Global risk factors, epidemiology, and disease burden of type 2 diabetes

A Worldwide Surge with Unequal Burden

Type 2 diabetes has grown from a relatively rare condition to a global epidemic within just three decades. Today, over 530 million adults live with diabetes worldwide, and projections indicate this number could climb to nearly 800 million by 2045. More than 90% of these cases are type 2 diabetes. Diabetes has become one of the top ten causes of death globally, reducing life expectancy by years and contributing to heart disease and stroke, the two leading causes of death.

The burden is not even spread. While prevalence is high in North America and Europe, the steepest increases are occurring in Asia and Africa. China and India alone account for more than one-third of the world’s cases, reflecting the rapid epidemiological transition in emerging economies. Sub-Saharan Africa, though still with relatively low absolute numbers, is experiencing some of the fastest growth rates, creating a dual challenge of managing infectious diseases and rising non-communicable conditions. These disparities underline an uncomfortable truth: type 2 diabetes is not only a medical issue but also a reflection of socioeconomic transitions, healthcare infrastructure, and policy priorities.

Why Is the Epidemic Accelerating?

The epidemic is driven by a convergence of powerful forces, including ageing, shift of dietary pattern, daily labour and exercise, and habits, and early life exposure. Older adults carry the highest prevalence, and by 2050, the proportion of the global population aged over 60 will nearly double. With daily life changes during urbanisation, diets rich in processed foods, sugary drinks, and red meat have become the norm in many middle-income countries, while sedentary behaviour has increased sharply with mechanisation and screen-based lifestyles. Early-life exposures to malnutrition predisposes individuals to diabetes decades later, particularly when followed by energy-rich environments in adulthood. In this sense, diabetes reflects both biological vulnerability and social change. The increasing diagnosis of diabetes in adolescents and young adults is another worrying trend, creating a generation at risk of lifelong complications.

The True Cost of Diabetes

Beyond individual suffering, type 2 diabetes imposes an enormous burden on health systems and economies. Type 2 diabetes shortens life expectancy and significantly reduces quality of life by impairing heart, kidney, eye, and nerves. People at younger age lost their competitive capacity in their working career.

The economic costs are immense. Globally, around 10 percent of all health budgets are already devoted to diabetes and its complications. In the United States more than half of lifetime costs are spent managing complications. In many lower income countries where health systems are less developed, late diagnosis and poor access to care drive high levels of preventable disability and death.

Prevention and Policy: A Global Imperative

Despite the grim numbers, type 2 diabetes is among the most preventable of major chronic diseases. Decades of evidence from large trials in Finland, the US, India, and China show that intensive lifestyle interventions — focusing on diet, weight loss, and physical activity — can reduce diabetes onset in high-risk individuals by up to 58%. More recent evidence demonstrates that remission of type 2 diabetes is achievable through sustained weight loss, overturning the long-held belief that the disease is irreversible.

Yet prevention remains the weakest link. Most healthcare systems still allocate most resources to managing advanced disease, while underfunding prevention and early intervention.

A Call to Action

At the end of manuscript, Zhang and colleagues call for an action across stakeholders and expect a turning point. With decisive action today — focused on prevention, early detection, and health equity — the global trajectory of type 2 diabetes can be altered. The epidemic of diabetes could define this century, or, if met with bold policy and clinical leadership, it could become an example of how science and society came together to change the future of health.