Pakistan Faces Doubling of Diabetes Cases as Doctors Warn of Risks to Young People

34.5 Million Adults With Diabetes, Millions Still Undiagnosed

Pakistan had an estimated 34.5 million adults living with diabetes in 2024, including about 9.3 million who had not been diagnosed, according to the International Diabetes Federation's Diabetes Atlas. Its projection for 2050 is 70.2 million people, more than twice the current number. Doctors in Karachi are warning that younger people also need attention, particularly those with a family history of diabetes, excess fat around the waist or little physical activity.

At a media session organised by Aga Khan University Hospital (AKUH), specialists in hormone disorders, blood vessel surgery and nutrition described a disease whose damage can extend far beyond a high blood sugar reading. Over time, poorly controlled diabetes can harm nerves and blood vessels, affecting the heart, kidneys, eyes and feet.

The Atlas places Pakistan first globally for age standardised diabetes prevalence among adults aged 20 to 79, at 31.4%. Age standardisation adjusts for differences in the ages of national populations, making comparisons between countries fairer. The Atlas also estimates roughly 230,000 deaths annually in Pakistan from complications related to diabetes.

A proposed national programme costing Rs6.8 billion would bring together screening, awareness, early diagnosis and treatment, beginning with a model project in Islamabad before expansion to the provinces. Its launch date and the timetable for expansion have not been announced.

For families, the immediate concern is practical: finding diabetes before lasting damage develops, getting appropriate tests and maintaining care after diagnosis. The 9.3 million undiagnosed people represent approximately 27% of Pakistan's estimated population with diabetes, or more than one in four.

Why Young People Need Attention

Dr Asma Ahmed, a consultant endocrinologist at AKUH, said type 2 diabetes is affecting younger people as well as older adults. An endocrinologist treats conditions involving hormones, including insulin, which helps sugar move from the blood into the body's cells. In type 2 diabetes, that process becomes less effective and blood sugar rises.

Ahmed identified family history, fat concentrated around the abdomen and physical inactivity as reasons to seek medical assessment. People whose weight appears healthy can also develop diabetes. Her advice was to arrange checks before symptoms appear, rather than waiting until someone feels ill.

Professor Abdul Basit, director of the Indus Diabetes and Endocrinology Centre and secretary general of the Diabetic Association of Pakistan, has also described cases among children. The national figures cited here cover adults, while the warnings about younger patients make early assessment a concern for families across age groups.

Basit described the scale of the country's response in urgent terms:

Screening, early detection, and affordable medicines must become top priorities at the national level

For a young adult with a parent who has diabetes, the message is to discuss that history with a clinician even when everyday life feels normal. Age is one part of the risk assessment; family history, waist size and other health conditions also matter.

What Pakistan's National Survey Found

A detailed picture of diabetes within Pakistani communities comes from the Diabetes Prevalence Survey, published in BMJ Open. Researchers examined 18,856 adults aged 20 or older across 378 clusters in 16 districts between April and November 2017.

The study was conducted by the Department of Diabetes, Endocrine and Metabolic Diseases at Hayatabad and the Khyber Pakhtunkhwa health department, with technical support from Khyber Medical University, the University of Manchester and the Pakistan Endocrine Society. Its sample included rural and urban communities across Pakistan.

Researchers estimated type 2 diabetes prevalence at 16.98%, identifying 3,201 participants through their screening approach. Another 2,057 participants, or 10.91%, had prediabetes, meaning blood sugar was above the normal range but below the threshold used to diagnose diabetes. The study also recorded 1,577 newly diagnosed participants.

Among participants reporting a family history of diabetes, prevalence was about 31.3%. The analysis linked diabetes with increasing age, obesity, fat around the abdomen and high blood pressure. Lower educational attainment was also associated with greater risk, supporting the researchers' call for screening, prevention and treatment within communities.

The survey's 16.98% estimate and the Atlas's later 31.4% figure describe different measurements. The survey assessed type 2 diabetes using a blood test in adults aged 20 and above in 2017. The Atlas figure is an age standardised estimate for diabetes among people aged 20 to 79 for 2024. Their dates, age groups and methods all matter when interpreting the numbers.

How Blood Tests Find Hidden Diabetes

The national survey used glycated haemoglobin, usually called HbA1c, as its main screening test. Sugar attaches to haemoglobin, the protein in red blood cells that carries oxygen. Measuring the proportion with sugar attached gives clinicians a picture of average blood sugar over roughly two to three months.

Researchers used an HbA1c level of 6.5% or higher as the diabetes threshold. Readings from 5.7% to below 6.5% were classified as prediabetes. A clinician interprets test results alongside a person's health and decides whether further testing is needed.

In a subsample, researchers compared HbA1c with an oral glucose tolerance test, which measures the body's response to a glucose drink. HbA1c had 84.7% sensitivity and 87.2% specificity. Put simply, it identified about 85 out of every 100 people classified as having diabetes by the comparison test, and correctly classified about 87 out of 100 without it.

The study also faced a practical limitation: 3,644 recruited participants, about 16%, were excluded because they had anaemia, a condition that can affect HbA1c readings. Choosing and interpreting a test therefore requires attention to the person's wider health, as well as the convenience of community screening.

