{"id":10296,"date":"2025-12-10T16:23:35","date_gmt":"2025-12-10T12:23:35","guid":{"rendered":"https:\/\/medscriptum.org\/?p=10296"},"modified":"2025-12-10T20:11:46","modified_gmt":"2025-12-10T16:11:46","slug":"diabetes-epidemiology","status":"publish","type":"post","link":"https:\/\/medscriptum.org\/en\/diabetes-epidemiology\/","title":{"rendered":"Global epidemiology of diabetes (2025) and the World Health Organization\u2019s first published recommendations for the management of diabetes during pregnancy"},"content":{"rendered":"<p style=\"text-align: justify\"><span style=\"font-weight: 400\">According to the latest data from the International Diabetes Federation (IDF), diabetes is one of the fastest-growing global public health emergencies of the 21st century. The continuously increasing global burden is particularly alarming, as the disease profoundly affects the health profile of populations and contributes significantly to overall mortality.<\/span><\/p>\n<p style=\"text-align: justify\"><b>Global prevalence and prognosis<\/b><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">According to 2024 data, approximately 589 million adults aged 20\u201379 worldwide were living with diabetes, accounting for 11.1% of the global population within this age group. Current projections indicate that by 2050 this number will rise to 852.5 million, illustrating the rapidly increasing trajectory of the disease. The global burden of diabetes is especially evident during pregnancy, as the prevalence of hyperglycemia in pregnancy continues to rise. Each year, an estimated 23 million pregnancies are affected by some form of hyperglycemia, representing one in every five pregnancies. Marked disparities in diabetes prevalence are observed between urban and rural populations. In 2024, 399.6 million cases (12.7%) were recorded in urban areas, compared with 189.1 million (8.8%) in rural population. A substantial proportion of the global burden falls on low- and middle-income countries, where more than 95% of diagnosed cases correspond to type 2 diabetes. Social inequities are particularly apparent in access to diagnostic services: globally, 86.9% of all undiagnosed diabetes cases occur in low-income countries. As of 2024, one in five adults aged 20\u201379 amounting to 251.7 million individuals (48.8%) were living with diabetes that had never been diagnosed throughout their lifetime. Undiagnosed diabetes is most prevalent in low-income countries (58.7%), followed by middle-income (45.5%) and high-income countries (28.9%).<\/span><\/p>\n\r\n                <style type=\"text\/css\">\r\n                    \r\n                    #tdi_1  .td-doubleSlider-2 .td-item1 {\r\n                        background: url(https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map11-160x120.jpg) 0 0 no-repeat;\r\n                    }\r\n                    #tdi_1  .td-doubleSlider-2 .td-item2 {\r\n                        background: url(https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map122-160x120.jpg) 0 0 no-repeat;\r\n                    }\r\n                <\/style>\r\n\r\n                <div id=\"tdi_1\" class=\"td-gallery td-slide-on-2-columns\">\r\n                    <div class=\"post_td_gallery\">\r\n                        <div class=\"td-gallery-slide-top\">\r\n                           <div class=\"td-gallery-title\">Diabetes Atlas 2025, International Diabetes Federation<\/div>\r\n\r\n                            <div class=\"td-gallery-controls-wrapper\">\r\n                                <div class=\"td-gallery-slide-count\"><span class=\"td-gallery-slide-item-focus\">1<\/span> of 2<\/div>\r\n                                <div class=\"td-gallery-slide-prev-next-but\">\r\n                                    <i class = \"td-icon-left doubleSliderPrevButton\"><\/i>\r\n                                    <i class = \"td-icon-right doubleSliderNextButton\"><\/i>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n\r\n                        <div class = \"td-doubleSlider-1 \">\r\n                            <div class = \"td-slider\">\r\n                                \r\n                    <div class = \"td-slide-item td-item1\">\r\n                        <figure class=\"td-slide-galery-figure td-slide-popup-gallery\">\r\n                            <a class=\"slide-gallery-image-link\" href=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map11-scaled.jpg\" title=\"map11\"  data-caption=\"\"  data-description=\"\">\r\n                                <img decoding=\"async\" src=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map11-765x420.jpg\" srcset=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map11-765x420.jpg 420w, https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map11-1531x840.jpg 840w\" sizes=\"(-webkit-min-device-pixel-ratio: 2) 840px, (min-resolution: 192dpi) 840px, 420px\" alt=\"\">\r\n                            <\/a>\r\n                            \r\n                        <\/figure>\r\n                    <\/div>\r\n                    <div class = \"td-slide-item td-item2\">\r\n                        <figure class=\"td-slide-galery-figure td-slide-popup-gallery\">\r\n                            <a class=\"slide-gallery-image-link\" href=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map122.jpg\" title=\"map122\"  data-caption=\"\"  data-description=\"\">\r\n                                <img decoding=\"async\" src=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map122-651x420.jpg\" srcset=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map122-651x420.jpg 420w, https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map122-1303x840.jpg 840w\" sizes=\"(-webkit-min-device-pixel-ratio: 2) 840px, (min-resolution: 192dpi) 840px, 420px\" alt=\"\">\r\n                            <\/a>\r\n                            \r\n                        <\/figure>\r\n                    <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n\r\n                        <div class = \"td-doubleSlider-2\">\r\n                            <div class = \"td-slider\">\r\n                                \r\n                    <div class = \"td-button td-item1\">\r\n                        <div class = \"td-border\"><\/div>\r\n                    <\/div>\r\n                    <div class = \"td-button td-item2\">\r\n                        <div class = \"td-border\"><\/div>\r\n                    <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n\r\n                    <\/div>\r\n\r\n                <\/div>\r\n                \n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">The high global prevalence of undiagnosed diabetes poses a substantial threat to public health. Delayed diagnosis or failure to identify the disease increases the risk of developing chronic complications, including cardiovascular disease, renal failure, neuropathy, and premature mortality. Epidemiological data indicate that limited access to diagnostic modalities, insufficient healthcare system resources, and low levels of health literacy constitute major barriers to the timely detection and effective management of diabetes.<\/span><\/p>\n<p style=\"text-align: justify\"><b>Diabetes and pregnancy<\/b><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">Among mothers of infants born in 2024, 23 million (19.7%) exhibited hyperglycemia during pregnancy. Of these cases, 79.2% were attributable to gestational diabetes mellitus (GDM). In 11% of mothers, diabetes was pre-existing, whereas in 9.9% it was newly diagnosed during pregnancy (types 1 and 2). The vast majority of hyperglycemia cases (89.5%) occurred in low- and middle-income countries, where access to antenatal care is limited. Additionally, 43.5% of cases were recorded in women aged 30 years or younger.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">Prior to 2025, no specific recommendations existed for the management of diabetes in pregnant women. In 2013, the WHO published diagnostic criteria and a classification system for hyperglycemia in pregnancy; however, guidance on diabetes management was not included. In 2016, an antenatal care guideline was released that incorporated 25 recommendations related to diabetes during pregnancy, 18 of which were tailored to high- and upper-middle-income countries. This occurred despite the fact that diabetes in pregnancy affected approximately 21 million women annually, roughly one in six pregnancies, with the majority of cases occurring in low- and middle-income countries.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">The new recommendations issued by the WHO in 2025 represent a critical milestone in addressing this growing public health challenge. Diabetes in pregnancy may be pre-existing (type 1 or type 2, classified as pre-gestational diabetes) or first detected during pregnancy, in which case it is categorized as diabetes in pregnancy or gestational diabetes. Evidence indicates that women with a history of gestational diabetes have an increased risk of developing type 2 diabetes in the postpartum period.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">Poorly controlled diabetes during pregnancy substantially increases the likelihood of life-threatening complications, as all forms of diabetes in pregnancy affect both fetal development and intrapartum outcomes. Pregnancy-related diabetic complications include pre-eclampsia, stillbirth, neonatal hypoglycemia, seizures, congenital anomalies, and birth trauma. Diabetes in pregnancy is also associated with long-term consequences, elevating the lifetime risk of type 2 diabetes and cardiometabolic diseases in both the mother and the offspring. Children born to mothers with diabetes in pregnancy face markedly increased risks of obesity, cardiovascular disease, metabolic syndrome, type 2 diabetes, hypertension, and non-alcoholic fatty liver disease in adulthood.