Types of Diabetes and Common Causes in Pakistan: Understanding the Silent Epidemic

 

Pakistan is facing a diabetes crisis of unprecedented proportions. With approximately 40 million adults living with diabetes in 2026; a staggering increase from just 5.2 million in 2000; the nation now ranks third globally in diabetes prevalence, behind only China and India. Even more alarming, the International Diabetes Federation estimated Pakistan's age-adjusted adult diabetes prevalence at 30.8% in 2021, one of the highest rates in the world .

This "silent pandemic" affects not only the elderly but increasingly younger adults in their 30s, driven by poor diet, lack of exercise, and chronic stress . Understanding the different types of diabetes and the unique factors driving its spread in Pakistan is the first crucial step toward prevention and effective management.

Part 1: The Main Types of Diabetes

Type 1 Diabetes: The Autoimmune Condition

What It Is:
Type 1 diabetes is an autoimmune condition in which the body's immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body produces little to no insulin .

Key Characteristics:

• Onset: Most commonly diagnosed in childhood or adolescence, though it can appear at any age

• Insulin Dependency: Requires lifelong insulin therapy; there is no pill alternative

• Cause: Environmental factors combined with genetic predisposition trigger an autoimmune response that damages pancreatic β-cells over time 

• Prevention: Currently cannot be prevented or reversed

Prevalence in Pakistan:
According to a study at the Pakistan Institute of Medical Sciences (PIMS), approximately 12% of diabetic patients have Type 1 diabetes .

Common Symptoms:

• Excessive thirst (polydipsia)

• Frequent urination (polyuria)

• Unexplained weight loss

• Extreme fatigue

• Blurred vision

• Slow-healing wounds 

Management:
Type 1 diabetic patients are directly given insulin, along with regular blood glucose monitoring and lifestyle adjustments .

Type 2 Diabetes: The Lifestyle-Related 

What It Is:
Type 2 diabetes is the most common form of diabetes, accounting for approximately 85% of cases in Pakistan according to PIMS data . It develops when the body becomes resistant to insulin or fails to use it properly, combined with impaired function of beta cells .

Key Characteristics:

• Onset: Most common among adults, but increasingly seen in younger populations

• Progressive Nature: Type 2 diabetes is a progressive disease in which ultimately the function of β-cells decreases, and eventually exogenous insulin may be required to maintain blood sugar levels 

• Prevention: Largely preventable through lifestyle modifications

• Reversibility: Prediabetes and early Type 2 diabetes can sometimes be reversed with significant lifestyle changes

Prevalence in Pakistan:
The PIMS study found that out of 200 diabetic patients attending its clinic, 85% were diagnosed with Type 2 diabetes .

Common Symptoms:
Many people with Type 2 diabetes have no symptoms initially. When symptoms appear, they include:

• Increased thirst and hunger

• Frequent urination

• Fatigue

• Blurred vision

• Slow-healing sores

• Frequent infections

• Numbness or tingling in hands or feet

Management:
Patients with Type 2 diabetes may be managed initially with diet and exercise. However, when diet and exercise fail to control raised blood sugar levels, an oral antidiabetic agent is started. Additional drugs from the same family or insulin may be added depending upon the patient's glycemic control .

Gestational Diabetes Mellitus (GDM): Pregnancy-Related Diabetes

What It Is:
Gestational diabetes mellitus (GDM) is a form of diabetes that appears during pregnancy and, if not controlled, can lead to complications for both the mother and child .

Key Characteristics:

• Onset: Typically diagnosed between 24-28 weeks of pregnancy

• Risk Factors: Elevated blood sugar levels, obesity, inter-pregnancy interval, and advanced maternal age at conception 

• Genetic Component: The CDKAL1 gene polymorphism (rs10946398) has been identified as a significant genetic determinant for GDM in Pakistani pregnant women 

• Resolution: Usually resolves after delivery, but increases future risk of Type 2 diabetes

Prevalence in Pakistan:
The PIMS study found approximately 3% of diabetic patients had gestational diabetes. However, given that many cases go undiagnosed, the actual prevalence may be higher .

