The Bottom Line: Pakistan has the world’s highest diabetes prevalence rate at 30.8% among adults, affecting over 33 million people. Despite growing awareness, our healthcare system struggles to keep pace with this epidemic. Cultural dietary habits and genetic predisposition create a unique challenge. This challenge demands urgent, targeted intervention.
Every Pakistani should pause their evening chai for a moment. One in four adults in Pakistan is living with diabetes. Not pre-diabetes, not “at risk”—actually diabetic. And here’s the kicker: approximately 8.9 million people with diabetes remain undiagnosed.
I used to think diabetes was just about eating too much sugar. Turns out, it’s way more complicated—especially for us South Asians.
The Numbers That Should Scare Us All
Let’s start with the brutal reality. Recent meta-analysis shows Pakistan has approximately 24 million individuals with type 2 diabetes. There are also 26 million with pre-diabetes, totaling 50 million affected. We’re not just talking statistics here—we’re talking about your neighbor, your colleague, maybe someone in your own family.
The incidence of diabetes is significantly higher in urban areas (15.1%) compared to rural areas (1.6%). As more people migrate to cities like Karachi, Lahore, and Islamabad, they’re walking straight into a diabetes trap.
The South Asian Genetic Lottery We Didn’t Ask For
Here’s where it gets really interesting—and frankly, unfair. South Asians develop type 2 diabetes early in life and often with normal body mass index (BMI). Your European friends might develop diabetes at a BMI of 30+. In contrast, South Asian people with a BMI of 24 are at risk of diabetes.
Wait, what? That’s technically in the “normal” weight range!
Dr. Fareha Jamal is a research associate at BionTech Munich. She has expertise in pharmaceutical research. She explains this phenomenon: “South Asian populations have unique genetic variants. These predispose them to insulin deficiency and unfavorable fat distribution patterns. For a given BMI, South Asians have a higher amount of total body fat. They also have higher amounts of abdominal adipose tissue compared to Caucasians.”
This isn’t just academic theory. Among individuals with obesity of White European ancestry, the prevalence of type 2 diabetes was lower. It was lower than that of normal weight individuals from the Indian subcontinent. Let that sink in.
Our Bodies Store Fat Differently (And It’s Not Good News)
The science behind this is both fascinating and alarming. Among people of South Asian descent, body fat is often stored around abdominal muscles. It also accumulates in the liver and other organs, rather than below the skin. This visceral fat is metabolically active and contributes directly to insulin resistance.
South Asians, on average, have lower muscle mass. They may have a specific propensity for ectopic hepatic fat accumulation. There is also a tendency for intramyocellular fat deposition. Our bodies are genetically programmed to store fat in all the wrong places.
Even worse, this predisposition to adiposity and insulin resistance begins during fetal development in South Asians. We’re literally born with a higher diabetes risk.
The Urban Lifestyle Time Bomb
Now add our modern lifestyle to this genetic predisposition, and you’ve got a perfect storm. Factors that predispose individuals to develop diabetes include obesity. A sedentary lifestyle is another factor. Additionally, the intake of more processed food with higher sugar content contributes significantly.
Think about how dramatically our eating habits have changed. Traditional Pakistani cuisine, while rich in flavor, has evolved into something quite different in urban settings. Traditional dietary norms have given way to calorie-dense, processed foods, contributing to a surge in obesity rates.
Maryam Jamal is a 5th-year medical student. She has health communication experience. She notes: “The shift from home-cooked meals to processed foods leads to changes. Increasingly sedentary jobs add to these changes. This combination creates a lifestyle that our genetics simply aren’t equipped to handle. Our bodies evolved for a different kind of life.”
According to WHO Asia-Pacific cutoffs, the overall weighted prevalence of generalized obesity was 57.9% in Pakistan, and central obesity was 73.1%. Central obesity—that dangerous belly fat—is particularly problematic for diabetes risk.
Our Healthcare System Is Drowning
Here’s the part that keeps me up at night: our healthcare system simply isn’t equipped for this epidemic. Most people in Pakistan earn less than $3 per day, which is insufficient to pay for insulin or diabetic medicines.
The government of Pakistan has introduced the “Sehat card” to cover healthcare expenses. However, it fails to cover outpatient visits. Medications that are crucial for diabetic patients are also not included. That’s like giving someone a car but no fuel.
Healthcare officials believe that although the government established NCD centres at district level, they lack facilities on the ground. These centres are not functional according to their capacity. A senior doctor reported: “We have glucometers. However, insulin and medicines for diabetic patients have not been available for the past one and a half years.”
Even more concerning, the substandard insulin supply is a contributing factor in inefficient diabetes management. This is due to Pakistan’s low-quality cold storage system and poor transport regulation.
The Economic Reality Check
The financial burden is staggering. Recent cost-of-illness studies show high costs are associated with type 2 diabetes in Pakistan. These costs are largely due to medication expenses. Medication costs are a major factor. If a person with diabetes gets a foot ulcer, the treatment cost is high. It could exceed a whole family’s health budget for 10 years.
This isn’t just a health crisis—it’s an economic catastrophe waiting to happen.
What Can We Actually Do?
Despite this grim picture, there are actionable steps both individually and systemically:
For Individuals:
- Get screened if you have a BMI greater than 23 or any family history of diabetes
- Focus on portion control and traditional, home-cooked meals
- Incorporate regular physical activity—even 30 minutes of brisk walking daily makes a difference
- Regular health check-ups, especially if you’re over 30
Systemic Changes We Need: The four main strategies include: creating multidisciplinary teams through capacity building of healthcare professionals. Promoting primary prevention using screening methods is another strategy. Defining management strategies through forums is important. Finally, implementing a nationwide diabetes care program is essential.
Pakistani medical guidelines have changed. They now recommend initiating screening for diabetes in all Pakistanis after age 30. This is compared to 45 years in other populations. This change is a recognition of our unique risk profile.
The Cultural Shift We Desperately Need
This isn’t just about individual choices—it’s about changing how we think about health as a society. Education has proven to be a powerful tool for spreading awareness about diabetes management and prevention.
We need to stop treating diabetes as a “Western disease” or something that only affects older people. Type 2 diabetes in South Asians presents with younger age at onset than in White Europeans.
The Hard Truth: Our genetics loaded the gun, but our lifestyle pulled the trigger. We can’t change our DNA, but we can absolutely change our response to it.
Important Medical Disclaimer: This article is for informational purposes only and should not replace professional medical advice. If you think you have symptoms of diabetes, talk to a qualified healthcare provider. It is important for proper diagnosis and treatment. Never stop or change prescribed medications without medical supervision.
The science is clear: Pakistan’s diabetes epidemic is a unique challenge requiring unique solutions. The question isn’t whether we can afford to act—it’s whether we can afford not to. What will it take for us to treat this crisis with the urgency it deserves?