Study Finds 44% of People With Diabetes Are Unaware, Raising Concerns About a 'Silent Epidemic'

Nearly half of people aged 15 and older who have diabetes are unaware of their condition, a new global analysis found, a gap researchers warn could fuel a “silent epidemic” as the number of people living with diabetes rises.

The study, led by researchers at the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine and published Monday in The Lancet Diabetes & Endocrinology, estimated that 44% of people with diabetes do not know they have it. The analysis was funded by the Bill & Melinda Gates Foundation. "By 2050, 1.3 billion people are expected to be living with diabetes, and if nearly half don’t know they have a serious and potentially deadly health condition, it could easily become a silent epidemic," said Lauryn Stafford, the study's first author.

Diagnosis rates varied widely across regions. Central sub‑Saharan Africa had the lowest rates of diagnosis, with fewer than 20% of people with diabetes aware of their disease, while high‑income North America had the highest rates of diagnosis. The researchers found underdiagnosis was most common among young adults, a group that faces elevated risks for long‑term complications when hyperglycemia is not treated.

Among people who had been diagnosed with diabetes, 91% were taking medication for the condition, but only 42% of those treated were achieving adequate blood sugar control, the study reported. Poor management of blood glucose increases the risk of serious complications, including heart attack, stroke, kidney disease, vision loss and nerve damage.

The analysis distinguished between Type 1 diabetes, which often begins in childhood, and the more common Type 2, which typically develops later in adolescence or adulthood. Known contributors to Type 2 diabetes include poor diet, physical inactivity and obesity, which can lead to insulin resistance. The authors emphasized that early detection and ongoing monitoring are essential to reduce the burden of complications.

Symptoms that may indicate elevated blood sugar include increased thirst, frequent urination, excessive hunger, unexplained weight loss, blurred vision, fatigue, slow‑healing wounds or infections, numbness or tingling in the hands or feet, dry mouth, skin tags or darkened patches of skin, and increased yeast infections. Because symptoms can be mild or develop slowly, many people do not recognize them as signs of diabetes.

Healthcare providers can confirm diabetes with laboratory tests. A fasting blood glucose test measures blood sugar after at least eight hours without caloric intake. An oral glucose tolerance test evaluates blood sugar response after the patient consumes a sugary solution, typically with measurements at one and two hours. The hemoglobin A1C test provides an average of blood sugar levels over the previous two to three months.

Public health experts said the findings underscore the need for expanded screening, particularly in regions and age groups with low awareness, and for efforts to improve glycemic control among those already diagnosed. The study's authors recommended targeted testing strategies and increased access to diagnostic tools and care to identify undiagnosed cases and reduce the long‑term clinical and economic burden of diabetes.

The research adds to a growing body of evidence that global diabetes prevalence is rising and that gaps remain in detection and effective management. Without increased efforts to diagnose and control the disease, the global health community faces mounting challenges related to diabetes‑related complications and associated healthcare costs.