MASLD and type 2 diabetes: a multisystem disease

The interaction between these two conditions is cyclic. First, fat builds up in the liver. Over time, this causes inflammation and liver damage. At the same time, MASLD can worsen insulin resistance. This creates a feedback loop that makes type 2 diabetes harder to manage. Because the two conditions interact, treating them together can lead to better outcomes.

MASLD and type 2 diabetes together threaten multiple organs, not just the liver. Research shows that MASLD sharply increases the risk of cardiovascular disease and chronic kidney disease, two of the most common diabetes-related complications.

Additionally, type 2 diabetes accelerates liver scarring (fibrosis). In fibrosis, healthy liver tissue is replaced by scar tissue. Over time, this can turn into cirrhosis or liver failure.

Why MASLD and type 2 diabetes often go undiagnosed

When MASLD develops, it is often asymptomatic, making early detection challenging. Many living with type 2 diabetes are unaware of liver complications. In low-resource settings, the risk is even greater: several additional barriers severely limit the ability to diagnose. Access to imaging tools, such as ultrasound, is often restricted, and healthcare providers’ awareness may be limited.

The financial burden of healthcare also makes it hard to get tests. At the same time, health systems often prioritise infectious diseases. As a result, MASLD and type 2 diabetes are usually treated separately, which can delay optimal care.

A growing global challenge with unequal impact

As mentioned MASLD and type 2 diabetes are both rising worldwide. However, LMICS are facing the most rapid escalation. This challenge is driven by several interconnected factors: urbanisation, unhealthy nutrition and reduced physical activity. Meanwhile, healthcare systems are under mounting pressure from competing demands. As a result, people with chronic conditions such as MASLD often go undetected.

The Middle East and North Africa Region has seen the highest increase in MASLD with an estimated 141 million people in the region affected, and about 25 million people living with MASLD and type 2 diabetes. Furthermore, underreporting in these countries limits the accuracy of prevalence estimates and differences in diagnostic methods make comparisons difficult. Long-term data are also limited in several regions, particularly in Africa. These regions already bear the brunt of the global diabetes burden – around 75% of all cases – intensifying the risk of liver disease.

Screening for MASLD and type 2 diabetes

We know that the timely detection of MASLD and type 2 diabetes complications requires practical, scalable approaches. Practical solutions include stepwise screening models that begin with simple risk scores derived from routine clinical data. When used promptly, they can identify individuals at higher risk of liver fibrosis.

Following this, an ultrasound can detect fat accumulation in the liver. Where available, elastography can assess the severity of fibrosis. This structured approach reduces reliance on expensive or invasive procedures. Furthermore, studies from countries such as India and China show that screening within diabetes clinics is effective. Therefore, integrating liver assessment into routine diabetes care offers a realistic solution.

Treatment options for MASLD and type 2 diabetes

Currently, no single medication targets MASLD. However, some diabetes treatments improve liver health. GLP-1 receptor agonists can reduce liver fat, improve glucose management and also help with weight management.

SGLT2 inhibitors also improve insulin resistance and reduce liver fat. Pioglitazone is a less expensive option but may cause weight gain, which can limit its use. New treatments, such as FXR agonists, show promise for treating liver fibrosis. Nonetheless, the cost limits their accessibility in low-resource countries.

Prevention strategies for MASLD and type 2 diabetes

Prevention remains a key part of managing MASLD and type 2 diabetes. Lifestyle improvements, such as dietary changes, increased physical activity, and better blood glucose control, can reduce liver fat and slow progression. Importantly, these strategies must be deployed without delay and tailored to every cultural and economic context. They remain a lifeline, even where healthcare resources are strained. While new therapies continue to emerge, they remain out of reach for many who need them most, underscring the need for policies to tackel these sharp inequalities to prevent needless suffering and deaths worldwide.

Time to integrate care for better outcomes

MASLD and type 2 diabetes should be addressed through a more integrated approach to care, with liver health becoming part of routine diabetes management. At the same time, healthcare providers require training to recognise and manage MASLD effectively. Expanding access to affordable screening tools will support earlier diagnosis.

Policies that improve access to care are of the solution, while immediate investment in prevention and treatment can help reduce long-term complications.  Addressing MASLD and type 2 diabetes together is an opportunity to improve outcomes and tackle health inequalities worldwide.

When a child is diagnosed with type 1 diabetes, life changes instantly. Daily insulin injections, blood glucose monitoring, carbohydrate counting, and constant vigilance become part of childhood. For economically disadvantaged families or those facing crisis, these demands can feel overwhelming. For these families, diabetes camps not only provide an escape from daily routines and a chance to relax but also give a lifeline.

For many years, the diabetes community has recognised diabetes camps as powerful spaces where children and adolescents living with type 1 diabetes gain confidence, knowledge and peer support. We know that camps can improve diabetes self-management, glycaemic outcomes and quality of life. Yet access to these opportunities is often shaped by socioeconomic realities. When families cannot afford fees, transport or time away from work, children are excluded from experiences that could strengthen their health and their sense of belonging.

In Türkiye, one paediatric diabetes centre has taken on the challenge of addressing this inequity. Established in 2007, the centre began organising diabetes camps in 2010. To date, they have hosted more than 50 camps, welcoming between 40 and 115 children at each session. The camps have lasted one to six nights, focusing on children and adolescents living in socially and economically disadvantaged environments.

