Diabetes prevalence in the Middle East and North Africa doubled in 33 years

Age-standardised diabetes prevalence across 21 Middle East and North Africa countries more than doubled between 1990 and 2023, from 5,564 per 100,000 (95% uncertainty interval 5,088–6,024) to 11,247 per 100,000 (95% UI 10,382–12,132), according to an analysis of Global Burden of Disease 2023 estimates published in July [s1].

Age-standardised incidence rose 92% over the same period, from 251.7 per 100,000 (95% UI 231.5–272.4) to 482.5 (95% UI 451.5–516.4) [s1].

Age-standardisation matters for reading those figures correctly. The increase is not an artefact of populations getting older — the method removes that. Something changed in the underlying risk.

The one group that improved

Children aged 0 to 14 were the only age group whose disability-adjusted life-year rates declined, falling between 52% and 57% [s1].

That divergence is the most informative single result in the paper, and also the least explained. The analysis does not decompose the paediatric figure by diabetes type, so it cannot show whether fewer children are developing diabetes or whether the same number are living with less disability from it. The second reading is the more plausible of the two for a disability-adjusted measure, and it would point at care — insulin supply, monitoring, specialist services — rather than at incidence. Either way, a halving of DALY rates in children against a doubling of prevalence overall describes two stories running at once.

The sex inversion

In 2023, men had higher DALY rates than women across most adult age groups from 15 onward — a reversal of the female-predominant pattern seen in 1990 [s1]. Female rates remained higher at several of the oldest age groups [s1].

The analysis does not explain the inversion, and an ecological study of this type cannot. Differential changes in obesity, physical activity, smoking, screening intensity, or healthcare-seeking between men and women over three decades would all produce this signature, and the design cannot separate them.

The risk factor attribution

High body-mass index was the leading modifiable risk factor identified [s1]. That is consistent with what other regional evidence shows about the underlying metabolic environment, and it locates the intervention target upstream of diabetes care itself.

The post-2019 signal, and why the authors hedge it

Using joinpoint regression to compare trajectories before and after 2019, the analysis found post-2019 incidence higher in 15 of the 21 countries, with six countries showing higher DALY trends whose confidence intervals did not overlap [s1].

The authors immediately qualify this. With only four to five years of post-2019 data, they describe these short trends as preliminary and requiring care in evaluation [s1]. That caution is appropriate and worth preserving: a four-year segment in a 33-year series is fragile, and the period in question includes the COVID-19 pandemic, which disrupted both diabetes care and the health information systems that GBD estimates draw on. An apparent post-2019 acceleration could reflect genuine deterioration, changed detection, or changed data quality.

What the surrounding literature adds

Two earlier studies of the wider Eastern Mediterranean Region give a sense of scale and cost.

A cost-of-illness study published in August 2025 estimated that diabetes affected more than 74 million people across the 22 EMR countries and territories in 2023 and caused approximately 833,000 deaths, with cases projected to reach 150 million and deaths 2 million by 2050 [s2]. It put the 2023 economic burden at 639 billion international dollars, 89% of which was attributable to indirect costs, rising to a projected Int$1.5 trillion by 2050 [s2].

The 89% indirect-cost share is the figure most likely to be misread. Indirect costs are productivity losses and mortality costs — in this study, mortality costs were estimated using a value-of-a-statistical-life-year approach [s2]. That is a modelling choice with large effects on the total, and it means the headline figure is not a health-system budget number. Direct medical spending is the remaining 11%.

A separate meta-analysis published in July 2025, pooling 186 studies from an initial 5,238 screened, estimated regional prevalence of diabetes at 15% (95% CI 13–16%), of which 6% (95% CI 4–7%) was undiagnosed and 8% (95% CI 7–10%) known [s3]. Type 2 diabetes accounted for 13% (95% CI 11–16%) and type 1 for 1% (95% CI 1–2%), with pre-diabetes at 15% (95% CI 13–18%) and gestational diabetes at 11% (95% CI 9–14%) [s3].

The undiagnosed share is the number with the clearest operational meaning. If roughly 6% of adults in the region have diabetes they do not know about — close to half of all cases [s3] — then detection capacity, not only treatment capacity, is a binding constraint.

What these designs can and cannot establish

The GBD analysis is ecological. It works with country-level modelled estimates, not individual records, and cannot support inference about individuals. GBD figures are themselves modelled from available data, and their uncertainty intervals widen where primary data is sparse — which in this region varies substantially between countries.

The cost study is prevalence-based projection to 2050, dependent on assumptions that will not hold precisely [s2]. The meta-analysis pools studies spanning January 1967 to December 2022 with heterogeneous diagnostic criteria [s3], which is why its confidence intervals are wide.

None of the three is a trial and none establishes causation. What they establish jointly is direction and magnitude, from three independent methods, and they agree.

What to watch next

Whether the paediatric improvement holds and whether it can be explained. A 52–57% decline in DALY rates in one age group [s1], against deterioration everywhere else, is the kind of result that usually has an identifiable cause — improved insulin access, better diagnosis of ketoacidosis, expanded specialist paediatric services. Identifying which would tell the region considerably more than another decade of prevalence estimates.

Sources

1. Diabetes Burden in the Middle East and North Africa Region, 1990–2023: An Ecological Time-Trend Analysis of GBD Estimates — Medicina, 13 July 2026 (primary)
2. A cost of illness study of the economic burden of diabetes in the Eastern Mediterranean Region — Eastern Mediterranean Health Journal, 4 August 2025 (primary)
3. The prevalence of all types of diabetes and pre-diabetes in the Eastern Mediterranean countries: a meta-analysis study — BMC Endocrine Disorders, 1 July 2025 (primary)