Tackling childhood obesity is one of our best tools for turning the tide on type 2 diabetes. For many years, paediatric diabetes care largely meant caring for children with type 1 diabetes. This outlook is changing. Rapid urbanisation, sedentary lifestyles and dietary changes are driving an increase in type 2 diabetes among children, a condition once seen only in older adults. Unlike type 1 diabetes, paediatric type 2 diabetes can be prevented.

Growth of type 2 diabetes in youth

Type 2 diabetes in children is also rising rapidly, although comprehensive global data remain limited. South Asia, the Middle East and parts of Africa are seeing increasing numbers of cases, driven by childhood obesity, reduced physical activity and the widespread availability of calorie-dense, nutrient-poor foods. Landmark prevention trials, such as the Finnish Diabetes Prevention Study, the US Diabetes Prevention Program, and the Indian Diabetes Prevention Program, have consistently shown that structured lifestyle interventions can reduce the risk of developing type 2 diabetes by as much as 58%. Although encouraging, these findings underline the need for culturally adapted interventions that address the specific needs of diverse populations.

One of the biggest reasons we are now seeing type 2 diabetes in teenagers – and even younger children – is the surge in childhood obesity. Extra body fat, especially around the abdomen, leads to insulin resistance, which can set the stage for type 2 diabetes.

Paediatric type 2 diabetes is rising worldwide, particularly in LMICs. Hotspots are found in the Pacific Islands, Latin America and among Indigenous youth populations. According to the IDF Diabetes Atlas report on Diabetes among Indigenous Peoples, Indigenous communities such as First Nations youth in Canada and Torres Strait Islander youth in Australia experience some of the highest rates of type 2 diabetes in adolescence, with prevalence climbing sharply during the teenage years.

Understanding the risk factors beyond obesity

Many factors beyond obesity influence type 2 diabetes in children and adolescents, and understanding these risks can contribute to prevention. A strong family history of diabetes is one of the most important predictors. In a major US study of young people with type 2 diabetes, almost 60% had a parent with the condition, and nearly 90% had an affected grandparent. Children exposed to maternal obesity or diabetes in utero have a much higher chance of developing diabetes themselves, often at a younger age and with poorer insulin-producing cell function. Researchers believe this increased risk originates from changes in the way the metabolism is programmed before birth, which can, in turn, create a multi-generational risk.

Early life factors also contribute. Both very low and very high birth weights, as well as preterm birth, are linked to a greater likelihood of type 2 diabetes later in life. Socioeconomic status adds complexity: in high-income countries, children from lower-income families are at increased risk due to barriers to healthy nutrition, safe exercise spaces and healthcare access. This demographic also has a higher incidence of preterm births, thus further increasing a person’s risk of developing type 2 diabetes in childhood or adolescence. In some developing countries, higher-income groups may be more affected due to diets high in processed foods and sedentary lifestyles.

During the COVID‑19 pandemic, diagnoses of type 2 diabetes in young people rose sharply, reflecting weight gain, reduced activity, stress and possibly viral effects on the pancreas. Genetics further shape risk, with studies identifying several key gene variants linked to early‑onset diabetes.

Turning evidence into action for prevention

Although the concept of diabetes prevention dates back to 1921, rigorous diabetes prevention research and clinical trials only gained momentum in the 1990s. Evidence from major prevention trials tells us that making changes to diet and physical activity can reduce the risk by more than half.

As the diabetologist Dr Amit Gupta noted during a symposium session at the IDF World Diabetes Congress 2025, type 2 diabetes is largely preventable, but only if evidence-based interventions are implemented and adapted to reach those most at risk. Addressing these inequities is no longer optional. Every child, no matter where they live, deserves the chance to live a healthy and full life with diabetes.

These two forms of diabetes differ in their causes and management. Yet, they share a critical need for timely diagnosis, appropriate treatment and sustained support to prevent complications later in life and to improve long-term health outcomes.

Managing type 1 diabetes in children typically involves daily insulin treatment, regular blood glucose monitoring, a balanced diet, and regular physical activity. For children with type 2 diabetes, lifestyle interventions focusing on improved nutrition, increased physical activity and weight management form the cornerstone of treatment. When lifestyle measures alone are insufficient, oral medications such as metformin are introduced, and in some cases, insulin may also be required. Co-existing health risks, such as high blood pressure or lipid abnormalities, must also be addressed.

The IDF 2025 session also emphasised that physical activity is at the centre of the prevention and management of type 2 diabetes. Dr Noël Barengo explained that even 30 to 60 minutes of moderate exercise each week helps reduce the risk of diabetes. This practice brings even more benefits when combined with dietary improvements.

Inequities in care across LMICs

However, these treatments are not reaching all who need them. Children in LMICs face profound challenges in accessing even the most basic components of diabetes care. Insulin – declared an essential medicine by the World Health Organization – remains unaffordable for many families, and stockouts are common.

