Global Diabetes: Rapidly Changing Landscape and a Rising Tide of Opportunities: The 2025 Distinguished International Service in the Cause of Diabetes Award Lecture

Diabetes affects an estimated 828 million people worldwide; prevalence is growing rapidly in low- and middle-income countries (LMICs), with major health and development consequences. Diabetes-related complications and mortality rates have declined across several high-income countries (HICs), largely through structured chronic disease care, sustained implementation of quality improvement strategies, and active risk factor control. However, rates of diabetes complications and mortality have been rising in LMICs. Along with evidence there are tools (e.g., teams, task shifting, data systems, decision-support mechanisms, etc.) for translating the gains in HICs to LMICs. Lessons from global collaborations in vaccines and antiretroviral therapy, especially in innovative ways of leveraging infrastructure, and lowering costs of therapeutics, can be applied to diabetes prevention and control. Furthermore, the following are several transformational opportunities that, if leveraged, can propel global diabetes prevention and control: 1) increasing recognition of diabetes heterogeneity and the differences in the frequency of diabetes subtypes in LMICs; 2) growth in therapeutics and technologies (e.g., mobile health [mHealth], telemedicine, artificial intelligence), which can help overcome infrastructural constraints and stimulate innovative models of prevention care; and 3) sustained economic growth across several LMICs, which offers possibilities of investment in health and data infrastructure and in research and development. Importantly, while ∼80% of the diabetes burden is in LMICs, >95% of diabetes-related research occurs in populations residing in HICs. This burden-knowledge gap is a major source of health inequity that must be strategically addressed to effectively prevent and control diabetes globally.