Stepping on a carpet nail became the unexpected turning point that led to Andre Brown being diagnosed with type 2 diabetes in 2007 at the age of 55. The carpet nail had left a tiny puncture in Andre’s big toe, which eventually grew and became infected to the point where he was sick and feverish. Worried by the worsening wound, he went to the doctor, who explained that the infection was so advanced his toe would need to be amputated.
Almost as an afterthought, the doctor added that Andre was also living with type 2 diabetes. His blood glucose measured a dangerously high 383 mg/dL (21.3 mmol/l), putting him on the verge of a major cardiac event.
Andre’s story is not unique. Around the world, millions live with diabetes without knowing it, until a health crisis forces diagnosis.
According to the International Diabetes Federation Diabetes Atlas 11th Edition, an estimated 589 million adults aged 20–79 worldwide were living with diabetes in 2024, equivalent to one in nine adults. Over four in ten, approximately 252 million, are unaware of their condition, putting them at risk of serious complications and premature death. This silent pandemic affects populations across all income levels, with underdiagnosis highest in low- and middle-income countries.
Taken together, China, India and Indonesia account for more than half of all people living undiagnosed worldwide. These three countries are also among the most populous and rank in the top five for the total number of people living with diabetes.
Beyond this, the proportion of people living with undiagnosed diabetes varies widely globally. The highest undiagnosed rate is in Africa, where nearly three in four adults with diabetes do not know they are living with the condition. In the Western Pacific, one in two live undiagnosed, and in South-East Asia, around two in five. By contrast, the lowest proportion is in North America and the Caribbean, with less than one in three. People most at risk are those with hypertension, obesity, a family history of diabetes, or those who use tobacco regularly.
Approximately 252 million people are unaware of their condition, putting them at risk of serious complications and premature death
Many factors shape why so many people live with undiagnosed diabetes. Social and economic conditions, the strength of healthcare systems, and levels of awareness among both healthcare professionals and the public all play a role.
Type 2 diabetes, the most common form, often develops slowly. Early signs, such as fatigue, may seem minor and are easily overlooked. Because symptoms are vague and not linked to a chronic condition, many people delay seeking medical advice. For many, they learn of their condition when a diabetes-related complication appears.
Access to care is another barrier. In many low- and middle-income countries, regular screening is limited, particularly for those in rural or remote areas. Even in high-income countries, people without insurance or consistent access to healthcare may go years without a diagnosis. A lack of awareness about risk factors, such as family history, previous gestational diabetes or living with overweight, also means many do not realise they need screening.
In some cultures, stigma around long-term conditions can make it harder to seek help. There may be a limited understanding of diabetes or a hesitation to discuss it openly. As a diabetes advocate, Andre has found that diabetes stigma decreases as education increases, “Once we normalise diabetes, it becomes easier to treat. We’ve got to figure out how we’re going to discuss type 2 diabetes just like we discuss breast cancer and even something as simple as the flu.”
Because symptoms are vague and not linked to a chronic condition, many people delay seeking medical advice
Since his diagnosis, Andre has faced many health challenges. Today, he is visually impaired and legally blind due to retinopathy, a diabetes-related complication. Living with undiagnosed diabetes increases a person’s risk of diabetes-related complications. Without diagnosis and management, chronically high glucose levels damage vital organs, silently affecting the heart, kidneys, eyes and nerves.
The International Diabetes Federation estimates that diabetes directly caused 3.4 million deaths in 2024, with almost 40% occurring in people under 60. Many might have avoided fatal complications had they been diagnosed earlier. In food-insecure populations, high prevalence of undiagnosed diabetes and poor glucose control reflect limited healthcare access, education and follow-up care.
Prevention does not start in a lab. It starts in communities. In many settings, universal health coverage (UHC) is still a goal. But where it exists, it is helping more people get diagnosed earlier—often before symptoms appear. Moreover, promoting healthier lifestyles through public health well-being campaigns that focus on diet, exercise and mental health can help prevent many of these conditions from developing in the first place.
Embedding screening into routine primary care and community life, while also offering checks in workplaces, local clinics or food pantries, can reach people who may not otherwise access formal health services. Tailored approaches are especially important for groups at higher risk, including people with risk factors such as hypertension, obesity, family history or tobacco use.
Alongside screening, public health campaigns that address stigma, increase health literacy, and highlight early symptoms can encourage more people to seek testing. Together, these strategies can close the gap in undiagnosed diabetes and ensure people receive care sooner.
Tailored approaches are especially important for people with risk factors such as hypertension, obesity, family history or tobacco use
Living with undiagnosed diabetes is an avoidable public health burden. The research is clear: targeted screening, newer AI-enabled tools and education campaigns reduce delays in diagnosis. Health systems and policymakers should leverage validated scientific findings to scale early detection, thereby improving individual outcomes, reducing healthcare costs, and mitigating the devastating consequences of unmanaged diabetes.
Andre’s story is a powerful reminder that even the most serious challenges can become turning points. With determination and honesty, he is using his own journey, not just as a cautionary tale, but as a call to action. He does not shy away from being viewed as an extreme example if it helps others take diabetes seriously. His mission now is to reshape how we think about health and wellness, especially for those who feel overwhelmed by a diagnosis.