Modern insulins and continuous glucose monitoring (CGM), which improve quality of life and long-term health outcomes, are often unavailable or priced far beyond the reach of most families. In addition, the lack of structured education means many caregivers are left to navigate complex treatment regimens without adequate support. Health systems in these countries often lack trained paediatric endocrinologists, meaning children are frequently managed in general clinics with limited resources and expertise.

Policy gaps further exacerbate these challenges. In many LMICs, paediatric diabetes is not adequately integrated into national non-communicable disease strategies, and universal health coverage rarely extends to insulin, glucose monitoring supplies or specialist care. School-based health programmes that could support early prevention in children at risk are often underdeveloped or absent. This lack of coordinated policy not only limits access to treatment but also increases the social isolation and stigma experienced by children living with diabetes.

In addition, national guidelines on clinical protocols for diabetes management in many LMICs are often poorly aligned with international standards. They can be unclear and do not address the needs of children and adolescents. A systematic review of type 2 diabetes guidelines found that only 18% identified policymakers as a target audience, and few incorporated strategies tailored to paediatric care. Health financing also remains a critical barrier. Although some countries have introduced universal health coverage, these schemes often exclude essential items, such as insulin, glucose monitoring devices, and specialist paediatric services, leaving families to rely on out-of-pocket spending or temporary donor support.

A further gap lies in early detection: UNICEF and NCD Child report that national non-communicable disease and child health strategies frequently omit provisions for school-based screening and community referral systems, thereby undermining opportunities for timely diagnosis and intervention.

Building healthcare systems that work for children

In order to close gaps in paediatric diabetes care, governments should integrate paediatric diabetes into national health strategies, expand financing for essential medicines and technologies, and establish early detection frameworks that bridge health and education sectors. Without such reforms, children in LMICs will continue to face preventable complications and premature mortality from diabetes.

Strengthening primary healthcare systems is the first step to ensure earlier diagnosis and timely referrals. Expanding access to affordable insulin and glucose monitoring technologies must become a priority for governments, with strategies that include bulk procurement, price negotiations and partnerships with non-profit organisations. We have seen improvements when healthcare workers, particularly those in rural or underserved areas, receive training in diagnosis and diabetes management.

Schools are also a factor in raising awareness, supporting affected children and promoting healthy lifestyles to prevent type 2 diabetes. Importantly, lifestyle interventions must be adapted to local contexts, building on the evidence from landmark trials while considering cultural, economic and social realities.

Partnerships and models offering promise

Global and local partnerships have a significant role to play. Programmes such as Life for a Child have demonstrated that providing insulin, education and basic monitoring leads to dramatic improvements in survival and quality of life for children with diabetes in LMICs. The Type 1 Diabetes Index, developed collaboratively by Breakthrough T1D, the International Diabetes Federation, ISPAD, and Life for a Child, is providing critical data to inform advocacy and policy. Community-based advocacy, too, is vital. Reducing stigma, engaging families and creating culturally sensitive education campaigns can empower communities and improve adherence to treatment.

Paediatric diabetes is a growing global health challenge, but it is one we have the tools to address. Insulin access, early diagnosis and structured care should not be privileges enjoyed by a few; they are fundamental rights for all children. Landmark trials have shown that type 2 diabetes is preventable, and type 1 diabetes, when properly treated, does not have to be fatal in childhood. To close the gap, governments, global health agencies and donors must prioritise paediatric diabetes in health planning, ensure universal access to essential medicines and technologies, and invest in education and prevention. The lives and futures of millions of children depend on it.

Intermediate states of hyperglycaemia, also known as prediabetes, is a condition that rarely makes headlines. Yet, it is a warning sign for diabetes. So, what exactly is intermediate hyperglycaemia, and why does it matter? In the early 2000s, the American Diabetes Association introduced the term “prediabetes”. It refers to people whose blood glucose levels are higher than normal but not yet in the range for diabetes, and who typically show no symptoms.

Experts argue that the criteria set by the ADA are too broad, labelling many people as having prediabetes when they may never go on to develop diabetes. Not only is the term unhelpful and unnecessary, but it can also affect a person’s mental health, causing undue stress and anxiety. The World Health Organization (WHO) does not recognise prediabetes as a formal diagnosis, but an intermediary condition. Their preferred term is intermediate hyperglycaemia, which encompasses impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Although they may sound technical, simply put, intermediate hyperglycaemia is higher than normal blood glucose levels, but not high enough to qualify as type 2 diabetes.

Recognising intermediate hyperglycaemia matters because, without intervention, it can progress to type 2 diabetes. Along the way, it increases the likelihood of diabetes-related complications and premature death. The good news is that the condition is also an opportunity. With awareness, lifestyle adjustments, and, where necessary, medical support, people can stop or even reverse its course.

