The Scale of the Crisis
Pakistan is confronting one of the most serious diabetes burdens globally. According to the International Diabetes Federation, in 2024 the country had 34.5 million adults aged 20–79 living with diabetes, representing an adult prevalence of 31.4%—the highest in the world. Pakistan also ranks fourth globally in the total number of adults with diabetes. Projections indicate that if current trends persist, this number could rise to 70.2 million by 2050.
The Second National Diabetes Survey of Pakistan (2016–17) found overall adult diabetes prevalence at 26.3%, with 28.3% in urban areas and 25.3% in rural areas—showing the disease is not confined to cities. The survey also revealed that 7.1% of adults were newly diagnosed during the study, indicating many were unaware of their condition. Pre-diabetes was found in 14.4% of adults, meaning millions more are on the path to developing diabetes.
Historical and Biological Roots
South Asians, including Pakistanis, often develop diabetes and central fat accumulation at lower body weights compared to other populations. One explanation is that generations exposed to food scarcity, repeated famines, and chronic undernutrition developed metabolic traits suited for survival in scarcity but harmful in today's environment of cheap sugar, refined starches, and sedentary lifestyles. Colonial rule exacerbated this vulnerability by deepening deprivation and causing some of the worst famines in the region's history. This does not remove personal responsibility, but it highlights that Pakistan's diabetes crisis is rooted not only in modern lifestyle choices but also in a long history of hunger, poverty, and distorted food systems.
Economic Toll
The economic impact of diabetes is immense yet receives insufficient policy attention. Diabetes reduces productivity, increases household medical spending, strains hospitals, and leads to costly complications such as heart disease, kidney failure, blindness, amputations, and stroke. The International Diabetes Federation estimates Pakistan's diabetes-related health expenditure at about USD 2.74 billion in 2024, projected to rise to nearly USD 5 billion by 2050. This figure understates the true burden as it does not fully capture lost income, family caregiving, premature deaths, and wider economic damage.
Government attention remains inadequate, with too much focus on managing complications after they occur and too little on prevention, early screening, nutrition education, primary care, and public health regulation. The cost of medication, especially insulin, is financially draining for individuals and families. Expenses include glucose monitoring, consultations, laboratory tests, treatment of complications, and lost working time. At the national level, this represents a continuing drain on health spending, productivity, and foreign exchange.
Transforming Our Relationship with Food
As a fundamental reform for economic development, the food we eat must change. Pakistan cannot build a healthier, more productive workforce while normalizing diets built around sugar, refined starch, fried food, and ultra-processed snacks. Nutrition should be treated as economic policy, not just personal advice. Prevention through better food habits, food labeling, school nutrition standards, public awareness, and primary care screening is far cheaper than paying for complications after decades of neglect.
Pakistani consumers need to rethink food choices. The question is not whether an egg or coffee is good or bad; the bigger problem is the daily combination of sweet tea, biscuits, rusks, paratha, large portions of roti or rice, sugary drinks, packaged juices, fried snacks, bakery items, low vegetable intake, and little physical activity.
Key Dietary Shifts
- Reducing Liquid Sugar: Soft drinks, packaged juices, energy drinks, sweetened lassi, and heavily sugared tea add calories quickly and create sharp glucose loads. They are easy to consume and underestimate, making them a primary target for reduction.
- Controlling Refined Carbohydrates: Roti and rice are normal parts of Pakistani diets and do not need to be banned. However, portion size matters, and pairing them with dal, chana, lobia, vegetables, yoghurt, eggs, chicken, fish, or salad ensures a slower, more balanced rise in blood sugar.
- Rethinking Packaged Snacks: Biscuits, rusks, cakes, chips, nimko, and instant noodles are often made from refined flour, sugar, salt, and poor-quality fats. Their routine use has quietly become part of the dietary problem. Occasional consumption is not the issue; daily dependence is.
- Cutting Back on Fried Foods: Parathas, samosas, pakoras, banaspati, bakery shortening, and repeatedly used frying oil should not be everyday staples. Healthy eating does not require imported foods or extreme diets but a steady shift toward simpler, fresher, and less processed meals.
Movement, Screening, and the Path Forward
Gentle, regular exercise is equally important. It does not have to mean punishing gym routines. For instance, swimming at least five times a week for about 40 minutes can help the body use glucose better, support weight control, improve circulation, and reduce the sense that diabetes management is only about restriction. Consistency, not intensity, is key.
Pakistan does not need expensive imported health foods. The practical answer is local and affordable: dal, chana, lobia, seasonal vegetables (saag, bhindi, cabbage, carrots, cucumbers, tomatoes), fruit, plain dahi, unsweetened lassi, eggs, fish (where affordable), peanuts, sesame, flaxseed, whole wheat roti, barley, and home-cooked sabzi.
Screening must become routine. Diabetes can damage the heart, kidneys, eyes, and nerves long before symptoms become obvious. People with family history, excess weight, high blood pressure, tiredness, frequent urination, excessive thirst, blurred vision, or recurrent infections should be tested. Earlier diagnosis gives people a better chance to manage the disease before complications set in.
Pakistan's diabetes crisis will not be solved by food scares, miracle diets, or imported supplements. It requires a practical shift in daily behavior: less sugar, fewer refined and packaged foods, smaller starch portions, more fiber, more protein, more vegetables, regular movement, and earlier testing.
