Foreword (original) (raw)

Authors

, President 2020–20221.

Affiliations

1 International Diabetes Federation

The International Diabetes Federation (IDF) is proud to launch the 10th edition of the IDF Diabetes Atlas. We have been publishing global estimates of the prevalence of diabetes for just over 20 years. During this time, the publication has established itself as the most cited and trusted source on the global impact of diabetes and an indispensable tool for diabetes advocacy. With each new edition, the popularity of the publication grows. Each edition is freely available online and downloaded more than 250,000 times. The publication of the IDF Diabetes Atlas 10th edition is timely, and its evidence and messages are more relevant than ever.

I wish I could report that the past two decades have witnessed decisive action to tackle diabetes and that the rising tide of diabetes has finally turned. I wish I could share news that universal health coverage has given more than half a billion people living with diabetes worldwide access to the care they need and can afford. I wish I could declare that, 100 years after its discovery, therapeutic insulin is now within reach of all those who need it to survive. Alas, I cannot. Rather, I must repeat the message that diabetes is a pandemic of unprecedented magnitude spiralling out of control.

Globally, more than one in 10 adults are now living with diabetes. Moreover, there is a growing list of countries where one-in-five or even more of the adult population has diabetes. Since the first edition in 2000, the estimated prevalence of diabetes in adults aged 20–79 years has more than tripled, from an estimated 151 million (4.6% of the global population at the time) to 537 million (10.5%) today. Without sufficient action to address the situation, we predict 643 million people will have diabetes by 2030 (11.3% of the population). If trends continue, the number will jump to a staggering 783 million (12.2%) by 2045.

The rising number of persons with diabetes is driven by multiple factors – people are living longer and we have higher quality data. However, much of the diabetes burden remains hidden. Almost every time we find new and more accurate data, our estimates have to be revised upwards.

The evidence presented in this edition will not cover the impact of COVID-19 on people living with diabetes. This impact will become clearer in subsequent editions. We do know that the virus has placed an additional burden on many with diabetes. We have seen that people living with diabetes can be more susceptible to the worst complications. There is concern that the current situation may cause a rise in the prevalence of diabetes and its complications over the coming years. We have yet to see the impact of lockdowns, shielding and the potential risk of COVID-induced diabetes on population health.

Diabetes must be taken seriously not only by individuals living with, or at high risk of, the condition but also by healthcare professionals and decision-makers. Diabetes remains a serious and growing challenge to public health and places a huge burden on individuals affected and their families. People living with diabetes are at risk of developing several debilitating and life-threatening complications, leading to an increased need for medical care, reduced quality of life and premature death. Globally, diabetes ranks among the top 10 causes of mortality. Why is not enough being done to prevent diabetes and its complications and provide the best available care to people with the condition?

I believe there are some rays of hope. The centenary of the discovery of insulin has attracted greater attention to the diabetes cause. In April 2021, the World Health Organization launched its Global Diabetes Compact, marking an increased focus on diabetes. We pledged our support to the development and implementation of the Compact through our advocacy and awareness activities. Soon after, a landmark Resolution highlighting the importance of prevention, diagnosis and control of diabetes was agreed by the World Health Assembly. These are important steps towards addressing the continued and rapid rise of diabetes prevalence, particularly in countries that do not have a national diabetes plan or coverage for essential health services.

There remain many countries for which we do not have data or data of sufficient quality to complete the global picture. The IDF Diabetes Atlas will continue to encourage the development of high-quality diabetes data in all countries to fill the gaps. More research is required to generate solid evidence to improve understanding of the impact of diabetes and inform national and global health targets. IDF is committed to fostering further epidemiological research in diabetes in collaboration with aligned organisations and partners.

Our sincere hope is that this 10th edition of the IDF Diabetes Atlas will help IDF members and the wider diabetes community advocate for more action to identify undiagnosed diabetes, prevent type 2 diabetes in people at risk, and improve care for all people with diabetes. United, the global diabetes community has the numbers, the influence and the determination to bring about meaningful change.

