Countries with the Most Diabetes (2026 Ranked)

The number of people living with diabetes has reached 589 million adults worldwide — 1 in 9 of the global adult population — according to the International Diabetes Federation's 11th edition Diabetes Atlas (2025). That figure is projected to rise to 853 million by 2050. Global health expenditure attributable to diabetes has crossed $1 trillion annually, a 338% increase over 17 years. Diabetes is not a future threat. It is the largest chronic disease crisis in current history, unevenly distributed across countries by diet, genetics, economics, and healthcare system quality.

What "diabetes" means in this ranking

Diabetes is a group of metabolic conditions defined by chronically elevated blood glucose. There are two major types. Type 1 diabetes is an autoimmune disease in which the immune system destroys insulin-producing beta cells in the pancreas. It requires insulin injection for survival, has no known prevention, and accounts for roughly 5–10% of all cases globally. Type 2 diabetes is characterised by progressive insulin resistance — cells stop responding to insulin effectively, forcing the pancreas to overproduce it until capacity is exhausted. It accounts for 90–95% of all cases and is strongly associated with overweight, obesity, physical inactivity, and dietary patterns high in refined carbohydrates and sugars.

Unless stated otherwise, all data in this article refers to total diabetes (predominantly Type 2), using the IDF Diabetes Atlas 11th edition (2025) as primary source.

Source: IDF Diabetes Atlas 11th Edition (2025), released by the International Diabetes Federation. Full data available at diabetesatlas.org.

Where this data comes from

The International Diabetes Federation (IDF), a Brussels-based non-profit comprising 200+ national diabetes organisations, publishes the Diabetes Atlas — the most comprehensive global diabetes epidemiology dataset. The 11th edition (2025) consolidates national survey data, health ministry reports, and academic research from IDF member states. Prevalence rates are age-standardised, meaning they control for population age distribution (allowing comparison between countries with different demographic structures). Absolute numbers are estimated by applying prevalence rates to national population figures. Data quality varies significantly: countries with national diabetes registries and regular population surveys (Japan, Nordic countries, USA) provide precise figures; lower-income countries with weaker health surveillance systems provide estimates with wider confidence intervals. The IDF methodology explicitly notes that true global diabetes prevalence may exceed reported figures due to underdiagnosis in low-income countries. Gestational diabetes is not included in these figures; only Type 1 and Type 2 diabetes are counted.

Analytical insight: diabetes concentration reflects diet, wealth, and healthcare systems

The diabetes rankings reveal a paradox: wealthiest countries do not top prevalence lists per capita. Instead, middle-income countries with rapid dietary transition (Pakistan 31.4%, Gulf states, Egypt) show highest rates. This reflects the "nutrition transition" — rapid shift from traditional diets to ultra-processed foods in countries experiencing economic growth fast enough to enable food industry expansion but not yet developed enough to have strong public health response. Pakistan's extraordinarily high 31.4% rate reflects combination of genetic factors (Central/South Asian populations show higher Type 2 diabetes genetic risk), rapid urbanisation (sedentary work), high obesity rates driven by palm oil-heavy processed foods, and healthcare access gaps delaying diagnosis. Conversely, Japan (8.9%) and Scandinavian countries show much lower rates despite similar wealth, reflecting both genetic factors and dietary retention of traditional (lower-sugar, higher-fibre) patterns. Notably, China (9.1% prevalence, 148 million absolute cases) and India (9.8%, 90 million cases) show similar prevalence rates but drastically different absolute numbers due to population scale — demonstrating that global diabetes crisis is fundamentally a large-population problem, with most absolute cases in Asia. The projection to 853 million by 2050 depends largely on whether high-prevalence countries implement dietary intervention and physical activity policies.

How countries are ranked

Two different metrics produce two different rankings that are both valid and tell different stories.

By absolute number (total people with diabetes): China leads, followed by India, the United States, and Pakistan. This ranking reflects population size as much as disease prevalence.