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">The burden of diabetes in pregnancy is particularly high in low- and middle-income countries, where access to specialized care and essential resources is often limited despite the greatest need. WHO Director-General Dr. Tedros Adhanom Ghebreyesus stated: \u2018WHO has long provided recommendations on diabetes and pregnancy, but this is the first time we are issuing a dedicated standard for the management of diabetes during pregnancy. These recommendations are grounded in the lived realities and health needs of women and offer clear, evidence-based strategies to ensure high-quality care for all women, everywhere.\u201d<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">The 2025 guideline principles encompass 27 core recommendations, highlighting several key aspects of the management of pregnant women with diabetes:<\/span><\/p>\n<ul style=\"text-align: justify\">\n<li><span style=\"font-weight: 400\">Individualized care: Guidance on diet, physical activity, and blood glucose management.<\/span><\/li>\n<li><span style=\"font-weight: 400\"> Optimal monitoring: All women with diabetes should have their blood glucose levels regularly assessed through both clinic visits and home self-monitoring, as needed.<\/span><\/li>\n<li><span style=\"font-weight: 400\"> Personalized treatment: Specific pharmacologic regimens for type 1, type 2, and gestational diabetes, including pharmacotherapy when indicated, such as metformin, insulin, or combination therapies. The recommendations also emphasize optimal blood pressure control (\u2264130\/80 mmHg).<\/span><\/li>\n<li><span style=\"font-weight: 400\"> Specialized support: Multidisciplinary care for women with pre-existing diabetes.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">The issuance of these guideline principles represents a significant step toward strengthening maternal health and combating non-communicable diseases (NCDs). They emphasize the integration of diabetes monitoring into routine antenatal care and the need for equitable access to essential medications and technologies.<\/span><\/p>\n<p style=\"text-align: justify\"><b>Diabetes-associated complications<\/b><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">Individuals with type 2 diabetes represent a particularly high-risk group for cardiovascular diseases. Studies have shown that people with diabetes have a 72% higher risk of myocardial infarction, a 52% higher risk of stroke, and an 84% increased risk of developing heart failure. Beyond cardiovascular complications, patients with diabetes also exhibit an elevated risk of neurodegenerative processes. They are 56% more likely to develop dementia compared to individuals without diabetes. Importantly, early onset of diabetes in patients is associated with an even higher risk of developing dementia. Globally, in 2024, the proportion of dementia attributable to diabetes was 2.6% among all causative factors. Another significant complication of diabetes is ocular disease. Statistically, the International Diabetes Federation reports that one in four patients with diabetes has diabetic retinopathy, and more than one in ten patients faces an increased risk of vision loss.<\/span><\/p>\n<p><a href=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map133-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-10288\" src=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/map133-scaled.jpg\" alt=\"\" width=\"2560\" height=\"969\" \/><\/a><\/p>\n<p style=\"text-align: justify\"><b>Diabetes-related mortality<\/b><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">Diabetes substantially increases the global burden of disease and poses multifaceted risks to the health of adults, pregnant women, and newborns. In 2024, 3.4 million people aged 20\u201379 years worldwide died from diabetes or its complications, of whom 2.4 million were diagnosed, and 1 million were undiagnosed. This represents 9.3% of global mortality. The highest mortality was recorded in the Western Pacific region (1.2 million). By country, China ranked first (0.76 million) due to its large population, followed by the United States (0.36 million), India (0.33 million), Pakistan (0.23 million), Indonesia (0.13 million), and Mexico (0.12 million).<\/span><\/p>\n<p style=\"text-align: justify\"><b>Epidemiology of diabetes in Georgia<\/b><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">According to the World Health Organization data from 2021, the country ranks 7th in diabetes-related mortality: the mortality rate is 29.5 per 100,000 in women and 33.7 per 100,000 in men. According to the National Center for Disease Control, between 2009 and 2019, diabetes consistently ranked 7th among the leading causes of death in Georgia. During 2018\u20132021, a declining trend in diabetes-related mortality was observed; however, in 2021, there was an increase in new cases of type 2 diabetes, with an incidence of 291.1 per 100,000 population, compared to 236 per 100,000 in 2020.