Two sides of the same warning sign

IFG is diagnosed when blood glucose levels are higher than normal after an overnight fast, but not high enough to meet the threshold for diabetes. It highlights difficulties in maintaining glucose control when the body is at rest, particularly in the liver’s ability to regulate glucose output overnight.

IGT, on the other hand, is diagnosed using the oral glucose tolerance test (OGTT), which measures the body’s response to a glucose surge after drinking a glucose solution. People with IGT exhibit higher-than-normal blood glucose levels two hours after this test, indicating that their muscles and other tissues are struggling to absorb and use glucose efficiently.

Some people may have only IFG, some only IGT, and others both. Identifying the type helps healthcare professionals better understand a person’s diabetes risk and the best lifestyle or medical interventions for each situation.

A global challenge hiding in plain sight

According to the International Diabetes Federation (IDF) Diabetes Atlas 11th edition, the prevalence of intermediate hyperglycaemia varies worldwide, ranging from as low as 5.5% in Ireland to over 40% in Nigeria. These variations reflect differences in health systems, screening practices and underlying risk factors. What remains consistent is the sheer number of people affected.

In 2024, more than 1.1 billion adults worldwide were living with IGT or IFG. Both conditions cut across income levels, though patterns differ. IGT is slightly more common in middle-income countries, while IFG rates are highest in high-income regions.

IGT affected around 635 million adults, with the highest prevalence in South-East Asia and the lowest in Europe. IFG was identified in about 488 million adults, most common in North America and the Caribbean.

Looking ahead, the numbers are set to rise sharply. By 2050, projections suggest 846 million people will have IGT and 648 million will have IFG. Together, this means that well over a billion adults – one in eight globally – will be living with these early warning signs of diabetes.

Why some people are more at risk

Intermediate hyperglycaemia arises from a mix of genetic, biological and lifestyle factors. A family history of diabetes increases the likelihood of developing IFG or IGT, but genes alone do not determine a person’s future health. Lifestyle choices play a decisive role in determining who goes on to develop diabetes. Nutrition high in processed foods, refined carbohydrates and sugary drinks, combined with a sedentary lifestyle, contribute to increased glucose levels.

Other health conditions, such as hypertension and high LDL cholesterol, frequently occur alongside IFG or IGT, further increasing the risk of diabetes. Demographics matter as well. Older adults are more likely to develop intermediate hyperglycaemia, and men show slightly higher prevalence than women. Although people of all body sizes can develop the condition, excess body weight further fuels insulin resistance.

Blood tests can tell the full story

The most redoubtable characteristic of the condition is its silence. Most people experience no apparent symptoms. When signs such as increased thirst, frequent urination, fatigue or blurred vision do occur, it usually indicates that type 2 diabetes has already developed. Because of this, blood tests are the only reliable way to detect IFG or IGT.

Diagnostic thresholds are well defined. According to the American Diabetes Association, intermediate hyperglycaemia is identified by fasting plasma glucose levels between 5.6 and 6.9 mmol/L (100 to 125 mg/dL), a two-hour plasma glucose result of 7.8 to 11.0 mmol/L (140 to 199 mg/dL) following an oral glucose tolerance test, or an HbA1c result between 5.7 and 6.4%.

In 2024, the International Diabetes Federation issued a Position Statement recommending the use of the 1-hour post-load plasma glucose (1-h PG) test as a more sensitive and practical tool for detecting intermediate hyperglycaemia and type 2 diabetes in people at risk. The statement proposes validated cut-off points of 155 mg/dL (8.6 mmol/L) for intermediate hyperglycaemia and 209 mg/dL (11.6 mmol/L) for type 2 diabetes, marking an important step towards earlier and more accurate diagnosis.

Each test offers a unique perspective on how the body manages glucose. Fasting plasma glucose reflects overnight control, the oral glucose tolerance test measures how glucose is managed after a meal, and HbA1c provides an average over the past two to three months. Used together, they offer a comprehensive picture of glucose regulation and help identify those most at risk.

The hidden dangers if left untreated

Even though intermediate hyperglycaemia is not yet diabetes, it carries risks. Without changes, many people with IFG or IGT will develop type 2 diabetes within five to ten years. The concern does not end there. The condition is independently associated with higher risks of cardiovascular disease, including heart attack and stroke. Complications involving the kidneys, nerves and eyes can also begin before diabetes is diagnosed. In fact, it is often when a diabetes-related complication appears that diabetes is diagnosed.

The need for early identification and management is therefore urgent, both for individuals and for health systems that are already struggling under the weight of chronic conditions.