Helping families fill the gap

Organising a diabetes camp is costly. Accommodation, meals, educational materials, sports equipment, medical supplies and transport all require funding. In many countries, families are expected to pay fees, though partial sponsorship may be available. For low-income families, even reduced fees can be out of reach.

According to estimates released by the International Diabetes Federation in 2025, in Türkiye, approximately 195,853 people across all age groups live with type 1 diabetes, including around 46,786 children and adolescents.

With this in mind, the centre decided to offer campers the opportunity to attend camps at almost no cost. The centre reduced costs by using public facilities, including those of Düzce University, the Turkish Red Crescent, the Turkish Diabetes Foundation, and the Ministry of Youth and Sports. Sometimes, municipal scout camps were used. When they could not find available public facilities, they rented hotels. Any additional expenses were covered by donations and support from affiliated associations.

The Turkish Red Crescent’s contribution was particularly significant. Over four years, eight camps were held at the Red Crescent Youth Camp on Heybeliada in Istanbul, with all expenses covered. Professional teams delivered educational, scouting, sports and recreational fun alongside diabetes education. For many children, this was their first time they experienced a structured camp environment where their health needs were understood and supported.

For children living with type 1 diabetes, being surrounded by peers who also check glucose levels and take insulin can be transformative. The burden of feeling “different” diminishes. Conversations about hypoglycaemia, insulin doses, or diabetes management at school become normal. In financially strained households, where families may struggle to access up-to-date education or psychosocial support, these shared experiences are especially valuable.

Overcoming transport barriers

Geography can be as limiting as finances. The centre provides care to around 1,400 children and adolescents living with diabetes across its province and seven neighbouring provinces. When camps were initially offered in nearby regions, children living farther away often lacked access.

In 2025, a new approach was introduced. A camp was first organised in Kula (Manisa), followed by three simultaneous camps in Kırkağaç (Manisa), Afyon, and Karabük, using youth camp facilities from the Ministry of Youth and Sports. Around 230 children and adolescents participated, including young people from provinces further afield.

This decentralised model illustrates an important lesson for diabetes services globally. Access is not only about funding – it is about proximity, infrastructure and intentional outreach. By bringing camps closer to children rather than expecting children to travel long distances, the programme reduced inequalities. For families who might not be able to afford extended travel or who worry about sending their child far from home, localised camps make attendance easier.

The disaster of the century

In February 2023, two devastating earthquakes, centred in Kahramanmaraş, struck Türkiye. More than 55,000 people lost their lives, and millions were left homeless. For children living with type 1 diabetes, natural disasters pose immediate and ongoing risks, such as compromised insulin storage, lost glucose monitoring supplies and interrupted access to healthcare. Psychological trauma adds to the daily challenges of diabetes management.

In the summer following the earthquake, around 60 children attended a five-day diabetes camp co-organised with local authorities in Kahramanmaraş. Children from neighbouring earthquake-affected provinces were also to attend. The camp had strong government support, reflecting a shared understanding that recovery is about more than treatment – it’s also about rebuilding confidence, connection and well-being.

In 2024, the Turkish Diabetes Foundation hosted the camp and covered all costs for children from Hatay, one of the hardest-hit provinces. They spent five days at a camp in Istanbul alongside children from Düzce, who had experienced earthquakes in 1999 and 2022.

Bringing together children who have lived through different disasters creates a unique form of solidarity. Beyond diabetes education, these camps offer a space to process trauma, rebuild routines and re-establish a sense of safety. For children living with a chronic condition, restoring predictability and peer connection can be as vital as restoring physical infrastructure.

Continuing through a pandemic

The COVID-19 pandemic presented another form of deprivation. Lockdowns, quarantine measures and fear of infection disrupted routine care. Families were advised to avoid hospital visits unless in an emergency. Follow-up appointments shifted to telephone and telemedicine.

During 2020 and 2021, two mini-camps were organised as family, child, and youth camps, each lasting two evenings and operating under strict safety measures. In 2022, five longer camps were held. Notably, the centre reports that it was the only institution to continue organising camps during the pandemic, with no consequences recorded.

For many families, isolation during the pandemic intensified anxiety. Children living with type 1 diabetes often faced additional fears about vulnerability to infection. Camps provided carefully managed opportunities to reconnect and learn in a time when many support systems were disrupted.

Measurable and meaningful benefits

The benefits of diabetes camps are now widely recognised. Structured education, supervised practice and peer learning can improve self-management skills and confidence. Psychosocial gains, including reduced feelings of isolation and increased self-esteem, are also well documented.

In this centre’s experience, participation in camps was associated with improved blood glucose levels. Children who attended camps demonstrated better glycaemic management than their peers who did not attend. As a member of the international SWEET network, the centre reports HbA1c levels twice yearly and has observed a steady decline in average HbA1c over time, with camps contributing to this improvement.

HbA1c, a measure of average blood glucose over approximately three months, is an important indicator of long-term diabetes management. While many factors influence HbA1c, including access to technology and medical care, educational and psychosocial interventions play a crucial role. Camps create immersive learning environments where children can practise adjusting insulin doses, understand carbohydrate counting in real-life settings and learn to recognise and treat hypoglycaemia safely.

Feedback from children and families is described as deeply moving. For parents, seeing their child manage diabetes independently, even for a few days, can restore confidence. For children, realising they are not alone can reduce the silent burden many carry.

