UNDERDIAGNOSIS and poor glycaemic management of diabetes remained major global challenges despite improvements over the past two decades, according to a new analysis spanning 204 countries and territories.
Diabetes is a growing health crisis worldwide, linked to disability, premature mortality, and significant economic burden. Although advances in treatment have been made, many people living with diabetes continue to fall through the cracks of care, particularly in low- and middle-income regions.
Diabetes care is often assessed through the ‘cascade of care’, which includes timely diagnosis, initiation of treatment, and achievement of optimal glycaemic concentrations. In this study, researchers applied data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to examine global trends in the diabetes cascade from 2000–2023.
In 2023, an estimated 55.8% of people with diabetes aged 15 years and older were diagnosed. Of those diagnosed, 91.4% were receiving treatment. However, only 41.6% of patients on treatment achieved optimal glycaemic concentrations, translating to just 21.2% of all people with diabetes worldwide. Substantial regional differences were observed: diagnosis rates were highest in high-income North America, treatment rates among those diagnosed were greatest in high-income Asia Pacific, and optimal glycaemic control among treated individuals was most common in southern Latin America.
Over the two decades studied, there were modest improvements. Diagnosis rates rose by 8.3 percentage points, treatment among diagnosed patients by 7.2 percentage points, and the proportion achieving optimal glycaemic concentrations by only 1.3 percentage points. These trends underscore both progress and persisting challenges in managing the disease effectively.
“Despite improvements over the past two decades, underdiagnosis and suboptimal glycaemic management of diabetes remain major challenges globally, particularly in low-income and middle-income countries,” the authors concluded. “These findings highlight the urgent need for enhanced strategies and capacity building to improve the detection, treatment, and management of diabetes worldwide.”
The study relied on modelling data from national surveys and health databases, providing a comprehensive view of global patterns. However, the use of indirect estimates rather than individual clinical data represented a limitation.
The findings call for urgent, targeted investment in healthcare systems to strengthen diagnostic capacity, ensure access to effective treatment, and expand support for long-term glycaemic management.
Reference
Stafford LK et al. Global, regional, and national cascades of diabetes care, 2000-23: a systematic review and modelling analysis using findings from the Global Burden of Disease Study. Lancet Diabetes Endocrinol. 2025:S2213-8587(25)00217-7.
