Pakistan faces a diabetes crisis with 34.5M adults affected and 3.4M at amputation risk. Urgent healthcare reforms are needed to tackle this epidemic.
The Numbing Statistics and Problems
The numbers of diabetes crisis in Pakistan are astounding. Pakistan is fourth in the world according to International Diabetes Federation (IDF) in terms of the number of affected adults with diabetes and only China, India and the United States are ranked higher. One-tenth of all diabetic patients in the country is affected with diabetic foot, the major cause of non-traumatic amputations in the world. To these 3.4 million people, even a small cut or abrasion can become a non-healing ulcer that becomes chronic and causes amputation in the end. It is usually the ultimate devastating consequence of an illness that has been either left unattended to or under-handled.
Besides amputation, uncontrolled diabetes is the catalyst to a plethora of other disabling health problems. It is a leading cause of heart attacks, strokes and kidney failure, and damages to nerves and blindness. The sinister aspect of the ailment where it silently advances in its initial phases, implies that about 26.9 percent of all diabetics in Pakistan -or 9.3 million individuals- remain undetected. They are unknowingly stumbling in the dark and heading to life threatening complications.
Root Causes of the Crisis
The problem of the increasing diabetes crisis in Pakistan is complex as it is the result of a mixture of lifestyle, genetic, and socio-economic factors. The nation is experiencing a fast epidemiological trans-shift where the traditional diets and the active lifestyle are being substituted by the modern lifestyle which is contributing to the epidemic.
Unhealthy Eating and Inactive Living
The overwhelming speed of urbanization has caused a general transition to high calorie, processed and sugary diets. This and decreasing engagement in physical activity as the result of an increased number of sedentary jobs has led to an increase in the prevalence of obesity. These lifestyle changes are even more harmful in Pakistan since the population has an unusual genetic predisposition to diabetes.
Ineffective Healthcare System
Pakistan has a very poor healthcare system with a small annual health expenditure of only 79 dollars per patient with diabetes; one of the poorest in the region. This underinvestment implies that the millions of people either do not or have poor treatment. Another major problem is that there is acute lack of trained healthcare providers, particularly in the rural communities making it hard to identify and treat the disease at a primary level.
Deficiency in Awareness and Education
A large segment of the population is not informed on the risk factors, signs and symptoms, and complications of diabetes in the long-term. The result of this ignorance is that it is usually detected late and does not follow through on the treatment plans. The cultural beliefs also contribute to some extent, most patients link insulin therapy to aggravation of the condition or other misconceptions, which make them believe in insulin denial and aggravation of the health conditions.
The Economic Burden
The financial price of this crisis is frightening just like the price in human life. The Diabetes Atlas 2025 by the IDF documents that in four years the expenditure on diabetes care has increased in Pakistan; while spending on diabetes care in 2017 was 2.6 billion it is now 2.7 billion. This number does not fully reflect the destruction of finances of individual families. An average individual with diabetes is using a good amount of his or her monthly earnings on drugs, laboratory tests, and physician visits. The disadvantaged members of the society suffer the most as some of these families can employ up to 18% of all their total income to cover the costs of diabetes treatment, something that can further lead them into poverty.
The expenses of treating complications, including a diabetic foot ulcer or an amputation, are astronomical and may devastate a family of its budgetary means. These economic strains compel most patients to forego treatment and there exists a vicious circle of deteriorating health and a rising cost of medical treatment.
The Way Forward: Emergent Interventions
The combination of the government, healthcare institutions, and the population should be a multi-faceted and coordinated effort to stem the tide of this crisis. Observers are demanding systematic interventions on a mass scale to avoid a health disaster among a generation.
Public Awareness Campaigns
The country should also conduct campaigns nationwide to sensitize people on the dangers, symptoms and management of diabetes. Such campaigns ought to be culturally relevant and make use of the diverse media in order to reach both the urban and rural population.
Enhancement of Primary Healthcare
Healthcare system should be transformed to focus on the early diagnosis and treatment of diabetes. This involves educating more medical workers, advancing infrastructures, and maintaining a steady supply of vital drugs and supplies, including insulin.
Policy and Regulation
The government should come up with policies that lead toward healthier lifestyles, including regulation of the marketing of sugary and processed food. It should also invest more in health especially on prevention and management of non communicable diseases.
Patient Education and Support
There should be training of the healthcare providers to offer better counseling and support to patients. Community based support groups should also be established to enable patients to overcome the social and cultural factors that lead to insulin denial and ineffective self management.
Conclusion
To conclude, the situation of diabetes in Pakistan is at the critical stage. In a population at risk of amputation of more than 3.4 million, the human and economic costs are enormous. The figures are frightening, but with a concerted and immediate effort it is still possible to reverse the tide against this silent epidemic and a future of widespread disability and anguish can be avoided.
