Diabetes is a silent epidemic sweeping Pakistan

Diabetes is fast becoming one of Pakistan's most serious public health challenges. Already, millions of adults have diabetes and millions more are at risk, while the nation reports one of the highest cases of diabetes in the world. Increasing obesity, urbanisation, low access to healthcare and genetic susceptibility have all been behind what experts say is an alarmingly rising epidemic.

To gain a better perspective on the size of the crisis, its causes and changing treatment and prevention protocols, we sit down with Dr Sarwar Malik, consultant endocrinologist and head of the Department of Endocrinology at the Capital Development Authority Hospital, Islamabad.

The Current State of Diabetes in Pakistan

Q: How would you describe the current state of diabetes in Pakistan, and are we facing an epidemic?

A: As of 2024, Pakistan has around 34.5 million adults with diabetes and an additional 12–17 million with prediabetes, putting the total number of affected individuals at over 50 million, according to the latest figures. This means nearly one in three adults either has diabetes or is at high risk of developing it soon. The country holds the highest diabetes prevalence rate globally (31.4 per cent), and this number is expected to rise to over 70 million by 2050 if urgent interventions are not implemented.

At-Risk Groups

Q: What groups are most at risk, age-wise, gender-wise or geographically and why?

A: In Pakistan, the groups most at risk of developing diabetes include adults aged 40 and above, who show the highest prevalence due to age-related insulin resistance and unhealthy lifestyle habits. Women, especially those who are overweight or have had gestational diabetes, are also more vulnerable, partly due to hormonal factors and limited access to healthcare and physical activity. Geographically, urban populations face a higher risk than rural ones because of sedentary lifestyles, unhealthy diets, and greater exposure to processed foods. However, rural areas are also seeing rising cases as modern habits and poor health awareness spread.

Alarming New Trends

Q: Have you noticed any new or alarming trends in the incidence or management of diabetes lately?

A: Certainly. There's sharp rise in diabetes cases in our country in recent years, with over 34 million affected, but still, a large portion of patients remain undiagnosed or undertreated, mirroring global patterns where nearly 60 per cent of diabetics over 30 are not receiving proper medication.

The new alarming trend is the early onset of Type-2 diabetes in younger individuals of 18-35 years of age and it is becoming a huge financial burden on the country's fragile economy.

Even among those on treatment, more than half have poor glycemic control, leading to serious complications like neuropathy and retinopathy. Widespread lack of awareness, high out-of-pocket healthcare costs and inconsistent follow-up further worsen the situation. Although emerging technologies like AI show potential for early detection and improved care, their impact in Pakistan remains limited due to infrastructure and access barriers.

Root Causes

Q: What do you believe are the key reasons behind the rising diabetes cases in the country? Is it purely lifestyle-related or are other factors at play?

A: The rising diabetes cases here are driven by a combination of lifestyle and non-lifestyle factors. While poor diet, physical inactivity, urbanisation and increased obesity are major contributors, the problem goes deeper. Genetic predisposition plays a significant role, especially in South Asian populations, who are more prone to insulin resistance. Also, lack of public health education, delayed diagnosis and limited access to affordable care have allowed diabetes to spread unchecked. Social factors like poverty, stress, and gender-based disparities, particularly affecting women, also contribute. So, while lifestyle is a core driver, it's part of a broader web of medical, social and systemic issues fueling the epidemic.

Public Awareness and Screening

Q: How effective are current public awareness campaigns and screening efforts in tackling this crisis?

A: Despite diabetes awareness and screening efforts, their overall effectiveness remains limited in our country. Campaigns, such as those run by community groups like CCD in Faisalabad and the Pakistan Diabetes Prevention Programme, have raised awareness and facilitated screening in localised settings, but their national-scale impact is still modest.

More structured programmes, like diabetes self-management education in tertiary care and health-education sessions for school teachers, have shown promising results in improving knowledge, treatment adherence and glycemic control. Yet, broader studies show that public awareness is still lacking, only about 47 per cent of people surveyed in Punjab had adequate knowledge, and awareness remains particularly low among rural, less educated and lower socioeconomic groups. In summary, while targeted interventions are effective on a small scale, large-scale, sustained public campaigns and systematic screening are still needed to meaningfully combat diabetes crisis in our country.

