MENA’s Health Systems Are Heading Into a Diabetes Storm

The scale of diabetes across the Middle East and North Africa has changed dramatically over the past three decades. Millions more people now require lifelong treatment, complication screening and protection from premature death, while several health systems remain organised primarily around acute care rather than sustained disease management.

That warning emerges from "Diabetes Burden in the Middle East and North Africa Region, 1990–2023: An Ecological Time-Trend Analysis of GBD Estimates," published in the journal Medicina. The study was conducted by Hanane Ouddoud, Judah Israel Ong Lescano, Keith Pardillada Belangoy, Yoshito Nishimura, Ko Harada, Hideharu Hagiya, Quynh Thi Vu, Naohiro Iwata, Tsukasa Higashionna, Tatsuaki Takeda, Yoshito Zamami and Toshihiro Koyama.

Using Global Burden of Disease 2023 estimates for 21 countries, the researchers tracked diabetes incidence, prevalence, mortality and disability between 1990 and 2023. Their findings show not only that the burden grew, but that its demographic profile, risk structure and policy implications changed substantially.

A 33-Year Surge Health Systems Can No Longer Absorb

The number of people living with diabetes in the region rose from 11.7 million in 1990 to 66.6 million in 2023. New cases increased from 640,000 to 3.19 million, deaths rose from 38,100 to 127,200, and disability-adjusted life-years climbed from 1.90 million to 8.02 million.

Some of that increase reflects population growth and ageing, but the underlying risk also worsened. After adjusting for differences in population age structures, incidence rose by 92%, prevalence more than doubled and the diabetes DALY rate increased by 48%. Age-standardised rates indicate whether disease risk is changing; absolute numbers show how much pressure is reaching clinics, pharmacies and hospitals. MENA is experiencing both.

The regional health challenge is therefore no longer limited to preventing new cases. Governments must also finance decades of glucose monitoring, medication, kidney and eye screening, cardiovascular risk management, foot care and treatment for complications.

Diabetes requires continuous care rather than a one-time intervention. A patient diagnosed in middle age may need medical support for decades. As prevalence rises faster than health-system capacity, missed appointments, medicine shortages and delayed complication screening can convert manageable disease into blindness, renal failure, amputation and early death.

The figures also expose the limitations of measuring progress mainly through mortality. A country can reduce deaths while accumulating a large population living with disability. Lebanon, for example, recorded the lowest age-standardised mortality among the highlighted countries in 2023, but had the region's highest share of diabetes DALYs driven by disability.

Survival is essential, but survival without effective chronic-care systems can produce a growing burden of illness, household expenditure and lost productivity.

The Burden Is Moving and Younger Men Are Now in the Firing Line

In 1990, women had higher DALY rates across most adult age groups. By 2023, men carried the higher burden in most groups from age 15 onwards, although women remained more affected in several of the oldest age groups.

The change was particularly sharp among younger adults. Diabetes DALY rates increased by 133% among men aged 15 to 39, compared with 83% among women in the same age range. Among adults aged 55 and above, male rates rose by 70% to 84%, while female increases ranged from 9% to 34%.

The shift should force a rethink of regional prevention strategies. Diabetes is often framed as a disease of older age, obesity or family history. The evidence now points to rapidly accumulating risk among working-age men.

Higher tobacco use among men, increasing adiposity and less active urban lifestyles may contribute, although the study cannot establish individual causes. The policy implication is nevertheless clear: screening and prevention programmes that reach people only after complications emerge will miss a growing high-risk population.

Workplaces, universities, transport systems and primary-care centres could become important points of intervention. Prevention messages also need to move beyond generic appeals to exercise and eat better. They must address the environments in which younger adults make daily choices: long working hours, sedentary occupations, tobacco availability, inexpensive processed food and cities designed around cars rather than safe walking.