Long-term Implications:
Women with GDM have a significantly increased risk of developing Type 2 diabetes later in life. Similarly, children born to mothers with GDM have higher risks of obesity and diabetes.

Management:
GDM is managed through blood glucose monitoring, dietary modifications, physical activity, and sometimes medication or insulin.

Other Specific Types of Diabetes

Less common forms include:

• Maturity-Onset Diabetes of the Young (MODY): A genetic form of diabetes often diagnosed before age 25
• Latent Autoimmune Diabetes in Adults (LADA): A slow-progressing form of autoimmune diabetes
• Secondary Diabetes: Caused by other conditions (e.g., pancreatitis, cystic fibrosis, Cushing's syndrome) or medications (e.g., glucocorticoids)

Part 2: Common Causes and Risk Factors in Pakistan

Pathway 1: Unhealthy Lifestyle Choices

The rising burden of diabetes in Pakistan is deeply influenced by unhealthy lifestyle choices, which are increasingly common due to urbanization and socioeconomic changes .

1. Poor Dietary Habits:

Pakistan has seen a significant shift away from traditional, wholesome diets toward ultra-processed foods high in refined carbohydrates and sugars. The "globalization of the Western diet" in the form of processed foods has led to obesity and diabetes .

• High consumption of refined carbohydrates: White rice, naan, and refined flour products cause rapid blood sugar spikes

• Excessive sugar intake: Sugary drinks, sweetened teas, and traditional sweets (mithai) contribute to insulin resistance

• Increased fast food consumption: Urban centers like Karachi, Lahore, and Islamabad have seen a proliferation of fast food outlets

2. Sedentary Lifestyles:

Physical inactivity has become the norm rather than the exception in urban Pakistan:

• Desk jobs replacing manual labor

• Increased reliance on cars and ride-hailing services

• Limited walkable spaces in cities

• Reduced physical education in schools

These behaviors often lead to obesity and weight gain, which are significant risk factors for insulin resistance .

3. Obesity:

Obesity, particularly among women, is a major driver of diabetes in Pakistan. Excess body fat, especially around the abdomen, increases insulin resistance and the workload on pancreatic beta cells.

Pathway 2: Genetic Predisposition

South Asians, including Pakistanis, have a three times higher susceptibility to developing Type 2 diabetes compared to Europeans .

Genetic Factors Specific to South Asians:

• Adiponectin Levels: South Asians have comparatively lower levels of adiponectin (encoded by the ADIPOQ gene), which results in decreased metabolism of glucose and lipids in insulin-sensitive tissues .

• GRB14 Polymorphism: Genetic polymorphism in growth factor receptor-bound protein 14 (GRB14) causes lower insulin sensitivity in South Asians, requiring higher levels of insulin to maintain normal blood sugar .

• PPARG2 Variants: Polymorphism in peroxisome proliferator-activated receptor gamma 2 (PPARG2) results in variable pancreatic beta cell function and adiposity among South Asians .

• Family History: Having a first-degree relative with diabetes significantly increases personal risk, reflecting both genetic inheritance and shared environmental factors .

Pathway 3: Limited Healthcare Access and Awareness

The second major pathway contributing to diabetes burden in Pakistan is limited healthcare access, which results in delayed diagnosis and poor management .

Urban-Rural Disparities:

Aspect	Urban Population	Rural Population
Diabetes Prevalence	Higher reported (~26.7% in Karachi) due to better detection	Lower reported (~13.9% in rural Sindh) but likely underdiagnosed
Healthcare Access	Better facilities and diagnostic services	Limited infrastructure and trained professionals
Key Challenges	Sedentary lifestyle, unhealthy diet	Low literacy, poor access to care
Intervention Needs	Lifestyle modification programs	Community outreach, mobile screening units

Barriers to Care:

• Limited screening: Many Pakistanis remain undiagnosed until complications appear
• High treatment costs: Diabetes medications and monitoring supplies are expensive relative to incomes
• Inadequate primary care infrastructure: Especially in rural areas
• Low health literacy: Limited understanding of diabetes risk factors and management. You can buy anti diabetics online in Pakistan from CSH Pharmacy, an online medical store in Lahore and across Pakistan.