Turning the tide: how to stop intermediate hyperglycaemia in its tracks

Intermediate hyperglycaemia can be turned around. Decades of research, including the landmark Diabetes Prevention Program, have demonstrated that lifestyle interventions can reduce the risk of progression to type 2 diabetes by nearly 60%. Even medication, such as metformin, has been shown to minimise the risk by about one-third. However, lifestyle changes remain the cornerstone of prevention.

The most effective strategies are simple but sustained. A healthy and balanced diet that includes whole grains, fruits, vegetables, lean proteins and healthy fats supports healthier glucose control. Regular physical activity — at least 150 minutes of moderate exercise each week — improves insulin sensitivity and helps maintain a healthy weight. For those who are overweight, even a modest weight reduction of 5–7% can have profound benefits.

At the same time, public health efforts that bring screening into daily primary care and community settings support diabetes prevention — especially in low- and middle-income countries, where access to formal healthcare is limited. Raising awareness, reducing stigma, and ensuring safe environments for exercise, as well as access to affordable and healthy food, are equally important in supporting long-term change.

Life between normal and diabetes

Behind every number is a person navigating uncertainty. For someone told they have IFG or IGT, the diagnosis can feel unsettling. It is neither diabetes nor a clear health issue. Nonetheless, with the proper support, it can be empowering. Many people find that small, manageable changes, such as walking daily, preparing meals at home, or reducing sugary drinks, not only improve glucose levels but also bring better energy, sleep, and overall well-being.

Healthcare professionals, advocates, and policymakers all have a role to play in supporting people living with intermediate hyperglycaemia. That begins with language. Blame has no place here. The condition is not a personal failure; it is a signal that the body is under strain and needs support. A person-first, compassionate approach helps individuals feel capable of making changes, rather than overwhelmed by risk.

Intermediate hyperglycaemia is widespread across the world, even though experts do not always agree on its exact definition. What is clear, however, is that these early changes in blood glucose are common and signal an increased risk of developing type 2 diabetes, underscoring the scale of the challenge facing health systems worldwide.

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.

Why diabetes goes undetected for millions

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.”

The cost of a missed diagnosis

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.

Closing the gap with prevention and outreach

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.

Turning knowledge into change

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.

Amid a subtle yet significant shift within diabetes care, continuous glucose monitoring (CGM) is emerging not simply as a tool for managing diabetes but as an aid to diagnose, predict and even prevent the condition. Diabetes remains one of the most underdiagnosed conditions globally. Just over four in ten people living with diabetes are undiagnosed, particularly in low- and middle-income countries. But even in high-resource settings, diagnostic blind spots exist.

CGM could be part of the solution. Unlike traditional methods such as the longstanding oral glucose tolerance test (OGTT)—a somewhat cumbersome and uncomfortable procedure, particularly for children—CGM provides a non-invasive, real-time window into changes in glucose levels over days and weeks. By continuously tracking blood glucose, a CGM device can reveal blood glucose patterns and fluctuations that a one-off test could easily miss. These patterns may not only signal an increased risk of developing diabetes, but—as newer research suggests—also foreshadow broader health complications.

With AI-driven analysis, CGMs can alert users to irregular glucose patterns so they can seek medical advice earlier and potentially reduce frequent medical appointments. When integrated with artificial intelligence and genetic risk profiling, CGM has the potential to transform personalised care and support the development of cellular therapies. In type 1 diabetes, these therapies replace damaged insulin-producing beta cells. CGM technology offers healthcare professionals a more accurate and dynamic method for evaluating transplant outcomes and measuring therapeutic effectiveness.

Given this potential, questions are emerging about whether current clinical thresholds for intervention are too low. As a result, researchers and clinicians are increasingly exploring CGM as a more accessible and potentially earlier diagnostic tool.

Expanding CGM use in diabetes management

In pregnant women, the stakes are even higher. An estimated 1 in 5 live births in 2024 had some form of hyperglycaemia in pregnancy, while 1 in 6 are affected by gestational diabetes (GDM).

Gestational diabetes is often diagnosed late, between 24 and 28 weeks of pregnancy, and carries risks not just for the mother but for foetal brain development. Earlier screening and diagnosis would prompt CGM use as early as the 10th week of pregnancy, potentially bringing life-changing interventions for both mother and child.

At the recent International Diabetes Federation (IDF) World Diabetes Congress 2025, the scientific session “The Future of CGM” explored how CGM is transforming diabetes care—from its emerging role as a diagnostic tool to its impact on diabetes remission, cell therapies, and personalised interventions.

Professor Tadej Battelino of the University Medical Center Ljubljana, Slovenia, spoke of CGM use as a diagnostic tool across type 1, type 2 and gestational diabetes, stressing the potential of AI and machine learning in early detection and tracking disease progression. Professor Battelino advocated for CGM as a first-line option in prenatal care, offering a non-invasive and significantly more comfortable alternative to the traditional, sugar-heavy OGTT used to screen for gestational diabetes.

