Diabetes is not inevitable—unless we put off these steps.

Source: Al Jazeera Net website

Diabetes, and the obesity that often precedes it, has become one of the world’s greatest disease burdens, with incidence rising fastest in the very same places—including large parts of our region—that until recently considered themselves to have overcome their biggest health threats.

This is not a story of individual failure. It is a story about how quickly a region’s food supply, cities, and daily habits can change—and how far our health systems still have to go to catch up.

Two forces are colliding, and the first is good news.

Vaccinations, clean water, antibiotics, and improved maternal and child care have achieved what they were designed to do: people now live longer than their parents and grandparents did.

But living longer means living long enough to face the diseases of ageing and abundance—chief among them diabetes and the obesity that precedes it. This epidemic is, in part, a result of success.

The second force is a kind of change that receives less attention: what we eat, and how we get it.

Cheap, calorie-dense, heavily processed foods, sugar-sweetened drinks, and snacks engineered to make overeating easy have steadily displaced traditional diets based on vegetables, legumes, and whole grains—while urbanisation has made walking a rare part of daily life.

In city after city, unhealthy calories are now cheaper and easier to obtain than healthy calories. Diabetes did not appear out of nowhere; it followed the food supply and the design of our cities.

It is worth pausing briefly on the impact of this disease, because statistics can make it seem abstract.

Diabetes is among the leading causes of death. It is the leading cause of heart attacks, strokes, kidney failure, blindness, and amputations, and it contributes to the deaths of more than a million people each year worldwide—while millions more die from cardiovascular diseases whose progression it accelerates.

By now, almost every family has lost someone to this disease, or watched someone lose a limb, a kidney, or their sight because of it.

Beyond deaths, diabetes is a leading cause of disability—and disability here rarely affects only one person: it may be a parent who can no longer work, an adult child reorganising life around dialysis appointments, or a grandmother who needs help with tasks she once did without thinking.

Many patients also carry a hidden burden in addition to the physical one: the feeling that their illness has become a burden on those they love. This emotional burden deserves the same attention as the clinical side.

Here is the hopeful part: type 2 diabetes is preventable for most people, and even after it appears, its worst complications can largely be avoided through early detection and ongoing care.

Weight management, physical activity, and a healthy diet can prevent the disease or delay its onset for most people at risk—and prevention does not require waiting for a diagnosis.

A simple, inexpensive fasting glucose test or an “HbA1c” test can detect prediabetes years before full diabetes develops—and that window matters: people who know they are in the prediabetes stage, rather than being told vaguely to “eat better”, tend to take the news seriously.

A specific number is far more motivating than a general warning, and lifestyle changes begun in the prediabetes stage can prevent or delay progression to full diabetes for a large share of people. Screening is a chance to change the course of the story before its hardest chapters are written.

For the tens of millions of people already living with diabetes, medications are not optional: they are the difference between a normal life and the complications mentioned above.

The newest and most effective diabetes medicines—including “GLP-1” drugs that also treat obesity—are extraordinary achievements, but their prices, in most of the world, far exceed what an average patient or health system can afford.

In the United States, a month’s supply of a leading “GLP-1” drug can cost more than $1,000 before any discount; even at the lower cash-pay prices some manufacturers now offer, a single month still costs more than the monthly minimum wage in many low- and middle-income countries. A treatment that works but that most patients cannot afford has not yet fulfilled its promise.

We have been here before. When effective blood pressure medicines first became widely available decades ago, they transformed health outcomes for those who could pay for them, while patients facing the same risks of stroke and heart failure—but without the necessary financial resources—often went untreated; and without much public debate, health outcomes ended up tracking income as closely as they tracked biological factors.

Diabetes care now stands at the same crossroads, at a time when this disease is far more widespread than high blood pressure was then.

This story also carries a second, quieter lesson: even now, when blood pressure medicines have become cheap and widely available, many people with hypertension still do not receive treatment—not because the pills are expensive, but because they were never screened, or they started treatment once and then quietly stopped.

Affordability alone has never been enough. Diabetes care can learn from both halves of this story at once: making treatment accessible to all, and building a system of screening and follow-up that ensures patients stay on treatment.

Here is a less comfortable note. Most health systems, for entirely understandable reasons, spend the bulk of their budgets on treatment rather than prevention: you cannot turn away a patient with a diabetic foot ulcer, while a campaign to curb sugary drinks—aimed at people who will not develop diabetes for another 20 years—is easy to postpone, and even easier to cancel when budgets tighten.

But this logic has a real cost: prevention is chronically underfunded relative to the burden it can avert, and prevention—not treatment—is often the first thing to be cut.

This trend must be reversed, or at least protected. Treating today’s patients and preventing the next generation from becoming patients are not in competition—but we will not be able to do both unless prevention funding is defended as a standing commitment rather than a discretionary line item that gets cut first.

Health education is the least expensive part of that commitment, and one of the most neglected. Few governments in the region invest seriously in explaining the underlying causes of diabetes and obesity in a simple, repeated way—not to lecture people, but to empower them to recognise the risks they face.

Schools, primary care, and national media are channels ministries already control, and can use to repeat one consistent message: that sugary drinks, ultra-processed foods, and physical inactivity are the main drivers of the disease; that risk can be screened early at low cost; and that a “prediabetes” result is a warning worth acting on, not a label to fear.

A population that understands the risks it faces is a population that makes sure to get screened.

Part of this lies directly in people’s own hands, and it deserves to be said clearly, without the fatalism that often surrounds this disease: know your numbers, and your family’s numbers. A fasting blood sugar test or an “HbA1c” test, along with measuring blood pressure and waist circumference, takes only minutes and tells you more than how you feel.