Experts Advocate Lifestyle Changes as Diabetes Cases Projected to More Than Double by 2050

Researchers predict the number of diabetes cases will rise to 1.3 billion people by 2050.

Diabetes currently impacts one in 10 adults globally, and according to the Centers for Disease Control and Prevention (CDC), one in five adults with diabetes don’t know they have the disease.

A majority of people who will be diagnosed with diabetes will have type 2. This condition is linked to obesity and lack of physical activity, as well as a family history of type 2 diabetes. It can be prevented by proper diet and healthy exercise habits.

Type 1 diabetes, on the other hand, is unable to be prevented. It is caused by an autoimmune reaction that destroys the cells in the pancreas that make insulin.

Diabetes is an extensive global threat that comes with many public health challenges. The condition caused 6.7 million deaths in 2021 alone.

New research indicates that the problem could potentially worsen if action is not taken. Scientists estimate that the number of people living with diabetes could balloon from 529 million in 2021 to more than 1.3 billion by 2050.

“The reason for such a gloomy picture is that we have been unable to stem the tide of diabetes on a population basis throughout the world as well as in the United States—even though we have the knowledge and the tools to do it, [including identifying] those at risk well before the disease manifests,” Florence Comite, MD, a multiple-specialty endocrinologist told Health.

There are multiple and nuanced factors within the population that contribute to the increase, said Liane Ong, PhD, the first author on the study and lead research scientist at the Institute for Health Metrics and Evaluation (IHME).

“Within the Global Burden of Disease (GBD) study, we looked at 16 factors that have been associated with type 2 diabetes, which drives the majority of diabetes,” she said. “We found that obesity is the main risk factor in every country.”

The study authors also note that major behavioral shifts and changes in food systems also could be contributing to the increase. They indicate that the greater availability of shelf-stable and high-calorie products, limited financial means, and limited access to healthy food options could be playing a role, too.

Diabetes growth is definitely multifactorial, Michael B. Natter, MD, an endocrinologist at NYU Langone Health told Health. Though the leading cause behind this increase is likely related to obesity, he said that sedentary lifestyles, an aging population, and genetic underpinnings may also play a role.

“Lack of quality sleep and increased stress also are correlated with higher blood sugar and diabetes,” Natter, assistant professor in the Department of Medicine at NYU Grossman School of Medicine said. “Both can elevate the hormone cortisol, and chronically high cortisol levels over time can lead to increased glucose levels.”

Even COVID could play a role in increasing numbers due to the fact that the virus tends to latch on to ACE2 receptors, he said. One study found that 14.4% of people who were hospitalized with severe COVID-19 also developed diabetes.

Because diabetes is often an individualized condition and not a “one-size-fits-all” diagnosis, it is hard to predict exactly how this increase will impact the day-to-day lives of those with the disease in the future, Natter said.

“After being diagnosed with type 2 diabetes, some people will be able to change their diet, exercise more, and take metformin and it really won’t impact their life. But for other people, it could mean more challenges.”

In fact, diabetes is a devastating disorder that could lead to a number of complications including heart disease, stroke, cancer, kidney disease, and even Alzheimer’s disease and other disorders depending on inherited genetic variants, said Comite, founder of the Comite Center for Precision Medicine & Health.

“Diabetes can even cause blindness, amputation, dialysis, and death,” Comite said.

Treating the serious complications of diabetes can be extremely expensive, she adds. “With so much of the world headed down the path toward diabetes, the results will be as devastating financially as it will be personally and physically on a global level.”

The good news is that people diagnosed with type 2 diabetes—and particularly those with pre-diabetes—can potentially reverse the condition by losing weight, improving their diet, getting better sleep, and de-stressing, both Comite and Natter said.

Even if the number of diabetes cases does increase, not all is lost. There are things that can be done to improve the outcomes.

Reducing body weight and visceral fat is one of the most effective ways to reduce the risk of type 2 diabetes, Comite said.

A recent study found that among people diagnosed with diabetes, reducing their body weight by 10% or within five years of being diagnosed doubled the likelihood of remission.

To do this, start by moving more throughout the day and adding in exercise.

“Walking or biking or rowing or gardening, even housework and sex are great exercises,” Comite said. “Add HIIT (High-Intensity Interval Training), which is as simple as a few sprints lasting 30 to 60 seconds. Shoot for at least 30 minutes a day at a moderate to brisk pace.”

You also should try to incorporate resistance exercises like bodyweight calisthenics, weightlifting, functional training, or using resistance bands to build muscle, which improves glucose control, she said.

It’s also helpful to avoid sugary beverages and simple carbohydrates without fiber.

“Soda, juice, sweet tea, and other sugary beverages and processed carbs like baked goods, bread and pasta that are low or devoid of dietary fiber will raise sugar levels,” Comite said. “Be especially wary of foods made with high-fructose corn syrup.”

She also advises against fad diets and instead encourages starting meals with lean protein, which digests slower than carbs and will reduce the impact of carbs later in the meal.

“Follow the general guidelines for a healthful diet—lots of low glycemic (low sugar) vegetables and fruits, whole grains, lean proteins, fiber, and healthy fats like olive oil, avocado, and fatty fish,” she said.

Additionally, practicing quality sleep habits also can impact blood sugar levels. “During sleep, you are restoring your immune system, regulating hormones that control sugar management, switching genes on, and repairing and building muscle, which is important for metabolic health,” Comite said.

Finally, you can experiment with a continuous glucose monitor (CGM).

“This is a tiny, wearable device that is placed on your upper arm (triceps area) and will reveal your responses to food, beverages, sleep, stress, and activity to help guide choices that can help you manage your sugar,” Comite said. “You can ask your physician for a prescription.”

Early diagnosis, patient education, regular checkups, diagnostic tests and recognizing a family history of diabetes are essential to preventing and slowing diabetes, Comite said.

“Unfortunately, few countries have healthcare systems that are equipped to take a proactive approach to intervention. We do in the United States, and yet we still struggle, waiting for symptomatic disease to present.”

It is also important to keep in mind that while much of type 2 diabetes is preventable through addressing risk factors, some amount of type 2 diabetes is more inevitable due to natural aging, said Lauryn Stafford, MS, the second author on the study and researcher at IHME.

“This means that as our global population ages over the next three decades, our healthcare systems must be prepared to detect people with diabetes through routine screening and also treat people with diabetes,” she said. “Effective treatment of diabetes is essential for preventing complications and reducing the risk of other serious conditions.”

Ong noted that in order to effectively address all these complicated factors, we need to bring all stakeholders to the table, including policymakers, researchers, healthcare professionals, and people affected by diabetes.

“It is clear that we need to rethink the way we are currently trying to address diabetes prevention,” he said. “Type 2 diabetes and obesity are complex issues with both behavioral and structural factors that intersect.”