The benefits extend beyond participants. Media coverage of camps has increased public awareness of diabetes and encouraged greater engagement from government and public institutions. Healthcare professionals involved in the camps report improved motivation and valuable professional development. In resource-constrained settings, renewed staff commitment can have a lasting impact on service quality.

Lessons for global diabetes care

This experience highlights several lessons relevant to policymakers, healthcare professionals and advocates worldwide.

First, equity must be intentional. If camps rely solely on participant fees, children living in poverty will remain excluded. Partnerships with public institutions, non-governmental organisations and community donors can make inclusion possible.

Second, access must be geographically responsive. Delivering programmes closer to where children live reduces hidden costs and practical barriers.

Third, crisis contexts require adaptive responses. Whether facing natural disasters or pandemics, continuity of psychosocial and educational support for children living with type 1 diabetes is essential. Health systems must plan not only for insulin supply, but also for emotional resilience.

Finally, camps are not luxuries. Under conditions of deprivation, they become protective interventions. In environments where children may feel isolated, stigmatised or overwhelmed, camps offer solidarity, skill-building and hope.

For the more than nine million people worldwide living with type 1 diabetes, and particularly for children growing up in low-resource settings or crisis, comprehensive care must extend beyond clinic walls. Diabetes camps, when designed with equity at their core, can help ensure that no child is left to navigate this lifelong condition alone.

We thank Ilknur Arslanoglu, Professor in Pediatric Endocrinology, Duzce University, Türkiye, for submitting the content that informed this article.

Lucia grew up with a story her grandmother rarely told without tears. Her grandmother lost her only son in his early twenties. The official cause was kidney failure. He had been young, strong, and seemingly healthy. At the time, the medical community considered type 1 diabetes as a condition that only affected children. No one imagined it could appear in a young adult, so he wasn’t tested for it. In fact, he had been living with undiagnosed type 1 diabetes. The condition progressed silently until fatal complications developed.

When type 1 diabetes is missed or misdiagnosed

Mistaking type 1 diabetes for type 2 in adults is partially rooted in assumptions. Because type 2 is far more common later in life, elevated glucose levels are often attributed to insulin resistance rather than to the autoimmune destruction of insulin-producing beta cells. In fact, some adults diagnosed with type 2 diabetes may have an autoimmune form of the condition, including latent autoimmune diabetes in adults (LADA).

This can lead to serious consequences: delays in starting insulin therapy, an increased risk of diabetic ketoacidosis (DKA) and avoidable complications. Studies suggest the problem is far from rare. Even in high-income countries, many children and young people are diagnosed with type 1 diabetes only when they are already in DKA. In the United Kingdom, around 26% of children are diagnosed with DKA. This rises to 38–45% in children under five, according to the National Paediatric Diabetes Audit.

DKA is largely preventable with earlier recognition of symptoms and prompt blood glucose testing. Monitoring programmes for children identified as being at higher risk of type 1 diabetes have shown that DKA rates at diagnosis can be dramatically reduced when families are educated and supported.

Why early type 1 diabetes diagnosis saves lives

Years later, when Lucia was just ten, she began drinking water constantly. She woke up at night, thirsty and needing to use the bathroom repeatedly. Her grandmother recognised the signs immediately -memories of her son’s undiagnosed diabetes were still vivid. Thanks to early screening Lucia was diagnosed and received timely treatment.

Type 1 diabetes is an autoimmune condition in which the immune system destroys insulin-producing cells, requiring lifelong insulin therapy. Although often seen as a childhood condition, more than half of new cases occur in adults. The condition develops in stages. Long before symptoms appear, the immune system begins producing islet autoantibodies, detectable months or even years before insulin is required. The risk of progression depends on the number of autoantibodies present, age at detection and genetic background.

The staging model of type 1 diabetes defines stage 1 as the presence of two or more islet autoantibodies with normal glucose levels, stage 2 as two or more autoantibodies plus abnormal glucose levels without symptoms, and stage 3 as symptomatic type 1 diabetes.

Screening for type 1 diabetes: promise and practical limits

Screening for islet autoantibodies identifies people at risk before symptoms develop. This allows closer monitoring, earlier insulin initiation and, most importantly, prevention of DKA. However, universal population screening is costly and logistically challenging, particularly in low- and middle-income countries (LMICs).

Targeted screening of higher-risk groups, such as first-degree relatives, is more feasible. Yet around 90% of those diagnosed have no known family history. This situation underscores the importance of broader awareness and accessible testing. Pilot programmes are assessing cost-effectiveness, psychological well-being and long-term outcomes. Digital health systems are emerging as important tools.

The emotional impact of knowing your risk

At 13, Anita developed constant thirst, frequent urination, weight loss and fatigue. In 1997, she was diagnosed in an Indonesian hospital with “diabetes,” but no one clearly explained the type. Doctors recommended insulin, but her parents were hoping for traditional alternatives and initially declined the treatment.

Anita’s condition quickly worsened, and she was later hospitalised in critical condition before finally starting insulin. Even then, she lived for years without a clear diagnosis. It was only in college, after C-peptide testing confirmed her pancreas was not producing insulin, that she learned she was living with type 1 diabetes. She finally received long-overdue clarity about her condition.