Modern Treatment Approaches

Q: What treatments are most commonly recommended now and how have approaches evolved over the years?

A: In Pakistan, the most commonly recommended treatments for diabetes today include a combination of lifestyle modification, oral medications, and insulin therapy, depending on the stage and severity of the disease. Initially, Metformin remains the first-line oral medication for Type 2 diabetes due to its safety, affordability, and effectiveness. However, in recent years, there's been a growing use of newer drug classes like SGLT2 inhibitors and GLP-1 receptor agonists, which offer added cardiovascular and kidney benefits though their high cost limits widespread use.

Treatment approaches have evolved significantly over the years. Earlier, care was mostly reactive and focused on managing blood sugar alone. Now, it's increasingly holistic, emphasising early screening, patient education, prevention of complications and individualised care. Self-management education, mobile health tools, and multidisciplinary clinics are also being introduced, though access remains uneven across the country.

Overall, while global treatment standards are improving, affordability and healthcare infrastructure continue to limit consistent, high-quality diabetes care for many in Pakistan.

Semaglutide: Benefits and Risks

Q: Medications like Semaglutide are gaining popularity. What are the benefits and possible side effects of such modern drugs?

A: Medications like Semaglutide, part of the GLP-1 receptor agonist class, are gaining popularity for their dual benefits in blood sugar control and weight loss. They help lower HbA1c, reduce appetite, and promote significant weight reduction, while also offering added protection against heart and kidney diseases. Recent studies even suggest potential anti-aging, anti-inflammatory and neuroprotective effects. However, these benefits come with risks, common side effects include nausea, vomiting, diarrhea, and more serious but rare issues like pancreatitis, gallbladder disease and possible thyroid concerns. While promising, these drugs require careful medical supervision to balance benefits with potential complications.

Semaglutide and Fertility

Q: Some patients report unexpected pregnancies despite using Semaglutide with birth control. How does this drug affect fertility and hormones?

Semaglutide can influence fertility and hormones primarily because it affects metabolism, appetite, and insulin regulation, which are closely linked to reproductive health.

A: While there's no direct evidence that Semaglutide improves infertility, its impact on weight loss and hormonal balance can sometimes disrupt menstrual cycles and ovulation. This hormonal fluctuation might reduce the effectiveness of some birth control methods or alter how the body processes contraceptives, potentially leading to unexpected pregnancies. Also, rapid weight changes can affect hormone levels involved in fertility. Because research is still limited, women using Semaglutide alongside contraception should consult their healthcare providers to ensure appropriate birth control methods and close monitoring.

Lifestyle: The Foundation of Care

Q: What role does diet, physical activity and stress management play in both controlling and preventing diabetes?

A: Diet, physical activity and stress management play crucial roles in both preventing and controlling diabetes. A balanced diet rich in whole grains, vegetables, lean proteins and healthy fats helps regulate blood sugar levels and maintain a healthy weight, reducing insulin resistance.

Regular physical activity improves insulin sensitivity, aids weight management and lowers blood glucose levels. Meanwhile, effective stress management is vital because chronic stress can raise blood sugar through hormonal changes and lead to unhealthy behaviors like poor eating or inactivity. Together, these lifestyle factors form the foundation of diabetes care, often reducing the need for medications and preventing complications.

A Vision for Change

Q: If you could change one thing in our healthcare or social system to reduce diabetes rates, what would it be?

If I've the power to make a single change, it'll be to implement widespread, accessible and sustained diabetes education and prevention programmes at the community level. Empowering people with knowledge about healthy lifestyles, early symptoms and the importance of regular screening, especially in rural and underserved areas, could drastically reduce new cases and improve management of existing ones.

This change would require integrating diabetes awareness into schools, workplaces, and primary healthcare, combined with affordable access to nutrition counseling and physical activity opportunities. Education fuels prevention, which is the key to reversing our diabetes epidemic.