 (19.3 – 24.0)	5	Brazil	26.0 (23.2 – 28.7)

The table illustrates the top 5 countries or territories for the number of adults in the 20-to-79-year age group with diabetes in 2019, 2030, and 2045. The countries with the largest numbers of adults with diabetes aged 20 to 79 years in 2019 are China, India, and The United States of America, and are anticipated to remain so in 2030. It is projected that the number of adults with diabetes in Pakistan will exceed that in the United States of America and will move to third place by 2045. The countries that have the highest number of people with diabetes do not, of course, necessarily have the highest prevalence.

Countries with undiagnosed diabetes

Top 10 countries or territories for the number of adults (20 to 79 years) with undiagnosed diabetes in 2019
Rank	Country or territory	Number of people with undiagnosed diabetes (millions)	Proportion undiagnosed (%)
1	China	65.2 (60.8 – 81.6)	56.0
2	India	43.9 (35.5 – 54.9)	57.0
3	United States of America	11.8 (10.2 – 13.6)	38.1
4	Pakistan	8.5 (3.5 – 13.3)	43.8
5	Indonesia	7.9 (6.8 – 8.5)	73.7
6	Brazil	7.7 (6.9 – 8.6)	46.0
7	Mexico	4.9 (2.8 – 5.9)	38.6
8	Egypt	4.8 (2.6 – 5.5)	54.4
9	Bangladesh	4.7 (3.9 – 6.0)	56.0
10	Germany	4.5 (3.7 – 5.0)	47.6

The table shows the top 10 countries or territories for the number of adults in the 20-to-79-year age group with undiagnosed diabetes in 2019. The number of people with undiagnosed diabetes varies by country, with the countries with the greatest number of people with undiagnosed diabetes is the same as those with the highest number of people with diabetes: China (65.2 million); India (43.9 million); and the United States of America (11.8 million). However, globally, Mozambique has the greatest proportion of undiagnosed diabetes (86.7%), followed by the United Republic of Tanzania 79.8% and Tunisia 75.0%.

Global estimates for type 1 diabetes

Global estimates for type 1 diabetes in children and adolescents (0 to 14 years and 0 to 19 years) in 2019
Population (0 to 14 years)	1.98 billion
Population (0 to 19 years)	2.58 billion
Type 1 diabetes in children and adolescents (0 to 14 years)
Number of prevalent (existing) cases of type 1 diabetes	600,900
Number of incident (new) cases of type 1 diabetes per year	98,200
Type 1 diabetes in children and adolescents (0 to 19 years)
Number of prevalent (existing) cases of type 1 diabetes	1,110,100
Number of incident (new) cases of type 1 diabetes per year	128,900

The table illustrates the global estimates for type 1 diabetes in children and adolescents (which means from 0 to 14 years and 0 to 19 years) in 2019. The number of children and adolescents with diabetes is increasing every year. In populations of European origin, nearly all children and adolescents with diabetes have type 1 diabetes, but in other populations, (for example - Japan) type 2 diabetes is more common than type 1 diabetes in this age group. It is estimated that the incidence of type 1 diabetes among children and adolescents is increasing in many countries particularly in those aged less than 15 years. The overall annual increase is estimated to be around 3% with strong indications of geographic differences. In total, 11,10,100 (which means, 1.11 million) children and adolescents younger than 20 years are estimated to have type 1 diabetes globally. It is estimated that around 98,200 children and adolescents under the age of 15 years are diagnosed with type 1 diabetes annually and this estimated number increases to 1,28,900 when the age range extends to under 20 years. There are more countries with data on type 1 diabetes incidence for the age group 0–14 and therefore the data presented here will focus on this age group. In countries with limited access to insulin and inadequate health service provision, children, and adolescents with type 1 diabetes, even when correctly diagnosed, face serious complications and consequently premature mortality.

Number of adults (20 to 79 years) with impaired glucose tolerance

Number of adults (20 to 79 years) with impaired glucose tolerance, by World Bank income classification in 2019, 2030 and 2045
	2019		2030		2045
World Bank income classification	Prevalence of IGT (%)	No. of people with IGT (millions)	Prevalence of IGT (%)	No. of people with IGT (millions)	Prevalence of IGT (%)	No. of people with IGT (millions)
High-income countries	11.4 (8.5 – 15.8)1	104.1 (77.7 – 144.0)	12.1 (9.1 – 16.5)	114.0 (85.3 – 155.4)	12.5 (9.3 – 17.0)	117.8 (87.7 – 159.7)
Middle-income countries	6.5 (4.1 – 11.0)	239.6 (151.2 – 407.9)	7.0 (4.5 – 11.9)	294.5 (189.0 – 498.4)	7.6 (4.9 – 12.8)	354.8 (228.7 – 598.4)
Low-income countries	8.3 (5.3 – 17.6)	30.2 (19.4 – 64.1)	8.8 (5.7 – 18.6)	45.3 (29.4 – 95.8)	9.8 (6.4 – 20.7)	75.8 (49.2 – 159.8)
IGT – Impaired Glucose Tolerance | 1 95% confidence intervals are reported in brackets.

