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Diabetes prevalence is steadily increasing around the globe, with around 828 million people affected today. It causes nearly 2 million deaths annually and can lead to severe complications. Although an approved cure is not yet available, ongoing scientific and clinical progress offers hope for improved management of the disease and potential recovery.

Diabetes is a chronic metabolic disorder characterized by abnormally elevated blood glucose levels. Often asymptomatic in its early stages, it primarily affects the vascular system. Inadequately managed chronic hyperglycemia leads to progressive damage to blood vessel walls, resulting in microangiopathy (pathological changes in small blood vessels) and macroangiopathy (dysfunction and disease of large blood vessels). These vascular complications increase the risk of severe health issues such as cardiovascular diseases, strokes, retinopathy (damage to the blood vessels of the retina), and nephropathy (damage to the small blood vessels in the kidneys), making diabetes a significant global public health concern.

Concerning Evolution

According to a study published on November 13 in The Lancet, approximately 828 million adults worldwide were living with diabetes in 2022, a figure significantly higher than the 200 million estimated in the early 1990s. This concerning, even alarming, evolution has been particularly pronounced in low- and middle-income countries, which recorded the highest prevalence rates globally that year. The report cites, among others, countries from South Asia (such as Pakistan) and Southeast Asia (such as Malaysia), as well as the Middle East and North Africa (such as Egypt), and Latin America and the Caribbean (such as Costa Rica). In contrast, the lowest global prevalence in 2022 was observed in Western Europe and East Africa for both genders, as well as in Japan and Canada for women.

Healthcare Access Inequalities

Inequalities in healthcare access remain one of the major challenges associated with this disease. According to data published by The Lancet, nearly 445 million adults with diabetes over the age of 30—about 59% of the diabetic population in this age group—did not receive any hypoglycemic treatment in 2022. This number represents a 3.5-fold increase compared to 1990. Among these untreated patients, 30% resided in India. While notable progress has been made in certain countries, particularly in Mexico, Eastern Europe, and Southeast Asia, Sub-Saharan Africa and South Asia have not seen significant improvements in treatment coverage, creating an alarming gap between disease prevalence and effective treatment.

Diabetes is classified into two main types: Type 1, often diagnosed in childhood due to a total lack of insulin, and Type 2, primarily caused by insulin resistance and linked to lifestyle risk factors such as smoking, obesity, and an unbalanced diet. Type 1 diabetes patients primarily rely on insulin therapy. In contrast, the pharmacological treatment of Type 2 diabetes primarily involves oral antidiabetics. Insulin use may also be necessary in these patients when insulinopenia (i.e., when the pancreas no longer produces sufficient insulin) develops as the disease progresses.

Seventh Leading Cause of Death

Uncontrolled diabetes can lead to potentially severe complications, such as blindness, kidney failure, cardiovascular diseases, and major amputations. According to the World Health Organization (WHO), this endocrine disease is responsible for nearly 2 million deaths annually worldwide, with nearly half occurring before the age of 70. Furthermore, WHO predicts that by 2030, diabetes will become the seventh leading cause of death globally. “To bring the global diabetes epidemic under control, countries must urgently take action. This starts with enacting policies that support healthy diets and physical activity, and, most importantly, health systems that provide prevention, early detection and treatment,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, in a statement issued on November 13, on the occasion of World Diabetes Day, celebrated on November 14.

Prevention and Management

The prevention and management of diabetes rely on several key pillars. A healthy lifestyle, including a balanced diet, regular physical exercise, and maintaining a normal weight, is crucial in preventing Type 2 diabetes. Early screening, coupled with appropriate treatment, also helps reduce the risk of complications. Moreover, managing comorbidities and consistent medical follow-up are essential to prevent disease progression. “Insulin is not a cure for diabetes; it is a treatment,” stated Frederick Banting, Nobel Prize laureate in 1923 for his co-discovery of insulin. While no cure has been approved yet, two remission cases were reported this year.

In a study published on October 31, 2024, in Cell, Wang et al. reported the successful transplantation of insulin-producing islets into the abdominal muscles of a Type 1 diabetes patient. The islets were derived from stem cells extracted from the patient’s body, which were then reprogrammed. Two and a half months later, the patient was producing enough insulin to live without medical treatment, and she maintained this level of production for more than a year. This study follows another group’s successful islet transplantation into the liver of a 59-year-old Type 2 diabetes patient. According to the report, published on April 30 in Cell Discovery, his insulin needs gradually decreased following the intervention, with complete withdrawal by week 11, while the oral antidiabetic medications were tapered starting at week 44 and discontinued by week 56.

Will stem cells represent the hope of a cure for millions of diabetic patients? Only time and scientific advances will reveal this.