Screening is not only clinical but also emotional. Learning that a child or adult has islet autoantibodies can bring anxiety and uncertainty. Psychosocial support and peer networks must be essential parts of screening programmes. Dating back to 2013, evidence from cohort studies suggests that when families are well educated and supported, the benefits of avoiding DKA and preparing for insulin therapy outweigh the stress associated with knowing one’s risk.

Delaying onset: new advances in disease-modifying therapies

In 2022, US regulators approved teplizumab, marking a turning point in efforts to alter the course of type 1 diabetes. This immune-modulating therapy is designed to delay the progression from stage 2 to stage 3, the point at which symptoms become clinically apparent, while preserving the body’s remaining insulin production.

The following year, the European Commission authorised teplizumab for people with stage 2 type 1 diabetes. What’s more, clinical trials suggest that a single course of treatment may delay the onset by approximately 2 years. This delay can provide valuable time, reduce DKA risk at diagnosis and allow families to prepare. However, high cost and limited availability mean access remains restricted in many LMICs.

Listening to lived experience

Behind every statistic is a person and a family. In Nkiruka’s family, type 1 diabetes has appeared in every generation on her mother’s side, reaching her as the fifth. Determined to act early, she had her two children tested for diabetes-related autoantibodies. When results showed they had a genetic predisposition, she began regularly monitoring their blood glucose, watching for symptoms like unusual thirst or unexplained weight loss.

Public awareness campaigns, school education and community partnerships can improve recognition of type 1 diabetes symptoms and reduce stigma. Some countries are embedding testing guidance into national health systems, though experts emphasise assessment based on symptom clusters and clinical judgement rather than rigid mandates. Ongoing training for healthcare professionals and stronger global collaboration between organisations such as the International Diabetes Federation (IDF), the International Society for Pediatric and Adolescent Diabetes (ISPAD), the World Health Organization (WHO) and UNICEF are also essential to ensure consistent, age-inclusive diagnosis and care.

Nkiruka discovered the ELSA (EarLy Surveillance for Autoimmune diabetes) study through Facebook. The process was simple: an online consent form, a finger-prick test sent by post, and results within weeks, followed by supportive check-ins. Yet screening like this remains limited to research studies in the UK. For Nkiruka, early detection is not optional – it prevents hospitalisation, reduces trauma and gives families something priceless: time and hope.

Early detection, lifelong impact

There is a growing global consensus on the way forward,  but behind every policy recommendation is a person. Lucia’s early diagnosis was possible because her grandmother recognised the signs that had previously been missed. Anita navigated misdiagnosis and delayed insulin treatment. Nkiruka chose screening for her children to prevent late diagnosis. Their experiences reflect both the cost of delay and the power of early action.

Ensuring universal access to insulin and essential care must remain the priority. At the same time, improving timely and accurate diagnosis across all ages, expanding targeted screening and digital follow-up, investing in equitable research, and strengthening awareness are essential actions. Early detection and modifying therapies are important advances, but they must be grounded in strong, inclusive health systems that guarantee care for every person living with type 1 diabetes.

IDF and ISPAD have produced a policy brief – Detect Early, Act Early: Improving Diagnosis of Type 1 Diabetes – that urges stronger global action to improve early diagnosis of type 1 diabetes. With over 9 million people living with type 1 diabetes worldwide and the majority of new cases occurring in adults, better awareness and accurate diagnosis are critical. The policy brief demonstrates the role of islet autoantibody screening in identifying risk before symptoms appear and notes emerging therapies that may delay progression. It calls for expanded access to insulin, diagnostics, education, and universal health coverage to reduce preventable deaths and inequities. Learn more and download.

This online event hosted by the International Diabetes Federation (IDF) highlights the role of islet autoantibody screening to identify people at risk of type 1 diabetes years before symptoms appear. The expert panel outlines evidence-based strategies to improve early diagnosis, reduce diabetic ketoacidosis, and promote prevention-focused approaches globally.

Universal health coverage (UHC) rests on a simple yet powerful idea: everyone should be able to access the healthcare they need without falling into financial hardship. For the close to 600 million people worldwide living with diabetes, and the millions at risk of developing the condition, this principle is not abstract. It is a matter of daily survival.

Diabetes care is not a one-off diagnosis or a single prescription. Treatment involves regular access to insulin, blood glucose monitoring, education, and the care of trained healthcare professionals, along with regular follow-up to prevent or delay diabetes-related complications. When any one of these elements is missing, the consequences can be swift and devastating.

As Emma Klatman, global policy and advocacy manager at Life for a Child, puts it: “Type 1 diabetes is survivable everywhere, but not everywhere is survival guaranteed.” In too many countries, children and young people never get the chance to “get started in life” because the systems designed to support them simply are not there.

Access is more than insulin

In addition to early diagnosis and prevention, the global debate around diabetes has also focused on insulin affordability, and rightly so. But Klatman argues that this focus often obscures a deeper problem. “Insulin without monitoring is unsafe,” she says.

In low- and middle-income countries (LMICs), blood glucose test strips, HbA1c testing, education and workforce support are all essential, yet they are frequently unavailable or unaffordable. Families may have access to insulin but no way to measure blood glucose safely. Without test strips, using insulin becomes a matter of guesswork. According to Klatman, that this is not a technical failure but a systemic one.

