THE diabetes epidemic cannot be controlled by medicines and hospitals alone. Pakistan must confront the lifestyle and environmental changes putting millions at risk, particularly its children.
A health crisis does not always begin in a hospital. Sometimes, it begins at the breakfast table, in a school canteen, on a sofa in front of a television or in a neighbourhood where children have no safe place to play. Pakistan’s growing diabetes epidemic is closely connected to these everyday realities. What we consider normal today may be creating serious health consequences forgenerations to come.
Diabetes mellitus has emerged as one of Pakistan’s most pressing public-health challenges. According to the International Diabetes Federation’s (IDF) Diabetes Atlas 2025, approximately 34.5 million adults in Pakistan were living with diabetes in 2024. With an age-standardised prevalence of 31.4 per cent, Pakistan ranks first globally. More alarming is the projection that this number could rise to 70.2 million by 2050 if current trends persist.
As we observe World Diabetes Day on 14 November, under the theme Early Action on Diabetes, we must ask a fundamental question: are we doing enough to prevent the next generation from becoming part of these statistics? A disease whose roots begin early Type 2 diabetes rarely develops overnight. Insulin resistance and other metabolic changes may progress silently for years before blood glucose levels reach the diabetic range. Genetic predisposition increases susceptibility, particularly in South Asian populations, but our changing lifestyles are also an important part of the problem.
Consider the lives of many Pakistani children today. Outdoor games have increasingly given way to mobile phones and other electronic devices. Walking and cycling are less common, while long hours are spent sitting in classrooms, tuition centres and homes. Sugary drinks, packaged snacks and fast food have become readily available.
Children learn physical activities by observing adults. When unhealthy food is routinely consumed at home and physical activity is neglected, occasional instructions to eat healthily are unlikely to makea lasting difference.
We must also reconsider the perception that a heavier child is necessarily a healthier child. Childhood obesity can persist into adulthood and increase the risk of developing early-onset type 2 diabetes.
The South Asian vulnerability: look beyond body weight An important aspect of diabetes risk is abdominal obesity. Excess fat around the waist is closely associated with insulin resistance and metabolic abnormalities. South Asians can develop type 2 diabetes at comparatively lower body mass index (BMI) levels than people from many other populations.
Consequently, individuals who do not appear visibly overweight may still have significant metabolic risk.
Body weight alone cannot provide a complete picture of health. Waist circumference, blood pressure and blood glucose levels deserve attention during routine health assessments. We must abandon the assumption that diabetes affects only visibly obese or overweight people.
Changing the culture, not just the menu Diabetes prevention does not require abandoning Pakistani cuisine or adopting expensive diets. It requires reconsidering how we prepare and consume everyday meals.
Whole-wheat chapati, pulses, chickpeas, vegetables, seasonal fruits and appropriate portions of rice can provide affordable nutrition. Excessive dependence on refined flour, oversized carbohydrate portions, fried foods and sugary beverages, however, deserves serious reconsideration.
Soft drinks and packaged juices should not be routine refreshments, particularly for children. Watershould become the preferred everyday drink. Whole fruits are generally a better choice than fruit juices because they retain their fiber.
The aim is not to ban favourite foods but to practise moderation.
Beyond diet and exercise Adults should aim for at least 150 minutes of moderate-intensity physical activity each week, while children and adolescents need an average of 60 minutes daily.
Physical activity does not necessarily require going outdoors or joining a gym. Walking around the house, climbing stairs, dancing, stretching and household chores can help people stay active. Those who sit for long hours should take regular breaks. Children can enjoy indoor games instead of spending excessive time on screens.
Prolonged sitting, inadequate sleep and chronic stress can also affect metabolic health. Sleep deprivation can disrupt appetite regulation and insulin sensitivity, while chronic stress may encourage unhealthy eating habits. Adults should aim for at least seven hours of sleep, while children need more, depending on their age.
Prediabetes: the opportunity we must not miss One of the most encouraging aspects of diabetes prevention is that developing type 2 diabetes is not inevitable, even when blood glucoselevelshave startedrising.
Prediabetes is a condition in which blood glucose levels are higher than normal, but have not reached the diagnostic threshold for diabetes. It often produces no noticeable symptoms, leaving many people unaware of their condition.
With timely identification, consultation with an endocrinologist or qualified healthcare professional,appropriate weight management, healthier eating and regular physical activity, progression to type 2 diabetes can often be prevented or substantially delayed. In many individuals, blood glucose levels can even return to the normal range.
People with a family history of diabetes, abdominal obesity, high blood pressure or a history of gestational diabetes should discuss screening with their healthcare providers rather than waiting for symptoms to appear. Even after glucose levels return to normal, continued monitoring remains important. It is equally important to understand that lifestyle changes cannot prevent every type of diabetes. Type 1 diabetes is an autoimmune condition requiring lifelong insulin treatment.
The responsibility begins before and beyond childhood Diabetes prevention must also include maternal health. Women who develop gestational diabetes during pregnancy have a greater risk of developing type 2 diabetes later in life. Appropriate antenatal screening, medical supervision and follow-up after delivery are essential. Pre-pregnancy counselling and continued monitoring can help protect mothers and future generations.
At the same time, healthy living is not simply a matter of personal choice. Families cannot prioritise outdoor activity when neighbourhoods lack safe footpaths and playgrounds. Schools cannot promote healthy lifestyles effectively if their canteens are dominated by unhealthy snacks. For lower-income households, a varied and nutritious diet may also be difficult to afford.
Diabetes prevention must therefore become a shared responsibility.
Schools should provide meaningfulphysical education and healthier food choices. Governments should strengthen nutritional awareness, encourage healthier food environments and improve access to affordable screening.
Healthcare professionals must focus on identifying people at risk rather than waiting until diabetes develops. Early screening and counselling can reduce the long-term burden of the disease. We must also abandon the tendency to blame people living with diabetes. Genetics, family history, social circumstances and environmental factors all influence the disease.
The choice Pakistan cannot postpone Pakistan is approaching a critical point in its diabetes epidemic. The projected increase in cases is a warning of what could happen if prevention continues to receive less attention than treatment.
Every generation inherits traditions, values and habits from the one before it. We also shape the health risks our children will face.
Although we cannot control every genetic or environmental factor, we can change many of the conditions contributing to preventable disease.
This World Diabetes Day, Pakistan needs more than another awareness campaign. Parents must lead by example, schools must take responsibility for children’s health, healthcare professionals must identify risks early, and policymakers must create environments in which healthier choices are possible.
The real measure of our response to diabetes will not be how many patients our hospitals treat, but how many future cases our society succeeds in preventing. The time to change the course of Pakistan’s diabetes epidemic is now.