By age-standardised prevalence rate (percentage of adults with diabetes, adjusted for age distribution): Pacific Island nations lead — Nauru, Kiribati, Marshall Islands — followed by Pakistan. This metric better captures how deeply diabetes has penetrated a population.

Both tables appear below.

Countries by diabetes prevalence rate (age-standardised)

Rank	Country	Prevalence (%)	Total adults with diabetes	Notes
1	Pakistan	31.4%	34.5 million	Highest large-nation rate
2	Kuwait	25.4%	0.6 million	Gulf states cluster
3	Qatar	23.1%	0.3 million
4	Saudi Arabia	18.7%	4.6 million
5	Egypt	18.1%	11.4 million
6	Malaysia	16.9%	3.6 million
7	Turkey	14.2%	8.8 million
8	Mexico	13.8%	14.9 million
9	United States	11.1%	38.5 million	High underdiagnosis
10	Brazil	10.8%	16.2 million
11	India	9.8%	90.0 million	2nd largest absolute
12	China	9.1%	148.0 million	Largest absolute total
13	Japan	8.9%	10.3 million
14	Germany	9.5%	6.1 million
15	United Kingdom	7.1%	3.4 million
—	Nauru	~47%	—	World's highest single-nation rate

Countries by absolute number of people with diabetes

Rank	Country	Adults with diabetes	% of global total
1	China	148 million	25.1%
2	India	90 million	15.3%
3	United States	38.5 million	6.5%
4	Pakistan	34.5 million	5.9%
5	Brazil	16.2 million	2.8%
6	Mexico	14.9 million	2.5%
7	Indonesia	14.1 million	2.4%
8	Bangladesh	13.1 million	2.2%
9	Russia	7.0 million	1.2%
10	Egypt	11.4 million	1.9%

Source: IDF Diabetes Atlas 11th edition (2025), Table 3.1 and Table 3.2. Country-level estimates are modelled figures with confidence intervals; absolute numbers reflect IDF best estimates for the 20–79 age group.

A brief history of the diabetes epidemic

In 1980, an estimated 108 million adults globally had diabetes — a figure that seemed alarming at the time. The number has more than quintupled in four decades. The explosion tracks almost precisely with three parallel global trends: urbanisation (more desk jobs, less physical activity), dietary westernisation (more refined carbohydrates, added sugars, and processed foods), and rising life expectancy (older populations have higher diabetes risk).

The 1960s Green Revolution dramatically increased global food production and reduced caloric scarcity for hundreds of millions of people. This was unambiguously good for hunger. The unintended consequence was that populations which had adapted metabolically to food scarcity — and had preserved traditional diets as a result of economic constraints — suddenly gained access to processed, calorie-dense foods. The dietary transition, combined with reduced physical activity from urbanisation, was the ignition point for the diabetes epidemic.

Type 2 diabetes was once called "adult-onset diabetes" because it was almost never seen in children. That name is no longer used. Childhood Type 2 diabetes is now a recognised global problem, particularly in high-income countries and among populations with high obesity rates.

China: 148 million — the world's largest diabetic population

China's diabetes epidemic is a story of the world's most rapid dietary transition compressed into 40 years.

In 1980, adult diabetes prevalence in China was approximately 1%. By 2025, it reached 9.1% — a 9-fold increase as hundreds of millions of people moved from rural subsistence farming to urban desk jobs, and from traditional plant-based diets to foods high in refined carbohydrates, cooking oils, sugars, and animal protein. The speed of this transition has no historical precedent.

The urbanisation link. China urbanised from roughly 20% of the population in 1980 to over 65% today. Urban Chinese have dramatically higher diabetes rates than rural Chinese, reflecting the relationship between sedentary work, higher incomes enabling richer diets, and reduced daily physical activity. The correlation is tight enough that researchers can track diabetes prevalence as a proxy for urbanisation rates.