Universal health coverage, when implemented effectively, addresses this gap by embedding diabetes care into health systems rather than treating it as an individual burden. Thailand offers a striking example. Since introducing UHC in 2002, the country has ensured that people living with diabetes can access regular check-ups, essential medicines and monitoring tools. For Khun Ni, a 26-year-old with type 1 diabetes, this has meant managing her condition while caring for her newborn daughter. For Sip, a schoolboy, it has meant coordinated care between his family and school, ensuring timely responses to episodes of low blood glucose.

Coverage gaps hide in plain sight

Yet access alone is not enough. What health systems choose to cover, and who they include, matters just as much. Klatman points to a troubling lack of transparency: in many countries, it is simply unclear what components of diabetes care are included in national health benefit packages.

“We don’t even know what’s being provided in most LMICs,” she says. While global tools such as the Diabetes Atlas count cases and deaths, they often fail to capture whether people are receiving human insulin or analogue insulin, whether diagnostics are included, or how much people with diabetes must pay out of pocket.

The absence of data brings consequences. Long-acting analogue insulins, which are considered routine in high-income countries, can sometimes be dismissed as a “luxury” elsewhere. Klatman challenges that framing. Analogue insulins have existed for more than two decades; what makes them inaccessible is not clinical uncertainty, but policy decisions. “Why should a young person in Zimbabwe be denied what is routinely provided in Sydney?” she asks.

Life for a Child has worked to close this information gap by building a global equity repository that compares health system provision of diabetes care. The goal is to make coverage gaps visible, and therefore harder to ignore.

The crushing weight of out-of-pocket costs

As of 2021, about 4.5 billion people, more than half of the world’s population, were not fully covered for essential health services. If access and coverage define whether care exists, financial protection determines whether people can actually use it. Here, the failures of non-universal systems become clearly apparent.

In Germany, public insurance caps out-of-pocket costs for chronic conditions at 1% of household income. Katie West, an American living with type 1 diabetes, was paying roughly $11 every three months for insulin, compared with 70 USD per month in the US, even with good insurance. That financial security was life-changing.

The absence of such protection can be fatal. In the US, 26-year-old Alec Raeshawn Smith died after rationing insulin he could no longer afford once he aged out of his mother’s insurance plan. His monthly costs exceeded 1,300 USD. He is far from alone: one in six insulin users in the US report rationing due to cost.

Klatman argues that test strips are an even greater, if less visible, financial threat. In many countries, even two test strips a day can consume a family’s entire income. “Test strips often cost more than insulin,” she says, “yet they are almost never provided by governments.”

UHC shifts this burden away from individuals and towards collective systems. Where early diagnosis, routine monitoring and follow-up are embedded into public care, people are less likely to experience catastrophic health spending and more likely to stay alive.

Long-term investment, not short-term savings

Critics of expanding diabetes benefits under UHC often cite cost. Klatman acknowledges that long-acting analogue insulins do cost more upfront. But she warns against short-term thinking. Evidence from programmes supported by Life for a Child shows that improved treatment leads to better glycaemic control, fewer complications and fewer hospitalisations.

“The real question isn’t whether we can afford better care,” she says. “It’s whether we can afford the inequity if we don’t provide it.”

Countries such as Rwanda and Costa Rica have demonstrated that even with limited resources, integrated and equitable care is possible when political commitment is strong. Others, including Kenya and Chile, show both the promise of UHC and the risks of underinvestment, particularly for non-communicable diseases.

A choice about the kind of world we want

In humanitarian settings, the stakes are even higher. In the past decade, Syrian families living with diabetes in refugee settlements in Lebanon often faced irregular insulin supplies and could not afford test strips. Clinicians reported children arriving with dangerously high glucose levels because care is fragmented and funding is uncertain.

UHC is not a panacea. But as Life for a Child’s work and global evidence show, it is one of the most powerful tools available to turn diabetes from a death sentence into a manageable condition. As the world moves towards the 2030 deadline for achieving UHC, the message is clear: diabetes must be fully integrated into national health plans. UHC is not just a financing mechanism. It is a statement of values—a decision to build systems that allow people not just to survive, but to thrive.

Around 70% of people living with diabetes are of working age. For many, the hours spent at work are the hardest time to manage their condition. This year’s World Diabetes Day focus put a spotlight on how workplaces can either protect or undermine health, dignity and professional opportunity. Insights from lived experience, findings from an International Diabetes Federation (IDF) survey, the WHO Global Diabetes Compact and emerging research all point in the same direction: stigma is widespread, support is patchy, and meaningful change is overdue.

The IDF survey, which gathered responses from 1,400 adults living with diabetes in Argentina, China, Germany, India, Pakistan, South Africa and the United States, reveals how deeply fear and stigma shape life at work.

A proportion of respondents have never disclosed their diabetes to their employer. Others delayed disclosure even when diabetes was already affecting their working life. Nearly one in three have shared their condition with only one colleague, often as a safety measure rather than because they feel genuinely comfortable. When asked why they do not disclose, people living with diabetes repeatedly used the word “fear”: fear of being treated differently, fear of being passed over for promotion, fear of harassment, and fear of losing their job.

These fears are not abstract. Many respondents described very concrete negative experiences. Four in ten reported that they had experienced some form of bias at work because of their diabetes. Many felt judged when they took time to attend a medical appointment or to manage their blood glucose.

When workplaces undermine diabetes management

Tasks that are essential to staying well, such as checking blood glucose levels, taking insulin or eating at a specific time, were made more difficult by strict schedules, a lack of privacy, and workplace cultures that equate breaks with a lack of commitment.