Pathway 4: Other Contributing Factors

1. Hypertension and Dyslipidemia:
High blood pressure and abnormal cholesterol levels are both risk factors for and consequences of diabetes, creating a dangerous cycle of metabolic dysfunction.

2. Smoking and Tobacco Use:
Pakistan has one of the highest rates of tobacco use in the world, including cigarettes, gutka, paan, and naswar. Smoking induces insulin resistance and increases diabetes risk .

3. COVID-19 Connection:
Recent studies have shown that SARS-CoV-2 binds to ACE2 receptors, which are also present in large quantities on pancreatic cells, leading to speculation about possible pancreatic damage and the development of diabetes in previously non-diabetic patients .

4. Economic Factors:

• Low healthcare budgets: Limited public spending on preventive care

• Inflation: Rising costs make healthy food options less affordable

• Unequal access to insulin: Due to lack of government policies on insulin selection and price standardization 

• Substandard supply chain: Pakistan's low-quality cold storage system affects insulin quality 

Part 3: Complications of Uncontrolled Diabetes

Diabetes either Type 1 or Type 2 can lead to various acute and chronic complications .

Macrovascular Complications (Affecting Large Blood Vessels)

• Ischemic heart disease: Affects 28.2% of diabetic patients in some studies 

• Stroke: 8.5% prevalence

• Peripheral vascular disease: 5.4% prevalence

Microvascular Complications (Affecting Small Blood Vessels)

A national multicenter observational study across 20 cities in Pakistan documented the prevalence of microvascular complications at 68.6% . These include:

• Diabetic retinopathy: Leading cause of blindness

• Diabetic nephropathy: Leading cause of kidney failure requiring dialysis or transplantation

• Diabetic neuropathy: Nerve damage causing numbness and foot ulcers

Part 4: Prevention and Management Strategies for Pakistan

Early Detection: Recognizing the Warning Signs

Doctors have identified common symptoms of diabetes, including:

• Excessive thirst

• Frequent urination

• Unexplained weight loss

• Fatigue

• Blurred vision

• Slow-healing wounds

"Prediabetes is reversible if caught in time," says Dr. Ahmal Khan, Medical Specialist and Diabetologist at Saeed International Hospital, Islamabad. "Regular checkups, especially for people above 30 or those with a family history of diabetes, are crucial" .

Lifestyle Modifications

Experts emphasize that diabetes management requires lifelong commitment and lifestyle adjustments:

• Balanced diet: Rich in vegetables, whole grains, lean proteins, and healthy fats
• Daily physical activity: Even 30 minutes of walking can significantly improve blood sugar control
• Stress management: Chronic stress raises cortisol levels, which increase blood sugar
• Smoking cessation: Quitting tobacco use dramatically reduces diabetes complications

"Treatment is not only about medicines; it's about a complete lifestyle shift," said Dr. Ahmal .

Regular Screening and Medical Care

• Regular blood glucose monitoring
• Annual HbA1c testing
• Eye examinations for retinopathy screening
• Kidney function tests
• Foot examinations to prevent ulcers and amputations
• Medication Adherence

For those diagnosed with diabetes, consistent medication or insulin therapy, when needed, helps prevent complications.

Conclusion: A Call to Action

Pakistan's diabetes epidemic is a complex crisis driven by behavioral factors (poor diet, physical inactivity, obesity) and systemic barriers (limited healthcare access, genetic predisposition, economic constraints). However, diabetes is largely preventable and manageable with early detection and consistent care.

Health professionals agree that prevention must begin at home through awareness, discipline, and commitment to a healthier lifestyle . As Pakistan faces an escalating number of diabetes cases, the message is clear: know your risk, know your response, and take action today before complications develop.