According to the International Diabetes Federation Diabetes Atlas, Pakistan has the third-highest rate of type 2 diabetes among adults globally, after China and India, making it a growing crisis in the country (1). Furthermore, with an estimated prevalence of 33.6% among individuals aged 20–79, Pakistan now holds the highest global ranking for type 2 diabetes (2). Despite these alarming figures, health and policy practitioners have made limited efforts to address the issue, leaving the country vulnerable to an escalating public health crisis. The situation is even more concerning, with millions already diagnosed as pre-diabetic (3). The rising incidence of diabetes is rapidly becoming a public health emergency that requires immediate attention.

To combat this epidemic, a comprehensive, multi-level approach is necessary, which would cover individual to communal and government level efforts. Our team contends that such an approach would be most effective if it included public awareness, education, outreach, behavioral and dietary changes, along with policy interventions.

This policy brief provides an accessible overview of diabetes, including its types, causes, and preventive measures. It also explores the increasing prevalence of diabetes in Pakistan, identifies contributing factors, and outlines strategies for individuals, communities, and public health authorities to effectively prevent and manage the disease within the country. As this policy brief is aimed at raising public awareness and stimulating policy and community conversations around this critical public health issue in Pakistan, we draw on relevant literature while also relying on our expertise and background to offer suggestions, which aligns with the journal’s scope for this collection.¹ To sustain public interest and to convey our message in plain language, we have deliberately minimized the use of dense academic citations and heavy medical jargon.

Diabetes is a chronic medical condition marked by elevated blood sugar levels (hyperglycemia) due to impaired insulin action, insufficient insulin production, or both. Insulin, a hormone produced by the beta cells in the pancreas, facilitates the uptake of glucose from the bloodstream into muscle and other body cells for energy (4).

Among the two primary types of diabetes (type 1 and type 2), type 1 diabetes is an autoimmune disorder in which the body’s immune system destroys insulin-producing beta cells in the pancreas, leading to little or no insulin production (5). In contrast, type 2 diabetes is primarily characterized by insulin resistance and progressive pancreatic beta-cell dysfunction, resulting in relative insulin deficiency and subsequent hyperglycemia (6, 7).²

Hyperglycemia in diabetic patients contributes to cardiovascular complications, kidney dysfunction, and oxidative stress, as well as metabolic dysregulation, which, in turn leads to increased appetite. Several factors contribute to the development of insulin resistance in type 2 diabetes, with obesity, genetics, and environmental and lifestyle factors playing significant roles.

Obesity, particularly visceral fat, is a major contributor to insulin resistance (8). In obese individuals, adipose (fat) tissue releases various biochemical substances (cytokines and hormones) that trigger inflammation and interfere with insulin signaling pathways, leading to insulin resistance. Simply put, excess fat can disrupt normal metabolism by causing inflammation and making it harder for the body to use insulin properly.

Genetics is another determinant for insulin resistance.³ Studies have identified several genetic variants that predispose individuals to impaired insulin signaling, beta-cell dysfunction, and altered glucose metabolism (8). These genetic factors may explain why some individuals develop insulin resistance despite having a normal body weight, while others remain metabolically healthy despite obesity. Inherited predispositions also influence how efficiently the body processes insulin and regulates blood sugar levels, affecting the risk of developing type 2 diabetes.

Beyond genetics and obesity, insulin resistance also develops gradually due to various environmental and lifestyle factors, with dietary habits playing a significant role (9). Overconsumption of refined sugars, processed grains, and high-glycemic carbohydrates results in frequent spikes in blood sugar levels. In response, the body produces excess insulin to manage these sugar spikes. Persistent overproduction of insulin causes the body to become less responsive, or more resistant, to it. Furthermore, this ongoing cycle of elevated blood sugar and excess insulin release leads to dysfunction in insulin-producing cells, ultimately resulting in diabetes. Physical inactivity, poor sleep, and chronic stress further contribute to insulin resistance by altering hormonal balance, inflammatory responses, and glucose metabolism.

Both types of diabetes are important to consider, but in Pakistan, the focus is primarily on type 2 diabetes due to its higher prevalence and preventable nature. According to recent estimates, Pakistan has one of the highest rates of diabetes in the world, with an estimated 33 million adults living with the condition (1).