The emotional toll is considerable. Just over two in five said that managing diabetes at work had harmed their mental well-being. One in three had considered leaving their workplace because of how they were treated. Together, these figures paint a picture of workplaces that are often poorly equipped to support basic diabetes care and, in some cases, actively undermine it.

Mark Tiller, an advocate and IDF Blue Circle Voice from the UK, recalled, “Apparently, the people in the room had been really uncomfortable with me injecting in front of them, and my employer asked if I could go to the toilets to do it in the future.” He also emphasised the role of education, “Almost all stigma is rooted in ignorance… whenever I get asked ‘Are you sure you can eat that?’ I choose to educate.”

Technology helps, but work culture still matters

Lived experience stories add depth and humanity to these numbers. People living with diabetes know the challenges of managing glucose levels around time-pressured meetings, laboratory work, demanding travel schedules and major presentations. Before continuous glucose monitoring (CGM) was available, some described diabetes management at work as “haphazard”. Often, decisions were squeezed into moments between tasks. CGM has allowed some to anticipate and prevent low blood glucose episodes more confidently. Still, access remains uneven, especially in low-resource settings, and technology alone cannot fix a hostile culture.

As Anum Anwar, an advocate and diabetes educator from Pakistan, explained: “Instead of looking at my glucose levels or injecting insulin or having my meals on time, I had to think about running the experiment… we need our time, short breaks, and it’s not always doable.” She added, “You always have to monitor yourself, you have to carry extra things like insulin and a glucometer… it is demanding and challenging.”

Finding support in the workplace

Disclosure remains emotionally complex. Colleagues have asked people with diabetes to inject insulin in a bathroom or expressed discomfort at seeing someone check their glucose. Others described more positive encounters, where a single informed colleague, “a diabetes buddy”, became a lifeline.

Sylvie Maloof, co-Founder of the association DiaLeb and an IDF Blue Circle Voice from Lebanon, recounts,” During a strategic meeting, I felt fine as I stood up to present, completely unaware that my blood glucose was dropping rapidly. A colleague who knew about my diabetes noticed subtle changes in my colour and behaviour and realised I was experiencing severe hypoglycaemia. She acted quickly to get me something to treat it and prevented me from collapsing, and I will always be grateful for the calm and care she showed in that moment.”

What began as a frightening moment became an opportunity for understanding: at subsequent meetings, snacks were always available, even during Ramadan, to support her health needs while still respecting the broader context.

What research reveals about flexibility and work

Flexibility is a recurring theme with diabetes management in the workplace. Sylvie also shared that after “a very tough night with persistent hypoglycaemia, I told my employer that I was going to work remotely. I am very blessed to work in an environment that is very flexible, very understanding.”

For many people living with diabetes, flexibility is not a privilege but a practical necessity that allows them to maintain their health. Yet such accommodations are far from universal. Some workplaces still insist on rigid hours and in-person attendance even when the COVID pandemic has shown that alternative models are possible in many sectors.

Research helps us understand the broader patterns that sit behind individual stories. A 2025 comprehensive review by Monash University examined 91 studies on diabetes and work. The findings confirm that diabetes can have significant consequences for employment.

People living with diabetes are more likely to leave work earlier, to experience work disability, and to spend more time off sick than their peers without diabetes. Even when present at work, they may struggle with “presenteeism”: continuing to work while unwell, often because they fear adverse reactions if they take time off. Shift work and night work present challenges, as irregular hours and disrupted sleep can make stable glucose management extremely difficult.

What experiences are missing from the evidence?

Qualitative studies provide insight into everyday barriers. However, the evidence base is still limited in meaningful ways. Most studies come from high-income countries and formal employment settings. Researchers know very little about the experiences of people living with diabetes in low and middle-income countries, in informal or precarious work or in physically intensive roles such as agriculture, manufacturing or construction.

Few studies distinguish clearly between type 1 and type 2 diabetes, or between people using insulin and those who are not. Psychosocial factors such as diabetes-related distress, burnout and anxiety tend to be overlooked. Without this detail, it is hard to design policies and interventions that respond to the realities faced by most of the world’s workforce.

Despite these gaps, unmistakable messages have emerged. Workplaces that offer flexibility, privacy, access to snacks and medicines, and a culture of understanding can help people living with diabetes remain healthy and productive. Those that ignore these needs risk harming both their employees’ health and their own long-term performance.

Where the WHO Global Diabetes Compact situates the workplace

The WHO Global Diabetes Compact situates the workplace within a wider vision for diabetes care. Member States have committed to ambitious global targets for 2030, including diagnosing at least 80% of people living with diabetes, improving blood glucose and blood pressure control, increasing statin use among those at risk, and ensuring that all people living with type 1 diabetes have access to affordable insulin and self-monitoring. Achieving these targets depends not only on clinics and hospitals, but also on the environments where people spend their daily lives—including workplaces.

WHO has used its own institutional settings to model parts of this approach. Offices have hosted information booths, blood glucose testing and awareness events, and have worked with staff health programmes to encourage supportive workplace norms. At the core is the idea that awareness goes hand in hand with structural change. Education alone is not enough if scheduling, staffing, and performance expectations still make safe diabetes management impossible.

