Global Trends and Inequalities in Diabetes Prevalence and Treatment Coverage, 1990–2022: Progress toward International Targets Across 195 Countries

Abstract

Background: Diabetes prevalence and treatment coverage have changed markedly, raising questions about inequalities and progress towards international targets. Aim: This study examined country-level trends, disparities, target attainment, and projected treatment coverage in 2030. Methods: This ecological analysis used age-standardised estimates (means) from the WHO Global Health Observatory for diabetes prevalence among adults aged ≥18 years and treatment coverage among adults aged ≥30 years from 1990 to 2022. Changes were assessed by WHO region and income group. The halt-the-rise criterion was defined as prevalence in 2022 being at or below the 2010 level. Treatment coverage was projected to 2030 using logit-linear regression and 10,000 simulations. Results: Mean prevalence rose from 7.7% in 1990 to 13.9% in 2022, an increase of 6.2 percentage points. Prevalence increased in 187/195 countries (95.9%); only eight (4.1%) were stable or declined. Between 2010 and 2022, 32 countries (16.4%) met the halt-the-rise criterion, while 163 (83.6%) remained off track. In 2022, prevalence ranged from 9.1% in Europe to 20.8% in the Eastern Mediterranean. Treatment coverage increased from 29.0% in 1990 to 41.3% in 2022 (+12.3 points) and improved in 180 countries (92.3%). Coverage ranged from 7.1% to 81.3% across countries, from 22.0% in Africa to 55.7% in Europe, and from 22.8% in low-income to 58.1% in high-income countries. Projected 2030 coverage was 45.0% (95% simulation interval 44.7%–45.4%); none of 10,000 simulations reached the 80% analytical benchmark based on the annual mean. Fifty-one countries (26.2%) had high prevalence and low treatment coverage. Conclusions: Diabetes prevalence increased in nearly all countries, while progress in treatment coverage remained insufficient and unequal. Accelerated prevention, diagnosis, and access to treatment are required.