The rise in diabetes cases in Pakistan can be attributed to three major cultural changes: increased consumption of refined sugars and processed grains, reduced physical activity paired with increased screen time, and more frequent eating and snacking. Western dietary influences have introduced more sugary and processed foods into the Pakistani diet, facilitated by the rapid growth of fast-food restaurants—a trend similar to nutritional shifts seen in other low and middle income countries (LMICs) (10). Moreover, traditional staples such as high-glycemic bread and rice continue to contribute to excessive carbohydrate intake. Decreased physical activity, coupled with more sedentary lifestyles, has further exacerbated the situation by lowering insulin sensitivity and increasing fat storage.

Frequent eating and snacking on unhealthy food may also contribute to the rising incidence of diabetes in Pakistan. While the scientific link between meal frequency and insulin resistance is still being studied, some research suggests that among women who eat breakfast irregularly, meal frequency is associated with a significantly higher risk of developing type 2 diabetes (11). Other studies indicate that frequent meal may contribute to higher BMI (and, by extension, obesity) (12), both of which are major risk factors for insulin resistance.

A critical factor in Pakistan’s diabetes epidemic is central obesity, which is highly prevalent, affecting over 70% of the Pakistani population (13). Excess visceral fat not only contributes to insulin resistance but also promotes chronic inflammation, further accelerating metabolic dysfunction (14). Given this strong link between obesity and diabetes, managing weight effectively is essential to reducing diabetes risk.

Research has consistently shown that weight reduction interventions are among the most effective strategies for preventing type 2 diabetes. The Diabetes Prevention Program (DPP) and similar studies have demonstrated that even modest weight loss (5–10% of body weight) can significantly improve insulin sensitivity and reduce diabetes risk (15). Comprehensive lifestyle interventions, including caloric restriction, increased physical activity, and nutritional counseling, have proven successful in weight management and diabetes prevention efforts (16).

Beyond weight management, insulin resistance itself can be reversed through targeted lifestyle changes. These include reducing the intake of refined sugars and processed grains, focusing on whole foods with low glycemic indices, limiting snacking and incorporating intermittent fasting. While intermittent fasting primarily aids in weight loss, emerging research suggests it may also enhance metabolic flexibility and reduce inflammation (17, 18), both of which play a role in diabetes prevention. Restricting eating to an 8-h window has also been associated with lower insulin levels and improved glucose metabolism (19).

Regular physical activity is equally crucial in this effort. Exercise, particularly after meals, has been shown to improve insulin sensitivity and helps muscles absorb and utilize blood sugar more efficiently (20).

To address the diabetes epidemic in Pakistan, comprehensive public health strategies are vital. Nationwide programs should be implemented to educate the public about healthy eating, weight management, and the risks associated with refined sugars and processed foods. Promoting physical activity through community programs, as well as initiatives in schools and workplaces, is equally important. Enhancing access to affordable, healthy food options—especially in urban areas where sedentary lifestyles and processed foods are more common—can have a significant impact. Additionally, regular screenings for prediabetes and diabetes are crucial for early detection and management.

Addressing the diabetes crisis in Pakistan requires a unified effort at multiple levels, including individuals, communities, and policymakers (see Table 1 for more details). By adopting such a multi-level approach that encourages informed lifestyle changes and the implementation of effective public health strategies, we propose it is possible to reverse the trend and mitigate this growing health crisis.

Table 1 outlines three types of interventions: individual, community, and policymaker interventions. These interventions primarily work synchronously and interdependently. For example, individuals depend on community support, and communities rely on individual participation for the successful implementation of many interventions. Similarly, policymaker support is crucial for both communities and individuals to carry out some of these interventions. This relationship is illustrated in Figure 1.

Now let us briefly explain the interventions this multi-level approach may entail at various levels in the following paragraphs.

Addressing Pakistan’s diabetes epidemic requires a coordinated, multi-level approach that engages individuals, communities, and policymakers. Through lifestyle changes including obesity management, community support, and strategic policy interventions, Pakistan can combat the rising prevalence of diabetes and work to reverse the trend. These efforts must be widespread and collaborative, ensuring that every level of society contributes to this urgent public health mission. We acknowledge that this approach is just one of many possibilities, and the policy recommendations we propose are suggestions that, if implemented, can help mitigate the diabetes crisis and improve public health outcomes.