Approximately Half of People with Diabetes Worldwide Do Not Know They Have the Disease: GBD Analysis

A new global analysis demonstrates that underdiagnosis and suboptimal management of diabetes remain major barriers to care, affecting hundreds of millions worldwide. Included among the findings is the fact that 44% of all people aged 15 and older with diabetes are unaware that they have the disease. Further, among those who are diagnosed and treated for diabetes, just 1 in 5 people globally reached optimal optimal blood glucose management in 2023.¹

Lauryn Kay Stafford, MS

Courtesy of Institute for Health Metrics and Evaluation

The study, published in Lancet Diabetes & Endocrinology, examined data from 2000 to 2023 across 204 countries and territories, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. Investigators calculated the diabetes cascade of care: "proportion of people diagnosed among those with diabetes, proportion of people receiving treatment among those with diagnosed diabetes, and proportion of people with optimal glycaemic concentrations among those receiving treatment for diabetes across all strata."

In 2023, just 55.8% (95% uncertainty interval [UI], 49.3%–62.3%) of people aged 15 years and older living with diabetes had received a diagnosis, leaving an estimated 248 million—44% of the total—unaware they had the disease, according to the findings.

Among those diagnosed, 91.4% (UI, 88.0%–94.2%) received pharmacologic treatment (eg, insulin or other antihyperglycemics). However, only 41.6% (UI, 35.7%–48.5%) of those treated reached optimal glycemic concentrations. Taken together, just 21.2% (UI, 17.4%–25.6%) of all people with diabetes globally in 2023 reached optimal blood glucose management.

“By 2050, 1.3 billion people are expected to be living with diabetes, and if nearly half don’t know they have a serious and potentially deadly health condition, it could easily become a silent epidemic,” Lauryn K. Stafford, MS, first author and researcher at the Institute for Health Metrics and Evaluation (IHME), said in a statement.

Findings Across Countries and Age Groups

• Regional variations: High-income North America had the highest rates of diagnosis, high-income Asia Pacific the highest treatment rates among diagnosed individuals, and southern Latin America the highest rates of optimal blood glucose management among those treated. Central sub-Saharan Africa showed the lowest rates of diagnosis, with fewer than 20% of people with diabetes aware of their condition.
• Trends since 2000: From 2000 to 2023, the proportion of people diagnosed increased by 8.3 percentage points, and treatment among diagnosed individuals rose by 7.2 percentage points. However, the share of treated individuals reaching optimal blood sugar levels increased by only 1.3 percentage points, underscoring slow progress in long-term management.
• Age variations: Although middle-aged adults represented the greatest number of undiagnosed cases, diagnosis was proportionally lowest among young adults and increased with age.

“Young adults continue to face challenges in accessing health care services including cost barriers, health insurance illiteracy and gaps in coverage, a lack of agency in health-care decision making, and a lack of trust in health systems globally,” wrote Stafford and colleagues. “Further efforts to reduce underdiagnosis of diabetes among younger adults are needed, although in limited-resource settings, the cost of more expansive screening programs will need to be balanced with the capacity of the health system to expand treatment and effective glycemic management.”

Implications for Practice & Policy

The analysis underscores the urgent need to expand screening, particularly for younger populations who have longer lifespans, exposing them to greater risk for accrued complications of diabetes. The World Health Organization’s (WHO) 2022 Global Diabetes Compact set a target for 80% of people with diabetes to be clinically diagnosed by 2030. Current estimates suggest the world is far off pace to reach that benchmark, particularly in low- and middle-income regions where underdiagnosis and limited treatment access converge.

According to the WHO, approximately 6% of the global population live with either type 1 or type 2 diabetes, a number that has quadrupled since 1980. Premature mortality from diabetes has increased by 5% since 2000 while early deaths from other major noncommunicable diseases has decreased in the past quarter century. "More people are living with diabetes, and more people with diabetes are dying earlier than they would have if they had access to high quality, equitable care and treatment," WHO stated.

Stafford and colleagues cautioned that their analysis did not include the impact of lifestyle interventions, which can reduce glucose concentrations independent of pharmacologic therapy. They also noted that the prevalence of diagnosed diabetes may be underestimated due to data limitations.

Nevertheless, the findings reinforce the critical importance of scaling up early diagnosis, access to affordable medications, and effective management strategies that reduce the global burden of diabetes.

References

1. Stafford LK, Gage A, Xu YY, et al. Global, regional, and national diabetes care cascades, 2000–2023: a systematic analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study. Lancet Diabetes Endocrinol. Published online September 8, 2025. doi:10.1016/S2213-8587(25)00217-7

2. New study: Nearly half of those with diabetes unaware they have the disease. News release. Institute for Health Metrics and Evaluation. September 8, 2025. Accessed September 10, 2025. https://www.healthdata.org/news-events/newsroom/news-releases/new-study-nearly-half-those-diabetes-unaware-they-have-disease

3. Global Diabetes Compact Forum. World Health Organization. 2025. Accessed September 10, 2025. https://www.who.int/initiatives/the-who-global-diabetes-compact/the-global-diabetes-compact-forum