What is driving Pakistan's alarming diabetes surge?

Health experts in Pakistan have expressed grave concerns over surging cases of diabetes in the South Asian nation, warning that the situation could spiral out of control if the government fails to take immediate action.

A recent report from the International Diabetic Federation (IDF) ranking the world's top countries for number of adults (20–79 years) with diabetes in 2021 has put Pakistan in third place with a total of 33 million, after China and India. 

The IDF ranked Pakistan first place for having the highest comparative diabetes prevalence rate in 2021 at 30.8%, followed by French Polynesia (25.2%) and Kuwait (24.9%). 

Pakistan is also the country with the highest proportion of deaths under the age of 60 due to diabetes, with 35.5%

The IDF found that a further 11 million adults in Pakistan have Impaired Glucose Tolerance (IGT), which puts them at higher risk of developing type-2 diabetes.

The report noted that more than a quarter (26.9%) of adults living with diabetes in Pakistan are undiagnosed.

The findings made headlines across Pakistani media. Health experts have called on the government to inject more funds into its national health budget to combat the problem.

Pakistan spends less than 1% of its GDP on health.

What is fueling Pakistan's diabetes rise?

Abdul Ghafoor Shoro, a doctor at the Pakistan Medical Association, says the country's decreasing health budget has forced public hospitals to shut down a wide array of health care services, including those for treating diabetes.

Diabetes health care and medicine, including insulin, used to be more affordable, Shoro said. However, in the last four years, costs have skyrocketed, steering away patients.

Karachi-based doctor Fatema Jawad says diabetes medicine and insulin cost between 2,000 rupees (€10, $11) and 7,000 rupees in Pakistan. But in a country where the majority live on less than $3 a day, "it's not possible to get proper treatment," she told DW.

"Only a few hospitals in Sindh province provide free medicine," she added.

Jawad said that poverty also plays an important role in diabetes.

About 22% of Pakistan's population live below the national poverty line, according to the latest available data from the World Bank.

Millions of women and more than 40% of children are malnourished across the country, Jawad said. These women give birth to malnourished babies, increasing the risk of childhood diabetes, she added.

Lack of education access

A lack of access to affordable education in Pakistan also plays a role in growing diabetes cases. Many Pakistanis living in rural areas are illiterate.

"They do not understand that diabetes is a silent killer," Jawad explained. Many only seek medical advice when their health status has declined to the point of diabetes-related complications, some of which would require amputation, she said.

Rising health care costs and poverty also prompt some diabetes sufferers to seek alternative help from mystics or traditional healers, doctor Shoro told DW.

Furthermore, Tipu Sultan, the former principal of Dow Medical College in Karachi, says candies and snacks high in sugar content are also widely distributed throughout Pakistan's many religious festivals.

Clerics tell people that eating sweets is a tradition of Prophet Mohammad, which might lead some people to pay less attention to the impacts of sugar on their health, Sultan told DW.

Pakistani schools see shrinking outdoor spaces

Ashraf Nizami, a Lahore-based medical expert, believes that lack of exercise, dietary habits and rising obesity are contributing to Pakistan's diabetes surge. He also attributes the problem to the country's lack of sporting facilities, as well as limited public spaces for exercise, particularly in schools.

Nizami said tens of thousands of schools have been established on small plots measuring 120 to 600 square yards. Some schools do not have any playgrounds, depriving students of physical exercise, and thereby increasing the risks of obesity and diabetes in the long run, he said.

How is the government dealing with the problem?

The Pakistani government is paying attention to the diabetes health crisis, reassures Senator Sana Jamali, a member of the Senate National Health Services, Regulations and Coordination Committee. Islamabad is making efforts to tackle the problem, Jamali told DW.

"The prime minister has recently launched health insurance cards in Punjab, which will go a long way in reducing diabetic cases besides making treatment easy for poor people," she said.

But according to Jamali, the government cannot solve the country's health problem alone.

"Unless people change their lifestyle and dietary habits, this problem will continue to haunt us and millions of more people will suffer from it," she maintained, adding that more awareness of the disease needs to be raised nationwide.

Edited by: Sou-Jie van Brunnersum