Authors

Professor Dianna Magliano, Chair1 and Professor Edward Boyko, Chair2.

Affiliations

1 IDF Diabetes Atlas Committee (10th Edition)

2 IDF Diabetes Atlas Committee (10th Edition)

For over two decades, the IDF Diabetes Atlas has been a leading source of information on the global impact of diabetes. Its widespread popularity and reach is testament to its value for people with a personal or professional interest in diabetes.

The 10th edition of the IDF Diabetes Atlas reports a continued global increase in diabetes prevalence, confirming diabetes as a significant global challenge to the health and wellbeing of individuals, families and countries. It is offered for careful and considered use in the support of continued and enhanced action to improve the lives of people with diabetes and those at risk of developing the condition.

Estimating the global impact of diabetes is challenging as raw data arises from country-specific studies conducted using different methodologies. While some effort has been made to standardise the approach to measuring diabetes prevalence by the introduction of the World Health Organisation (WHO) STEPwise approach, not all countries have adopted it and the diabetes data available remain not always of high quality and can be heterogeneous, even within the same country. This is further complicated by the various diagnostic tests employed for the diagnosis of diabetes, the use of differing diagnostic criteria (WHO vs American Diabetes Association) and a range of diagnostic methodologies (plasma or capillary glucose, hemoglobin A1c (HbA1c), self-report). Other areas of potential divergence are the sampling frames used, response rates achieved, age-groups reported and geographical scope of each study. It should also be noted that the diagnostic criteria for diabetes used for estimations in the IDF Diabetes Atlas is epidemiological, which differs from the criteria used for a clinical diagnosis of diabetes that requires two abnormal tests in the absence of signs and symptoms.

Our inability to provide comprehensive coverage of global diabetes prevalence is also due to the sheer lack of data in some parts of the world. In the 9th edition of the IDF Diabetes Atlas, only 144 out of 215 countries (67%) had quality data derived from in-country studies. Estimates for the remaining 71 countries were modelled from other countries with similar characteristics, a necessary compromise that allows the IDF Diabetes Atlas to present a complete picture of prevalence for each country and territory. For the 10th edition, we have introduced more changes to improve the quality and relevance of our estimates. We have removed the majority of studies published before 2005. This means we now have fewer data sources, but those included are more representative of the current prevalence of diabetes. This loss of data sources is offset somewhat by the inclusion of new data from national population-based diabetes registries. With the recent emergence of big data generally and specifically in the area of diabetes, it was important for the IDF Diabetes Atlas to stay abreast of the generation of ‘real world, real time’ diabetes data and modify our methodology to include it.

Previous editions of the IDF Diabetes Atlas have used different sources of raw data, made different assumptions, and focused on different metrics of burden. Therefore, our estimates may vary across editions due to improvements in methodology and data sources. This may lead to unexpected changes in estimates for a country or region that do not reflect a real change. This should be taken into account when comparing estimates from the 10th edition with previous editions.

Forecasting future diabetes prevalence can be challenging and the projections are only as good as the data inputs which inform them. The IDF Diabetes Atlas takes the view that simple predictions that only consider changing distributions of age, sex and urban/rural residence are likely to be the most robust. It is acknowledged that other factors such as trends in obesity and overweight are important when predicting diabetes prevalence. We have plans to include these in the next edition.

The COVID-19 pandemic has dominated our lives over the last 18 months, so it would have been remiss of the IDF Diabetes Atlas not to address the relationship between COVID-19 and diabetes. We have included a chapter that summarises the data currently available globally and will look to update it in future editions.

The 10th edition of the IDF Diabetes Atlas was produced under unique circumstances. The pandemic delayed its start, prohibited face-to-face contact with members of the IDF Executive Office and imposed different and novel ways of working. It would not have been possible without the tireless commitment and efforts of the the Editorial Team and members of the IDF Diabetes Atlas Committee, to whom we are extremely grateful.