Among the implications of fluctuating blood glucose are far more troubling findings. A key study from the UK Biobank links glucose variability within the “normal” range to reduced brain volume and cognitive decline in people with type 1 diabetes. In fact, there is a link between changes in glucose patterns and cognitive decline, even in people whose levels are deemed ‘normal’ by current standards. Arguably, the damage begins even before the onset of diabetes.

However, the case for CGM is not merely technological—it is strategic. By pairing CGM data with genetic risk profiles and deploying AI to interpret the findings, clinicians could move from reactive treatment to predictive intervention. Yet this is not simply a matter of better gadgets. It is about redefining how we think about risk, diagnosis and responsibility. If glucose fluctuations harm the brain before diabetes is diagnosed, and if we can track and respond to those fluctuations at home, should we not act sooner?

A window for monitoring and delaying type 1 diabetes

As our understanding of type 1 diabetes grows, there is increasing emphasis on early detection and timely intervention. CGM is entering a new phase in managing the condition and identifying and assessing risk before symptoms appear. In the IDF 2025 scientific session, CGM use in pre-type 1 diabetes, Professor Chantal Mathieu, UZ Leuven, Belgium, explained how a combination of CGM,  with genetic and immune profiling, the analysis of the immune system to understand its role in disease, could help redefine diagnostic criteria and support new strategies for early prevention.

For children newly diagnosed with type 1 diabetes, the traditional model has long prioritised insulin therapy and periodic monitoring via HbA1c levels. However, a wave of new research suggests a subtler picture that paints CGM as a diagnostic tool rather than only a blood glucose management device.

Using CGM data, researchers identified four clusters based on glucose management patterns. They introduced metrics such as “post-hypoglycaemic hyperglycaemia” (PHH)—sugar spikes following low episodes—as powerful indicators of risk or progression of the condition. The findings suggest that this temporary phase of improved glycaemic control—often called ‘remission’ or the ‘honeymoon phase’—is not merely a lucky lull but a metabolic state that is predictable with the right CGM thresholds.

CGM and cell therapies

In the domain of cutting-edge cellular therapies—such as islet cell transplantation and stem cell-derived insulin production—CGM is proving essential. Islet cell transplantation aims to restore natural insulin production in people with type 1 diabetes by using donor pancreas cells. Stem cell-derived insulin production offers a renewable and scalable alternative by generating insulin-producing cells in the lab, eliminating the need for donor organs.

As Professor Camillo Ricordi, University of Miami, USA, noted in his talk at the IDF Congress, CGM now informs not just candidate selection but also the real-time evaluation of graft success and early signs of rejection, allowing for timely clinical interventions.

Traditionally, transplant success was judged by whether a person with diabetes could stop insulin therapy. Now, more granular metrics such as “time-in-tight-range” (TITR) are closely related, more precise metrics than traditional “time-in-range” (TIR). TITR provides a more transparent lens into metabolic function.

CGM has also enabled breakthroughs in identifying candidates for immunosuppression-free autologous islet transplants, a procedure in which a person’s insulin-producing islet cells are harvested and re-implanted without needing immunosuppressive treatments. CGMs provide detailed, real-time insights into glucose patterns that reflect the body’s ability to regulate blood glucose. By doing this, people with the best chances of successful outcomes—and minimal need for lifelong medication—are selected.

When data becomes diagnosis

The use of CGM in early-stage type 2 diabetes is equally transformative. Studies reveal that reliance on HbA1c or fasting glucose alone results in substantial underdiagnosis and misdiagnosis. In one population-level study, over 17% of people with diabetes were not diagnosed using traditional criteria—while others were incorrectly diagnosed with diabetes.

Long periods of high blood glucose—even slightly above normal levels—can be an early warning sign of intermediate hyperglycaemia (prediabetes) or type 2 diabetes. For example, spending more than 8–10% of the day with high blood glucose (above 140 mg/dL). This information, gathered from a CGM, could help healthcare professionals spot early changes in blood glucose before a complete diagnosis, giving people a chance to take action sooner.

Moreover, when combined with genetic risk factors and tests for specific autoimmune markers, CGMs can help build a much more personalised picture of a person’s risk of developing diabetes.

A new map for today’s healthcare

The economic implications are staggering. In many countries, diabetes-related costs account for a significant proportion of national health budgets. In 2024, global health expenditure related to diabetes reached an estimated USD 1.015 trillion, a 338% increase since 2007 and 12% of total global health spending. Estimates suggest that reducing “unhealthy lifespans” by one year globally could save $38 trillion. Such savings would come not only from diabetes prevention but also from a broader reduction in age-related condition, many of which share metabolic pathways with diabetes. The savings could be vast if CGM can help shift the model from reactive care to proactive prevention.