What employers can do to make a difference

For employers, several practical areas offer immediate opportunities for change. The first is knowledge. Basic diabetes literacy across an organisation can reduce fear and misunderstanding. Staff should understand that diabetes is not a sign of weakness or poor self-discipline and that both type 1 and type 2 diabetes have complex causes, including genetics. Clear guidance on low and high blood glucose episodes, what signs to look for and how to respond in an emergency can help colleagues feel confident rather than helpless.

The second area is daily practice. Allowing brief, regular breaks for glucose checks, insulin administration or snacks can prevent dangerous fluctuations. Providing a clean, private space for these tasks respects dignity. Ensuring that people living with diabetes can carry and access their supplies easily, and store insulin safely, supports both safety and performance. Keeping fast-acting carbohydrate in a known location, with simple instructions, is a low-cost, high-impact measure.

Third, workplaces should consider culture and workload. Healthy workplaces do not celebrate long hours or constant availability, nor treat breaks as a lack of commitment. They encourage staff to raise health needs without fear. Offering more nutritious, culturally appropriate food options, or rethinking team-building activities, benefits everyone.

First aid and emergency planning also matter. Many organisations already train staff to respond to cardiac arrest or anaphylaxis. Updating these programmes to include diabetes scenarios, with proper training, can help colleagues feel prepared without turning them into clinicians.

Finally, people living with diabetes should be able to share information confidentially with human resources or a trusted colleague, without pressure to disclose more than they wish. Anti-discrimination policies and manager training must be active and meaningful, not just statements on paper.

Championing dignity and support in the workplace

No one chooses to live with diabetes. No one should feel compelled to hide their condition at work for fear of losing their job, missing out on a promotion or being humiliated. People living with diabetes demonstrate resilience every day, balancing complex self-management with professional and family life. Their lived experience is not a liability but a strength—evidence of problem-solving, adaptability and persistence that any employer should value.

The World Diabetes Day focus on diabetes in the workplace is a call to action. It challenges employers to examine their policies, cultures and assumptions. It urges policymakers to integrate workplace realities into national diabetes strategies. And it invites colleagues to replace judgement with empathy and curiosity. With intentional effort, workplaces can become environments where people living with diabetes are safe, respected and able to thrive—not despite their condition, but alongside it.

D-Talk: Diabetes in the workplace

In this dedicated World Diabetes Day podcast, host Phyllisa Deroze welcomes three advocates from the IDF Blue Circle Voices network to explore how people with diabetes navigate challenges at work, such as disclosing a diagnosis and balancing self-care with professional responsibilities. The discussion also highlights the need for more inclusive, understanding and supportive work environments.

When Shamsul Bahri Othman was diagnosed with diabetes in his early forties, he never imagined how deeply it would affect his sight. Four years after his diagnosis, he began losing vision—first suddenly in one eye, then gradually in the other. What started as blurred vision became a life-changing experience. Once able to drive his children to school and work independently as a mechanic, Shamsul now depends on others for daily tasks.

Diabetes-related retinopathy (DR) is caused by long-term damage to the small blood vessels in the retina. With 853 million people projected to live with diabetes by 2050, more than 250 million could experience some form of retinopathy, and around 45 million may progress to sight-threatening stages such as proliferative retinopathy or diabetic macular oedema.

Preventable, yet millions remain at risk

While DR is preventable, millions remain at risk of vision loss because screening and treatment are not equally accessible. Shamsul was diagnosed with diabetes in 2018 and, four years later, with DR. Before his diagnosis, he had never heard of the condition, and his doctor had not explained that he was at risk of developing it. He only discovered the possibility while searching online for information about diabetes-related complications. Because he had no symptoms at the time, he never imagined it could happen to him.

The development of DR is closely associated with the duration of a person’s diabetes. After 15 to 20 years, almost nine in ten people with type 1 diabetes and around two in three people with type 2 diabetes will develop some degree of the condition. There is not one factor, but many, that cause progression. These include prolonged high blood glucose levels, high blood pressure, pregnancy, ethnicity and genetic predisposition. Encouragingly, DR often progresses slowly, giving healthcare teams time to intervene. As a result, only about one in ten people with the condition go on to develop vision-threatening changes.

Pregnancy adds another layer of complexity when hormonal changes can accelerate the development of retinopathy. At the same time, rapid improvements in glucose control, often made to protect the foetus, can sometimes worsen existing eye disease. Preconception care, which allows women with diabetes to optimise glucose levels before pregnancy, is therefore essential in preventing progression during pregnancy.

When vision loss signals more than an eye problem

In many cases, early signs of diabetes-related vision damage manifest before other complications. They can indicate complications in the kidneys or heart. Protecting vision, therefore, presents a broader opportunity to intervene early and reduce the risk of more severe systemic complications. In fact, the real culprit is the condition’s painless, asymptomatic progression, which makes early detection difficult without screening.

Treatment options such as laser therapy, anti-VEGF injections, and vitrectomy can slow or stop vision loss when detected early. However, these treatments cannot restore vision once it is lost, making timely screening essential for preserving vision and overall health. Treatment for Shamsul’s right eye involved laser therapy and intravitreal injections. He also underwent a vitrectomy and laser procedure with silicone oil injections in his left eye. Six months later, the silicone oil was removed, and a cataract extraction with a lens implant was performed. Shamsul continues to attend regular follow-up appointments and receives additional injections in his right eye when needed.