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">During the same period, the incidence of type 1 diabetes also increased: in 2021, 16.4% of new cases were reported in children under 15 years of age, substantially higher than the 7.9% observed in 2020. According to the Non-Communicable Disease Risk Factor Survey (STEPS-2016), 2% of the population aged 18\u201369 years were found to have elevated glucose levels, while fasting hyperglycemia (&gt;7 mmol\/L) was observed in 4.5% of the population.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">Between 2009 and 2019, in the analysis of health burden (DALYs), elevated fasting plasma glucose moved from 5th to 4th position, whereas high body mass index, conversely, declined from 4th to 5th position.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">According to the 2025 data from the Diabetes Federation, the prevalence of diabetes among the population aged 20\u201379 years in Georgia is 200.7 per 1,000 individuals. Disease prevalence is 7.8%, the proportion of undiagnosed diabetes is 36.9%, and the age-standardized prevalence rate is 6.7%.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">Natia Vashakmadze, founder and president of the Georgian Association of Endocrinology and Metabolism and head of the Endocrinology Department at Helsikori Clinic, spoke with <\/span><i><span style=\"font-weight: 400\">MedScriptum<\/span><\/i><span style=\"font-weight: 400\"> about contemporary approaches to diabetes management, the importance of disease prevention, and the impact of hyperglycemia during pregnancy:<\/span><\/p>\n<p><a href=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/natia-scaled.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-10289\" src=\"https:\/\/medscriptum.org\/wp-content\/uploads\/2025\/12\/natia-scaled.jpg\" alt=\"\" width=\"1707\" height=\"2560\" \/><\/a><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">In your opinion, how should healthcare policy be developed to make diabetes manageable across all age groups, and how can public awareness of diabetes-related complications be increased?<\/span><\/p>\n<p style=\"text-align: justify\"><b>Healthcare policy should be developed both toward better diabetes management and, even more importantly, toward diabetes prevention. Diabetes is a serious chronic disease, and its management is complex and challenging across all age groups. In terms of diabetes prevention, healthcare policy development should include the promotion and facilitation of a healthy lifestyle, early screening, and timely interventions in high-risk groups such as individuals with obesity, a family history of diabetes, and other risk factors through lifestyle optimization and, when necessary, timely pharmacotherapy to prevent the onset of diabetes. This represents the most rational policy strategy in the fight against diabetes. Regarding the management of patients who already have diabetes, healthcare policy should focus on improving patient access to endocrinology consultations, as well as ensuring the availability of appropriate diagnostic tests and medications. Today, much is known about diabetes, and many new medications with high efficacy and favorable safety profiles have been added to the therapeutic arsenal. It is crucial that these treatments are physically accessible and practically implementable for our patients. Diabetes is characterized by vascular damage, which leads to both microvascular and macrovascular complications. Patients often believe they are healthy, only to suddenly experience a myocardial infarction or stroke. Of course, myocardial infarction and stroke are acute events that develop over a short period, but they represent the culmination of years of progressive vascular damage, which, unfortunately, occurs asymptomatically and goes unnoticed by the patient. The same applies to microvascular complications such as neuropathy, nephropathy, and retinopathy. Until vascular damage reaches an advanced stage, patients with diabetes generally feel well; however, once symptoms appear, it is often too late to reverse the condition. Therefore, early screening and proactive assessment of vascular health are essential to prevent advanced complications. Increasing public awareness begins with education, delivering clear, simple, and understandable informational messages, and culminates in individualized work with each patient by their healthcare provider.<\/b><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">How important is the diagnosis and treatment of diabetes in shaping a healthy population?