The genetics factor. People of East Asian descent develop Type 2 diabetes at significantly lower body mass indexes (BMIs) than people of European descent. A Chinese person with a BMI of 23 — classified as "normal weight" by Western standards — may face insulin resistance equivalent to a European person with a BMI of 28. This means that BMI-based risk tools calibrated on European populations systematically underestimate diabetes risk in Chinese populations, and that "obesity" is not the sole or even primary risk predictor.

The healthcare burden. With 148 million diabetics and an estimated 35–40 million more in the pre-diabetic range (impaired glucose tolerance), China faces an extraordinary chronic disease management challenge. Diabetes complications — cardiovascular disease, kidney failure, peripheral neuropathy leading to amputations, retinopathy causing blindness — are expensive to treat, generate long-term disability, and are largely preventable with adequate early detection and management. China has invested heavily in diabetes screening programmes and national treatment guidelines, but the sheer scale creates resource pressure.

Source: IDF Diabetes Atlas 11th edition (2025), China country profile. East Asian BMI-diabetes relationship documented in peer-reviewed literature including Diabetes Care journal.

Pakistan: the world's most severe large-nation epidemic

Pakistan's age-standardised diabetes prevalence of 31.4% — nearly 1 in 3 adults — is the highest of any large country in the world. This is not a modelling artefact. Survey-based studies conducted within Pakistan consistently report prevalence rates of 26–33% in adults, with some urban surveys exceeding 40%.

Converging causes. Multiple risk factors operate simultaneously. Pakistan has high rates of overweight and obesity, driven by diets centred on refined wheat, white rice, and sugary beverages. Physical activity is low, particularly for women in conservative regions. The population has a genetic predisposition to insulin resistance at lower BMIs, similar to other South Asian populations. Urban poverty combines caloric excess (cheap processed carbohydrates) with sedentary work in ways that maximise metabolic risk.

The undiagnosed majority. An estimated 230,000 Pakistanis die annually from diabetes-related complications — a figure that almost certainly understates the true toll because cause-of-death reporting quality is limited. More critically, the IDF estimates that the majority of Pakistan's diabetic population remains undiagnosed. Without diagnosis, complications proceed unchecked: kidney disease advances to renal failure, retinopathy advances to blindness, peripheral neuropathy leads to amputations. Pakistan has the world's highest rate of diabetes-related lower-limb amputations.

The sugarcane paradox. Pakistan is one of the world's largest sugarcane producers. Sugar consumption is high and culturally embedded — three to four teaspoons in a cup of tea (chai) is standard practice, and tea is consumed multiple times daily across income levels. Reducing sugar consumption faces both economic resistance (the sugarcane industry employs millions) and cultural resistance (sweet tea is a social ritual). This is not unique to Pakistan — it illustrates the structural difficulty of dietary behaviour change when food environments are shaped by agricultural and trade policy.

Healthcare infrastructure mismatch. Pakistan has approximately one doctor per 1,000 people, compared to three to four per 1,000 in high-income countries. Diabetes management requires regular blood glucose monitoring, medication access (insulin, metformin), dietary counselling, and foot care. These services are heavily concentrated in urban areas, while most Pakistanis live in rural settings with limited primary healthcare access.

The Pacific Islands: a colonial food disaster in numbers

Pacific Island nations collectively hold the world's highest diabetes prevalence rates. Nauru has an estimated 47% adult prevalence — nearly half the adult population. The Marshall Islands, Kiribati, and Tonga all report rates exceeding 35%. These are not statistical anomalies.

The traditional baseline. Pre-colonial Pacific Island diets were characterised by taro, sweet potato, breadfruit, coconut, and fish — high in fibre, complex carbohydrates, and protein, with minimal refined sugars. These populations maintained low rates of metabolic disease.