A threshold moment

As global consensus begins to form around CGM-based diagnostics, making the case for widespread adoption becomes harder to ignore. Yet this promising technology is still out of reach for many people with diabetes, particularly in low- and middle-income countries, were three in four of the estimated 589 million people currently living with diabetes reside.

Access to CGM devices remains severely limited due to high costs, inadequate healthcare infrastructure and shortages of trained professionals. Public awareness of early warning signs and prevention is low. In many cases, even basic diagnostic services are inaccessible. Without targeted investment and policy support for universal health coverage (UHC), the promise of CGMs may remain inequitable—delivering cutting-edge benefits to a few while leaving vulnerable populations behind.

Addressing these barriers will require a multi-pronged approach. Public health systems would benefit from bulk procurement and tiered pricing models with CGM manufacturers negotiated through governments and health agencies to reduce costs and improve affordability. Partnerships with non-governmental organisations and private companies could support the development of community-based training programmes to equip local healthcare workers with the skills needed to interpret CGM data and deliver culturally appropriate care. At the same time, investing in mobile health platforms could bridge infrastructure gaps by enabling remote monitoring and virtual consultations. Finally, public awareness campaigns, delivered through trusted community channels, can demystify CGM use and promote early screening, making prevention and proactive care a shared, accessible goal across populations.

The story is indeed changing. The widespread use of CGMs may result in earlier diagnoses, more personalised care and even delayed onset, reshaping clinical guidelines and the expectations of millions affected by or at risk of diabetes. Yet, meaningful progress in CGM-driven detection, prevention and management means ensuring access to this technology for the diabetes community worldwide.

Diabetes registries have emerged as powerful tools that can help transform how healthcare systems provide treatment for people with diabetes. These comprehensive databases serve as the cornerstone for evidence-based decision-making and strategic healthcare planning for diabetes management to help delay and prevent complications.

Medical registries collect information on people with a particular disease, condition or risk factor that could lead to a health-related event. Stakeholders, including healthcare professionals, diabetes advocates and policymakers, can use the information collected for in-patient care, public health, technology assessment and research. Non-communicable diseases, such as diabetes and related complications, have also benefited from patient registries.

Building international registry networks

Evolving from isolated national databases to interconnected international networks, diabetes registries underpin many advancements in global diabetes management. These collaborative platforms transform how healthcare systems collect, share, and use patient data for improved outcomes. The guarantee of interoperability and standards ensures the effective integration of diabetes registries into existing healthcare information systems for seamless data sharing.

Today, there are approximately 500 diabetes registries worldwide, mainly in high-income countries. This gap reinforces the need for registries in low- and middle-income countries (LMICs) and cross-border collaboration and interoperability. Standardising rules and regulations between countries is one solution to ensure interoperability of data collection systems. A prime example is Health Level 7 (HL7) FHIR healthcare standards commonly used for data sharing between digital platforms.

Starting a diabetes registry

The consensus when building a diabetes registry is to start small. One such example is the creation of the National Diabetes Registry (NDR) in Pakistan. Initially a small endeavour to collect real-time data on insulin distribution, in 2006, the registry evolved to include data on people with type 1 diabetes.

Then, in 2016, the registry began including data on people with type 2 diabetes following the publication of figures on the prevalence of the condition in Pakistan. In 2021, the IDF Diabetes Atlas reported 33 million people with diabetes in the country, which led to the development of an NDR in Pakistan. Today, information collected by the national registry informs a national action plan and policies for prevention and standardised clinical care. To ensure the accurate collection and integration of data, every person with diabetes uses their national identity card number to ensure interoperability with all the other national health registries.

The World Health Organization (WHO) selected the national diabetes registry in Pakistan as an example for LMICs. The next phase involves public and private sector stakeholders to develop guidelines for standardising care for use in these countries.

Where registries are most needed

The global diabetes burden is increasing most rapidly in Asia today and is expected to do so in Africa in the future. The disparity in the availability of diabetes registries often leads to late diagnosis and a greater risk of diabetes-related complications, further burdening fragile healthcare systems and extending healthcare budgets.

Figures released by IDF in 2021 indicate that diabetes is projected to grow to affect 1 in 8 adults, approximately 783 million people, by 2045, an increase of 45%. Even more alarming, nearly half of people living with diabetes today are unaware they have the condition. This silent epidemic demands urgent attention from healthcare providers, policymakers and the public.