Children under 15 were the only group to record declining DALY rates, falling by 57% among girls and 52% among boys. The authors suggest that improved diagnosis and insulin access may have helped, although the study's combined diabetes category prevents a definitive distinction between type 1 and type 2 disease.

Clinical improvements may be reducing childhood burden, while broader social and economic conditions are driving greater disease among adults.

Obesity Is the Lead Driver, but the Crisis Is Bigger Than Lifestyle

High body-mass index was the leading modifiable contributor to diabetes-related DALYs in every country studied. The attributable rate ranged from 524 per 100,000 in Yemen to 2,208 in Bahrain. However, reducing the crisis to obesity would be a policy mistake.

Particulate-matter pollution ranked as the second-largest contributor across all 21 countries, accounting for between 187 and 606 DALYs per 100,000. Smoking imposed a substantial burden in several countries, while dietary risks were also prominent. These findings recast diabetes as a product of systems, not merely individual behaviour.

Food prices and marketing affect what households eat. Urban planning shapes whether people can walk safely. Heat can restrict outdoor activity. Tobacco policy influences exposure. Air quality affects metabolic risk. Employment conditions determine how much time people have for exercise, medical appointments and food preparation.

The region's diabetes response thus belongs as much to finance, agriculture, trade, transport and environmental ministries as it does to health departments.

Taxes on sugar-sweetened beverages can reduce consumption, but they need to be accompanied by affordable healthy foods, clear labelling, school nutrition standards and restrictions on aggressive marketing. Saudi Arabia and the United Arab Emirates introduced sugary-drink taxes in 2017, offering a regional example of fiscal action, though such measures cannot substitute for a comprehensive prevention strategy.

Air pollution deserves far greater attention. In several countries, pollution-attributable diabetes burden exceeded that associated with tobacco. Cleaner transport, stronger industrial-emissions controls and better urban air monitoring should therefore be recognised as diabetes interventions as well as environmental policies.

Why Policy Must Abandon the One-Size-Fits-All Model

The study documents enormous differences between countries. In 2023, diabetes DALY rates varied 3.6-fold, from approximately 974 per 100,000 in Yemen to 3,461 in Bahrain. Saudi Arabia recorded the highest incidence rate, while Lebanon had the lowest mortality rate among the selected country comparisons.

These differences reflect differences in urbanisation, diet, obesity, smoking, healthcare capacity, age structure and conflict exposure. They also show why a single MENA strategy will not work.

Countries with disability-heavy burdens need strong long-term care: retinal and renal screening, foot services, self-management support and affordable medicines. Countries where premature mortality is more prominent require earlier diagnosis, reliable treatment and better management of cardiovascular and acute complications.

Conflict-affected states face a more basic challenge. In Afghanistan, Libya, Palestine, Sudan, Syria and Yemen, weak registries, population displacement and disrupted services make both surveillance and continuity of treatment difficult. The immediate priority may be maintaining insulin supplies, simple diagnostics and portable records rather than deploying sophisticated digital-health systems.

Recent trends add another layer of urgency. Incidence rose faster after 2019 in 15 of the 21 countries, while Türkiye, the UAE, Tunisia, Yemen, Lebanon and Algeria recorded higher post-2019 DALY trends with non-overlapping confidence intervals.

These changes may reflect pandemic-era service disruptions, reduced physical activity, delayed diagnosis, rebound detection or biological effects associated with COVID-19. But the evidence is not sufficient to establish causation. The post-2019 period contains only four to five data points, and the comparisons were exploratory.

The study cautions that it uses modelled GBD estimates rather than direct national registry counts, and uncertainty is greater in countries where underlying data are sparse. Its ecological design cannot determine individual causes, distinguish subnational inequalities or fully separate type 1 from type 2 diabetes.

Despite the limitations, the scale and persistence of the surge leave little room for complacency. Diabetes is emerging as a long-term structural pressure on MENA's economies and health systems, threatening to raise public costs, reduce workforce participation, deepen household vulnerability and widen existing inequalities.