The table illustrates the number of adults in the 20-to-79-year age group with impaired glucose tolerance, by World Bank income classification in 2019, 2030, and 2045. In 2019, 373.9 million adults aged 20 to 79 years worldwide, 7.5% of the adult population, are estimated to have impaired glucose tolerance. The vast majority (72.2%) live in low- and middle-income countries. The number of adults aged 20 to 79 years with impaired glucose tolerance is projected to increase to 453.8 million – or 8.0% of the adult population – by 2030 and to 548.4 million – or 8.6% of the adult population – by 2045. Almost half (48.1%) of adults aged 20 to 79 years with impaired glucose tolerance are under the age of 50 years (180.0 million). This age group will continue to have the highest number of people with impaired glucose tolerance in 2030 and 2045, rising to 204.1 million and 231.8 million, respectively. It is important to note that nearly one-third (28.3%) of all those who currently have impaired glucose tolerance are in the 20–39 years age group and are therefore likely to spend many years at risk of type 2 diabetes and adverse cardiovascular disease outcomes.

Global estimates of hyperglycaemia in pregnancy

Global estimates of hyperglycaemia in pregnancy in 2019
Total live births to women (20 to 49 years)	129.5 million
Hyperglycaemia in pregnancy
Global prevalence	15.8%
Number of live births affected	20.4 million
The proportion of cases due to gestational diabetes mellitus	83.6%
The proportion of cases due to other types of diabetes first detected in pregnancy	8.5%
The proportion of cases due to diabetes detected prior to pregnancy	7.9%

The table and a graph illustrate the global estimates of hyperglycaemia in pregnancy in 2019 and the prevalence of hyperglycaemia in pregnancy by age group in 2019, respectively. It is estimated that 20.4 million or 15.8% of live births to women in 2019 had some form of hyperglycaemia in pregnancy. Of which, 83.6% were due to gestational diabetes mellitus, while 7.9% were the result of diabetes detected before pregnancy, and 8.5% due to diabetes (including type 1 and type 2) first detected in pregnancy. It is projected that in 2030 and 2045, 18.3 million and 18.0 million live births will be affected by hyperglycaemia in pregnancy, respectively. 

The vast majority (86.8%) of cases of hyperglycaemia in pregnancy are seen in low- and middle-income countries, where access to antenatal care is often limited. Prevalence of hyperglycaemia in pregnancy, as a proportion of all pregnancies, increases rapidly with age, with the highest prevalence (37.0%) in 45- to 49-year-old women, although there are fewer pregnancies in this age group. Of course, this age group also has a higher prevalence of diabetes generally. As a result of higher fertility rates in younger women, half (50.1%) of all cases of hyperglycaemia in pregnancy (10.2 million) occur in women under the age of 30 years.

Deaths due to Diabetes by Age and Sex

The graph illustrates the number of deaths due to diabetes in adults in the 20-to-79-year age group by age and sex in 2019. Approximately 4.2 million adults aged 20 to 79 years are estimated to die because of diabetes and its complications in 2019. This is equivalent to one death every eight seconds. Diabetes is estimated to be associated with 11.3% of global deaths from all causes among people in this age group. Almost half (46.2%) of deaths associated with diabetes among the 20 to 79 years age group are in people under the age of 60 years – the working-age group. Globally, there are more deaths associated with diabetes in women (2.3 million) than in men (1.9 million). Premature death and disability due to diabetes are also associated with a negative economic impact for countries, often called the "indirect costs" of diabetes.

Total Diabetes-related Health Expenditure

The graph illustrate the total diabetes-related health expenditure for adults in the 20-to-79-year age group with diabetes in 2019, 2030, and 2045 and the top 10 countries or territories for total health expenditure (in USD billion) due to diabetes in the 20-to-79-year age group in 2019, respectively.

Despite its impact characterized by premature mortality and lower quality of life due to diabetes-related complications, diabetes also imposes a significant economic impact on countries, health systems, and, when healthcare needs to be funded ‘out-of-pocket’, for individuals with diabetes and their families.

Top 10 countries or territories for total health expenditure (USD billion) due to diabetes (20 to 79 years) in 2019
Rank	Country or territory	Total diabetes-related health expenditure in 2019 (USD billion) (20 to 79 years)
1	United States of America	294.6
2	China	109.0
3	Brazil	52.3
4	Germany	43.8
5	Japan	23.5
6	Mexico	17.0
7	France	16.9
8	United Kingdom	14.1
9	Canada	12.3
10	Russian Federation	10.6

Direct costs are the health expenditures due to diabetes – regardless of whether this expenditure is born by patients themselves or by private or public payers or government. The rise in this expenditure has been considerable, growing from USD 232 billion spent worldwide in 2007, to USD 727 billion in 2017 for adults aged 20 to 79 years. In 2019, as per the estimates, the total diabetes-related health expenditure will reach USD 760 billion. This represents a 4.5% increase on the 2017 estimate. The economic impact of diabetes is expected to continue to grow. It is projected that expenditure will reach USD 825 billion by 2030 and USD 845 billion by 2045. This represents an increase of 8.6% and 11.2%, respectively. These projections are conservative, as they assume that the mean expenditure per person and diabetes prevalence remains constant while considering only demographic changes. On a country level, the highest diabetes-related health expenditures were estimated for the United States of America with USD 294.6 billion, followed by China and Brazil, with USD 109.0 billion and USD 52.3 billion, respectively.