Diabetes registries and registries for diabetes-related complications can be part of the solution.  More than data repositories, they have the potential to improve patient care, reduce healthcare costs, and ultimately save lives. They also support epidemiological research by identifying trends and informing policy initiatives to improve the well-being of people with diabetes. An estimated 150 examples of registries exist throughout IDF regions, representing an enormous potential to build a harmonised platform for standardised diabetes registries.

iCaReMe — demonstrating how diabetes registries can work

Cardiovascular and kidney disease are the two most common and life-threatening complications of type 2 diabetes. People living with diabetes are up to four times more likely than the general population to develop cardiovascular complications such as heart attack and stroke, and CVD is the leading cause of death in people with diabetes. Furthermore, research from the IDF Diabetes Atlas Report: CKD and Diabetes found that seven in ten people with diabetes were diagnosed with CKD due to an existing complication.

However, global data on prevalence, quality of care and outcomes for people living with these complications are not widely available.

The Integrative Cardiovascular and Renal Metabolic Health Registry, iCaReMe, is one example of how diabetes registries can work. A key component of the IDF Type 2 Diabetes and Cardio-Renal Complications programme, the iCaReMe registry provides global data on the prevalence, quality of care, and outcomes of people living with these complications.

iCaReMe is an international observational study that collects real-world evidence on people with type 2 diabetes and cardio-renal complications. Healthcare professionals can access a cloud-based tool to monitor data and follow up with their patients. The registry data are used to evaluate the quality of care, inform policies and raise awareness of risks associated with cardiovascular disease (CVD) and chronic kidney disease (CKD).

To date, more than 490 healthcare professionals from 30 countries have uploaded data on more than 38,000 people with type 2 diabetes to the iCaReMe registry.

Tapping the power of registries

Diabetes registries have become a powerful component in transforming healthcare delivery. The insights from registry data shape policy decisions, improve treatment outcomes and address healthcare disparities within diverse populations and ethnicities.

The future of diabetes management relies heavily on expanding and strengthening these registry networks. Their success depends on continued technological advancement, international collaboration, and unwavering commitment to data quality. Medical professionals, researchers, and healthcare professionals are aligning to tap the power of registries to combat the growing diabetes burden and ensure better health outcomes for everyone with the condition.

Webinar | How registries can help tackle the global diabetes burden

Learn more about diabetes registries from this online event where experts share best practices for building diabetes registries, tips on starting small and how to avoid interoperability pitfalls. You’ll receive an overview of national diabetes registries and data collection methods. Healthcare professionals will learn the benefits of including data on diabetes-related complications, management plans and quality of care in their clinical practice. Additional learning points for diabetes advocates include leveraging data from registries to build advocacy campaigns for policies on better quality of care, standardised early diagnosis, and prevention of diabetes and diabetes-related complications.

Podcast | Using real-world evidence to tackle the global burden of diabetes and cardiovascular disease

Diabetes and cardiovascular disease, or CVD, are a global public health burden. People living with diabetes are up to four times more likely than the general population to develop cardiovascular complications such as heart attack and stroke. In this episode of D-Talk, host Phyllisa Deroze welcomes Professor Kamlesh Khunti to explore how registries are invaluable for managing and understanding diabetes and cardiovascular disease.

Laura’s* world changed forever when she was diagnosed with type 1 diabetes at just nine years old. Despite her young age, she quickly learned to manage her condition. However, her greatest challenge was the absence of support from her school peers and staff due to a need for diabetes education.

One day, a lack of diabetes awareness led to a devastating turn of events. A fellow student saw Laura with a syringe in the school bathroom, preparing to take her insulin. Uniformed and misinterpreting what she saw, the girl loudly accused Laura of taking drugs, alerting the entire school. Hearing this, school administrators reacted by telling Laura that “injecting insulin in the bathroom would alarm other students” and to use the cubicles instead.

Overwhelmed and feeling utterly alone, Laura left all her belongings and fled home. When she returned from work, Laura’s mother found her body. Aged only 14, she had taken her life.

Although awareness and education about diabetes in schools has become more widespread in recent years, this tragedy is a stark reminder of the ongoing need for greater awareness and school support systems. With rising diabetes prevalence among children and adolescents, educational institutions are increasingly seen as pivotal arenas for fostering understanding and support. However, a global survey by the International Diabetes Federation (IDF) suggests alarming gaps in policies and initiatives for diabetes education within national school curricula.

According to global figures published by the IDF in 2021, 1.2 million children and adolescents live with type 1 diabetes, and 184,100 new cases are diagnosed each year. Although type 1 diabetes is the most common form of diabetes in children and adolescents worldwide, other forms of diabetes also occur, including type 2 diabetes and monogenic diabetes.

*Not her real name.

Current policies and initiatives

Earlier this year, the IDF Kids and Diabetes in Schools (KiDS) programme carried out a global survey among IDF national member associations to identify gaps in diabetes education. Responses were received from 128 IDF Members in 105 countries across all seven IDF regions. The key finding from the survey indicates that only 15% of respondents reported that their country has formal initiatives or policies mandating diabetes education in school curricula. This statistic underscores the need for diabetes education in educational frameworks worldwide.