The colonial food transition. Post-WWII and post-independence food systems in the Pacific were progressively replaced by imported goods: white rice, white flour, tinned corned beef, tinned fish, sugary drinks, and instant noodles. This transition was partly driven by deliberate food aid policies (US surplus agricultural commodities exported to Pacific territories), partly by economic development patterns that reduced traditional subsistence food production.

The result was a population with possible genetic adaptations to cyclical food scarcity (the "thrifty genotype" hypothesis, proposed by geneticist James Neel in 1962 — though its exact mechanisms remain debated) suddenly experiencing constant caloric surplus from low-quality foods. The combination is metabolically catastrophic.

Nauru: the phosphate wealth parable. Nauru became briefly one of the world's highest per-capita income nations in the 1970s–1980s through phosphate mining. With this wealth, Nauruans imported processed food and adopted sedentary lifestyles. When the phosphate ran out in the 1990s, the food habits persisted. Nauru now has a 47% diabetes prevalence rate and essentially no capacity to treat the complications — dialysis for diabetic kidney failure is largely unavailable on-island and requires medically expensive evacuation to New Zealand or Australia.

Source: IDF Diabetes Atlas 11th edition (2025), Pacific region data. Thrifty genotype hypothesis: Neel JV, Am J Hum Genet. 1962;14:353-362.

The Gulf States cluster: wealth and dietary transition

Kuwait (25.4%), Qatar (23.1%), and Saudi Arabia (18.7%) form a cluster of high-income, high-prevalence nations whose diabetes rates reflect a different version of the dietary transition story.

The Gulf States shifted within one generation from nomadic or semi-nomadic traditional diets — dates, camel milk, fish, grains — to some of the world's highest per-capita consumption of ultra-processed food, sweetened beverages, and fast food, accompanied by extremely sedentary urban lifestyles enabled by oil wealth. Air-conditioned malls replaced outdoor activity. Domestic workers replaced manual labour. Government subsidies on food and energy made caloric excess cheap.

This transition happened so rapidly — within 20–30 years — that it outpaced any public health response. Saudi Arabia and Qatar have since invested heavily in diabetes management programmes and public health campaigns, but are fighting against deeply established behavioural norms.

Why 250 million people don't know they have diabetes

One of the most striking findings in the IDF 2025 Atlas is that over 250 million adults globally are unaware they have diabetes. They meet the diagnostic criteria but have never been tested.

Undiagnosed diabetes is not benign waiting-to-be-discovered diabetes. It is diabetes actively causing damage — elevated blood glucose over years raises cardiovascular risk, damages kidneys, destroys retinal blood vessels, and impairs nerve function. By the time many undiagnosed patients are identified, they already have complications that are expensive and often irreversible to treat.

Undiagnosis is highest in low-income countries (where diagnostic testing is limited) but is also substantial in the United States — where 22% of diabetics are estimated to be undiagnosed, concentrated in populations with limited healthcare access.

Can Type 2 diabetes be reversed?

Yes — under specific conditions. The DiRECT trial (2019, UK, published in The Lancet) demonstrated that intensive caloric restriction (an 800 kcal/day liquid diet for 12 weeks, followed by structured reintroduction) produced diabetes remission — normal blood glucose without medication — in 46% of participants at two years. Remission was closely correlated with weight loss: participants who lost 15 kg (33 lbs) or more had an 86% remission rate.

Bariatric surgery (gastric bypass, sleeve gastrectomy) achieves remission in approximately 60–80% of severely obese diabetic patients. The mechanism is not purely weight loss — there appear to be hormonal changes from gut restructuring that independently improve insulin sensitivity.

The phrase "reversal" requires qualification. Remission requires sustaining weight loss, which is the central challenge. For most people, without sustained weight loss maintenance, blood glucose rises again. But the evidence is clear: Type 2 diabetes is not irreversible in the way it was once taught to be.

Source: Lean MEJ et al. "Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial." The Lancet. 2018;391(10120):541-551.