<\/span><\/p>\n<p style=\"text-align: justify\"><b>The timely detection of diabetes, initiation of treatment before complications develop, and subsequent regular monitoring are absolutely essential for shaping a healthy population. I would like to note that type 2 diabetes has become significantly more prevalent in younger age groups. I have patients diagnosed with type 2 diabetes at the ages of 25, 27, and 30, which is extraordinarily young for this condition. As I have already mentioned, diabetes damages blood vessels, which in turn supply the entire body. Therefore, if diabetes is undiagnosed and treatment is delayed, especially at a younger age, the patient faces a multitude of chronic complications. This significantly reduces both life expectancy and, even more importantly, quality of life. Beyond direct diabetic complications, the presence of diabetes serves as a worsening factor for virtually all diseases. From a simple influenza infection to severe acute or chronic illnesses, diabetes increases the risk of disease severity, complications, and slow recovery. Therefore, the early detection, timely treatment, and, even more importantly, proactive prevention of diabetes are essential prerequisites for the formation of a healthy population.<\/b><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">How does hyperglycemia during pregnancy affect maternal and fetal health, and why is it essential for a woman to consult an endocrinologist both during pregnancy and in the preconception period?<\/span><\/p>\n<p style=\"text-align: justify\"><b>Hyperglycemia during pregnancy, whether due to pre-existing diabetes or gestational diabetes acquired during pregnancy, negatively affects both the course of pregnancy and the health of the mother and fetus. It is important to begin by noting that pregnant women have individualized glycemic targets, which differ from those of non-pregnant women, and in the presence of diabetes, these targets are even more individualized. Close and active monitoring of blood glucose levels during pregnancy is essential to prevent adverse effects on both the mother and the fetus. I do not wish to alarm readers unnecessarily, but if hyperglycemia is not properly managed during pregnancy, it can lead to serious complications such as fetal developmental defects, preterm birth, neonatal respiratory problems (respiratory distress syndrome), macrosomia (&gt;4 kg), an increased risk of diabetes and obesity later in life, neonatal hypoglycemia, and even stillbirth. Therefore, when a woman plans pregnancy, it is crucial to undergo routine preconception screening and consult an endocrinologist to evaluate the endocrine system and glucose levels prior to conception.<\/b><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">The 2025 Global Diabetes Campaign focused on the theme \u201cDiabetes Across the Life Course.\u201d The campaign aimed to ensure that all individuals living with diabetes, regardless of age group, have access to integrated care, supportive environments, and healthcare policies that help the population maintain health at every stage of life.<\/span><\/p>\n<p style=\"text-align: justify\"><span style=\"font-weight: 400\">Sources:<\/span><\/p>\n<p><a href=\"https:\/\/diabetesatlas.org\/resources\/idf-diabetes-atlas-2025\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400\">Diabetes Atlas 2025<\/span><\/a><\/p>\n<p><a href=\"https:\/\/www.who.int\/publications\/i\/item\/9789240117044\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400\">WHO recommendations on care for women with diabetes during pregnancy<\/span><\/a><\/p>\n<p><a href=\"https:\/\/test.ncdc.ge\/pages\/user\/News.aspx?ID=ea1784b5-d3d0-4dd9-b29f-1369f5d6bbec\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400\">NCDC Georgian Statistical Yearbook 2021<\/span><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>According to the latest data from the International Diabetes Federation (IDF), diabetes is one of the fastest-growing global public health emergencies of the 21st century. The continuously increasing global burden is particularly alarming, as the disease profoundly affects the health profile of populations and contributes significantly to overall mortality. Global prevalence and prognosis According to [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":10290,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1699,1596,1653,1594],"tags":[2325,3314,2004],"class_list":["post-10296","post","type-post","status-publish","format-standard","has-post-thumbnail","category-for-patients","category-internal-medicine","category-interview","category-news","tag-diabetes","tag-diabetes-in-pregnancy","tag-who"],"acf":[],"_links":{"self":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/10296","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/comments?post=10296"}],"version-history":[{"count":2,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/10296\/revisions"}],"predecessor-version":[{"id":10326,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/posts\/10296\/revisions\/10326"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/media\/10290"}],"wp:attachment":[{"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/media?parent=10296"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/categories?post=10296"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medscriptum.org\/en\/wp-json\/wp\/v2\/tags?post=10296"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}