By mandating diabetes education in schools, administrators and teachers can create a more supportive environment and prevent tragedies like Laura’s.

Why the need for diabetes education in schools

Young people diagnosed with diabetes often face unique challenges, both physically and emotionally. Educational settings can exacerbate these challenges or serve as supportive environments that help children and adolescents confidently manage their condition.

Schools are uniquely positioned to raise awareness about diabetes and promote healthy lifestyle choices to prevent or delay type 2 diabetes. They can also create a supportive and safe environment for students living with diabetes. This means having clear procedures for handling diabetes-related incidents so staff can intervene effectively.

One common request from parents of children with diabetes is that schools employ a nurse or healthcare provider to manage diabetes-related emergencies and provide day-to-day support. A second request is to provide school staff with comprehensive diabetes education. Only 43% of survey respondents reported that their country has policies to educate school staff about diabetes, leaving many educators unprepared to support students.

Barriers to effective implementation

Despite recognising the importance of diabetes education, systemic, educational and societal barriers hinder effective implementation in schools. Limited resources and restrained budgets mean many educational institutions struggle to implement comprehensive diabetes education programmes. While 54% of survey respondents indicated that healthy nutrition education is compulsory in their country, in only half of these countries does it apply to all age groups.

Furthermore, over two-thirds (70%) of survey respondents reported that their country had no initiative or policy requiring diabetes education inclusion in school curricula so that students could receive basic information about diabetes symptoms, hyper and hypo episodes, and blood glucose levels.

This absence of a cohesive national policy can lead to fragmented efforts at the local level, resulting in disparate education and information.

Success stories and best practices

Implementing comprehensive health education programmes is a twofold endeavour. It comprises incorporating diabetes education into health curricula to ensure all students receive foundational knowledge and hosting events for students, parents and staff to promote awareness and understanding of diabetes management and prevention.

In several IDF member countries, innovative programmes integrate diabetes education into school curricula. These programmes often include hands-on workshops with interactive sessions that teach students about diabetes management and healthy living.

One such example is the launch of the KiDS programme in Thailand in June of this year. The kick-off was marked by a one-day ‘Train the Trainers’ workshop for 60 diabetes stakeholders, who learned how to implement the programme in schools. Participants included teachers, healthcare professionals, nurse educators, representatives from the diabetes parents’ network and diabetes advocates.

A different approach was launched in China for children with type 1 diabetes and their parents. A series of half-day summer camps held in hospitals included specialised sessions on navigating the emotional and relational challenges of diabetes in a school environment. These camps are part of a KiDS initiative to partner with national diabetes associations to support families of children with diabetes and reinforce the importance of national policies that address diabetes education and care in schools.

Collaborating with diabetes associations

Partnerships with national and local diabetes associations and advocates can provide schools with educational materials and training programmes for staff.

In Ecuador, IDF Blue Circle Voice (BCV) advocate Roxana Vizcaíno organised a school diabetes education session presenting the different types of diabetes, the symptoms, management and prevention. Her son Sergio, a pupil at the school, shared his story of living with type 1 diabetes to raise awareness of the condition among his peers.

Following these awareness sessions, parents of children with diabetes often find that their children’s classmates become the best “diabetes buddies”. Françoise Georgel, a BCV advocate in Belgium, noticed how her son’s classmates became involved in his glucose monitoring, even checking his levels before sports practice after school.

Advocacy for change

Laura’s mother tried to educate her daughter’s school about diabetes. She provided all the medical reports, prescriptions, and instructions so that Laura could manage her condition during school hours. Her daughter only needed understanding from the school staff and an appropriate place to manage her condition. If the student who interrupted Laura in the school bathroom had received the necessary education, she would have reacted with understanding and compassion, and Laura would still be alive.

As the prevalence of diabetes continues to rise, addressing the gaps in diabetes education within schools is a collective responsibility. Advocating for policy can bridge this gap in diabetes education within schools. Stakeholders, including parents, educators and healthcare professionals, must collaborate to push for comprehensive national policies that mandate diabetes education in schools and training programmes for school administrators and teachers to support students with diabetes.

I recently had the privilege and the opportunity of travelling around the world as one of the three nominees for Director-General of the World Health Organization (WHO). Wherever I went, in addition to presenting my candidature, I utilised the opportunity to visit hospitals, hospices, primary healthcare centres and communities—and everywhere, I found the footprint of diabetes disturbingly present. The official figures are estimated at 425 million adults currently living with diabetes and these estimates are projected to increase to 522 million by 2030. Approximately 200 million women live with diabetes which is projected to rise to 313 million by 2040.¹ I fear this may just be the tip of the iceberg.