Unequal access, unequal outcomes

Data from the IDF Diabetes Atlas indicate striking regional variations in the prevalence of diabetes-related retinopathy, particularly in parts of Europe and Southeast Asia, where disparities in access to prevention and care are evident. However, it is best to err on the side of caution when interpreting these figures since estimates often depend on the populations studied and the methods used for disease detection. Hospital-based research tends to show higher levels of DR because it captures individuals who are already experiencing symptoms. In contrast, community-based screening tends to provide a more accurate picture of the population.

Studies using handheld or smartphone-based cameras in rural areas make screening possible where hospital infrastructure is limited. Still, image quality and field of view can be lower than in clinical settings with some studies excluding ungradable images, which can further skew prevalence estimates. Ethnicity adds another important dimension: people of South Asian and Black descent are more likely to develop diabetes and its complications, underlining the need for localised strategies that consider entire population characteristics and resources. The differences between regions are not only the result of biology or technology but also of policy and investment.

When countries prioritise regular screening and timely treatment, diabetes-related vision loss declines. One such example is the National Diabetic Eye Screening Programme in the UK. Following its introduction in the early 2000s, diabetes-related vision loss fell by half within just five years. The screening is carried out by trained photographers and graders rather than ophthalmologists, allowing specialists to focus on people who need advanced care. Clinics operate in hospitals, primary care practices, community centres and mobile vans, to screen people wherever they live.

Outcomes from the UK model demonstrate that investment in prevention saves both sight and money. While systematic screening requires upfront costs in staff training, equipment and coordination, it reduces long-term healthcare expenses associated with vision loss and disability. The approach also underscores that screening is only effective when linked to treatment.

The importance of an integrated system

Identifying people with sight-threatening DR is meaningless if they cannot access laser therapy, anti-VEGF injections or surgical care. Comprehensive eye care requires an integrated system that connects prevention, detection and treatment, supported by affordable access to essential diabetes medicines and glucose monitoring.

Although the IDF Diabetes Atlas reports a slight decrease in the overall prevalence of DR— from 27% in earlier editions to 23% in the 11th edition — this apparent progress masks a more complex picture. The prevalence of proliferative retinopathy, the most severe form, has actually increased fourfold, from 1.4% to 6%. This paradox reflects both improvements in diabetes management and the uneven quality of global data collection. It also serves as a reminder that the overall burden of disease remains immense and that continued investment in prevention, research and equitable care is essential.

AI and telemedicine within eye care

Where national screening programmes are not feasible, technology offers new opportunities. Telemedicine enables retinal images to be taken in community settings and graded by specialists based elsewhere, reducing the need for in-person appointments. Artificial intelligence (AI) tools are increasingly capable of identifying more advanced stages of DR, enabling earlier referrals and lower costs. These approaches are already used in India to expand access in under-resourced areas.

However, success depends on ensuring that AI systems are trained on diverse and representative data. Suppose algorithms are developed primarily using images from young or white European populations. In that case, they may perform less accurately when applied to other ethnicities or age groups. Inclusive design and testing are therefore critical to avoid perpetuating inequities in care.

Beyond eye disease, advances in retinal imaging and AI are opening new eye health frontiers. Researchers are investigating how subtle changes in the retina might signal broader systemic diseases, including cardiovascular disease, kidney disease and dementia. The eye, long regarded as a window to the body, could become a vital tool in detecting and managing a range of conditions associated with diabetes and metabolic health.

While technology and clinical innovation hold promise, the foundation of progress lies in education, training and equitable access. Studies show that nearly half of all people with diabetes worldwide are unaware that their condition can cause blindness, and many cannot afford the treatments required to prevent it. Bridging this gap requires concerted action at multiple levels. People living with diabetes need clear, culturally relevant and language-appropriate information explaining why regular eye examinations are vital.

Expanding access requires both political commitment and practical investment

Early detection and treatment result from upskilling healthcare professionals, from doctors and nurses to optometrists. International collaboration is at the core of telemedicine initiatives, shared training programmes and efforts to reduce the cost of essential drugs and equipment. These initiatives support access to affordable screening in low-income countries. Yet even in a high-income region like Europe, universal screening remains far from reality, with fewer than one in five countries offering national coverage for diabetes-related eye disease screening.

For Shamsul, the emotional toll of his diagnosis was overwhelming. He experienced fear of blindness, anxiety about supporting his family, and frustration at the lack of psychological and medical support before symptoms appeared. His story reflects the reality for many people living with diabetes who remain unaware of their risk until vision loss disrupts their lives. It also underlines the importance of awareness, early detection, and access to affordable treatment and support.

Diabetes-related vision loss is not inevitable. We know that early detection and timely treatment not only preserve sight but also save health systems money by reducing the long-term social and economic costs of blindness. With equitable policies, well-trained health professionals, and informed communities, millions of cases could be prevented. Protecting eyesight means protecting independence, livelihoods and quality of life. It also offers a broader lesson: when health systems invest in prevention, they strengthen their ability to manage the many challenges of diabetes. The path forward lies in ensuring that where a person lives no longer determines whether they lose their sight to a preventable complication.

Podcast: Diabetes-related eye conditions

In this episode, host Phyllisa Deroze is joined by Dr Rebecca Thomas to explore the latest findings on diabetes-related eye conditions from the 11th edition of the IDF Diabetes Atlas, which indicate that nearly 1 in 3 people with diabetes have some form of retinopathy – 1 in 10 of whom develop sight-threatening conditions, such as proliferative retinopathy or macular oedema.

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.