What low-prevalence countries do differently

Sub-Saharan African countries have historically shown lower diabetes rates — reflecting traditional diets with less refined carbohydrate, higher physical activity from agricultural work, and lower obesity rates. However, this is changing rapidly. Nigeria, Kenya, and South Africa are seeing diabetes rates rise as urbanisation accelerates. Rates in Ethiopia, Rwanda, and Uganda remain relatively low, but trend data shows consistent increases.

Japan presents a different case: despite having a relatively high prevalence (8.9%), Japan's diabetes management system — characterised by universal health coverage, frequent health check-ups (annual employer-mandated health screenings catch pre-diabetes early), and a national public health emphasis on dietary modification — produces better outcomes (fewer complications, lower amputation rates) than countries with similar prevalence but weaker management systems.

Frequently asked questions

Q: What is the difference between Type 1 and Type 2 diabetes? A: Type 1 is an autoimmune condition — the immune system destroys insulin-producing cells in the pancreas. It has no known prevention, typically begins in childhood or early adulthood, and requires insulin for survival. Type 2 is a metabolic condition characterised by insulin resistance, strongly associated with lifestyle factors including diet, physical inactivity, and overweight. It accounts for 90–95% of all diabetes globally and is largely preventable — and in early stages, reversible with significant weight loss.

Q: Why does China have more diabetics than any other country? A: China's 148 million diabetics reflect the combination of the world's largest population and a dramatic dietary transition over 40 years — from traditional plant-based diets to Western-influenced food patterns high in refined carbohydrates and processed foods, alongside rapid urbanisation and reduced physical activity. Additionally, East Asian populations develop Type 2 diabetes at lower BMIs than European populations, meaning standard Western obesity thresholds underestimate risk.

Q: Is global diabetes getting better or worse? A: Worse. The IDF 2025 Atlas records 589 million adults with diabetes, up from 537 million in the 2021 edition. The number is projected to reach 853 million by 2050. Progress on prevention has been insufficient to offset the effects of continued urbanisation, dietary change, and population aging.

Q: What is the economic cost of diabetes globally? A: The IDF estimates that diabetes caused at least $1 trillion in global health expenditure in 2024 — a 338% increase over 17 years. This includes direct medical costs (hospitalisations, medications, monitoring) and indirect costs (lost productivity from disability and premature death). The US alone accounts for approximately $413 billion of this — the highest of any country.

Q: Which countries have the lowest diabetes rates? A: Sub-Saharan African countries with traditional diets and high physical activity levels tend to have the lowest rates — countries like Ethiopia, Rwanda, and Uganda report prevalence rates of 3–5%. However, these figures also partly reflect limited diagnostic capacity (undiagnosed diabetes is difficult to measure). Among high-income countries, France (7.1%), Netherlands (6.8%), and South Korea (9.0%) have relatively lower rates.

Q: Can diabetes be prevented? A: Type 2 diabetes is largely preventable. The landmark Diabetes Prevention Program (US, 2002) demonstrated that modest weight loss (5–7% of body weight) and increased physical activity reduced Type 2 diabetes incidence by 58% in high-risk individuals — more effective than metformin drug therapy (31% reduction). Prevention at population scale requires changes to food environments, urban design, and food policy that go well beyond individual behaviour change.

The takeaway

589 million people with diabetes in 2026 represent one of the most foreseeable public health crises in history — driven overwhelmingly by dietary transition, urbanisation, and inactivity patterns that have accelerated since the 1980s. China's 148 million cases are the product of a 40-year dietary revolution. Pakistan's 31.4% prevalence reflects a healthcare system unable to prevent or manage a fast-moving epidemic. The Pacific Islands illustrate what happens when a dietary transition is both rapid and colonial — imposed by external food systems on populations whose metabolic backgrounds made them particularly vulnerable. The solutions are known: diabetes prevention works when applied systematically. The barrier is not knowledge but political will to reshape food environments, pricing, and healthcare access at the scale the problem requires.

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