Variation in type 2 diabetes prevalence across different populations: the key drivers

The global prevalence of type 2 diabetes has risen sharply in recent decades, with significant regional and demographic variation. While high- and middle-income countries generally report a higher diabetes prevalence than low-income countries, substantial differences exist within these categories. The highest prevalence is observed in regions such as the Middle East and North Africa, whereas parts of Europe and sub-Saharan Africa report a much lower prevalence. Several factors drive these disparities, including urbanisation and industrialisation, which have led to changing lifestyles, including more sedentary behaviours and greater consumption of processed, energy-dense foods, particularly in rapidly developing economies. The rising prevalence of obesity, driven by these lifestyle changes, further exacerbates health disparities, significantly increasing the risk of developing type 2 diabetes. Declining mortality rates among people with diabetes, and incidence, will also impact prevalence. Genetic predisposition influences diabetes risk, with certain populations, such as Indigenous and Pacific Islander groups, exhibiting higher susceptibility. Environmental factors, including air pollution and persistent organic pollutants, also impact diabetes prevalence, and disproportionately affect lower income regions. Migration plays a role at both individual and population levels, with migrant populations from high-risk regions often having a higher diabetes prevalence than host populations due to lifestyle and socioeconomic changes they experience. Additionally, healthcare access and diagnostic practices vary widely, leading to underdiagnosis of type 2 diabetes, particularly in low-resource settings. Addressing these disparities requires a comprehensive approach that considers socioeconomic factors, environmental factors and weight management to develop effective prevention and intervention strategies worldwide.