What the Proposed National Programme Would Do

The planned Rs6.8 billion programme would connect public awareness and screening with diagnosis and treatment. Islamabad would serve as the initial model before the approach spreads to other provinces. Basit described the strategy as part of the prime minister's programme for diabetes prevention and control.

One proposed tool is the RAPID score, which takes about 30 seconds and uses three pieces of information: age, waist circumference and whether diabetes runs in the family. Its purpose is to identify people who should receive further medical testing. Diagnosis then depends on clinical assessment and appropriate blood tests.

The age component gives zero points to people younger than 40, one point to those aged 40 to 60 and three points to those older than 60. Waist measurement and family history contribute to the complete assessment, so a younger person's age score is only one part of the process.

For people attending a community screening session, the useful outcome would be a clear route to the next step: where to obtain testing, how results will be explained and where continuing care is available. The proposed programme brings those tasks together, while the doctors' warnings show why follow through matters after an initial check.

Prediabetes Offers an Opportunity to Act

Ahmed cited Aga Khan University's Pakistan diabetes prevention research project, in which people with prediabetes received guidance on changing their daily habits. After one year, blood sugar returned to the normal range in 61% of the group adopting lifestyle changes.

Prediabetes gives clinicians and patients an opportunity to act before blood sugar reaches the diabetes threshold. Food choices, physical activity and continued monitoring are central to the approach described by AKUH. An improved reading is a reason to maintain those habits and continue the checks recommended by a medical professional.

The 61% finding concerns participants in a prevention project. The briefing did not provide the group's size or a comparison group's result. Those details would help readers judge how widely the result might apply, while the finding itself gives a concrete example of improvement following structured guidance.

For someone already diagnosed with diabetes, Ahmed's advice included taking prescribed medicines regularly, attending medical reviews and making sustainable changes to daily life. Prevention support and treatment serve people at different stages, with continued care important at each stage.

Why a Small Foot Wound Can Become Serious

Dr Fareed Ahmed Shaikh, assistant professor and head of vascular surgery at AKUH, explained how diabetes can affect both blood flow and sensation in the legs and feet. Nerve damage can reduce the ability to feel an injury, allowing a small wound to go unnoticed.

Reduced circulation can also make healing more difficult. A wound may develop into a serious infection or a larger ulcer, and delayed treatment can lead to amputation of a foot or part of a leg. For a patient, a minor injury can therefore become a threat to mobility and independence.

Shaikh advised people with diabetes to examine their feet regularly and seek medical help promptly for any wound. Regular checks are especially useful when reduced sensation makes pain an unreliable warning.

The AKUH specialists called for care that includes medicines, nutrition advice and examinations of the feet and blood vessels alongside blood sugar monitoring. Bringing those services together gives clinicians a chance to address problems before they become harder to treat.

Food Advice Built Around Everyday Meals

Farah Syed, a senior dietitian at AKUH, said a diabetes diagnosis does not require people to abandon every favourite food or impose severe dietary restrictions. Her recommendations focused on balanced meals, suitable portions and changes that can become part of ordinary life.

Vegetables, pulses and whole grains were among the foods she encouraged, alongside avoiding sugary drinks. Portion size matters because the amount eaten affects how much sugar the body must manage, even when a food forms part of a balanced diet.

Syed stressed consistency. A meal plan that fits a household's routine is easier to continue than a short period of strict restriction. Nutrition advice also sits alongside prescribed treatment and medical checks, allowing changes in food and blood sugar to be reviewed together.

From the 2017 Survey to the 2050 Projection

Pakistan's challenge combines a large existing population with diabetes, millions awaiting diagnosis and a projected rise in future cases. The key dates show how evidence gathered in communities connects with the longer planning horizon:

• April to November 2017: The national prevalence survey examined 18,856 adults across 16 districts.
• 2024: The IDF estimated 34.5 million adults in Pakistan were living with diabetes, including about 9.3 million undiagnosed.
• 2025: Findings from the 11th edition of the Diabetes Atlas were presented at the IDF World Diabetes Congress in Bangkok.
• 2050: The Atlas projects 70.2 million people with diabetes in Pakistan and age standardised prevalence of 34.2%.

The projected increase is 35.7 million people, approximately 103% above the 2024 estimate. Globally, the Atlas projects a rise from 589 million adults with diabetes in 2024 to 853 million in 2050, about 45%. Pakistan therefore faces a much faster projected increase in the number needing care.

Basit cited annual diabetes related healthcare spending of just $79 per person in Pakistan. Against that constraint, earlier diagnosis must connect to affordable treatment and regular follow up. The central task is to reach people before complications develop and keep care accessible once diabetes is identified.

Key Points

• Pakistan had an estimated 34.5 million adults with diabetes in 2024, including 9.3 million undiagnosed.
• The IDF projects 70.2 million people with diabetes by 2050, more than double the 2024 total.
• AKUH doctors warn that younger people also face risks, especially with family history, abdominal fat or physical inactivity.
• A proposed Rs6.8 billion national programme would begin in Islamabad and expand to the provinces.
• The RAPID score assesses risk in about 30 seconds; clinical assessment and blood tests guide diagnosis.
• Regular medicines, sustainable food changes, medical reviews and foot checks are central to continuing care.