Diabetes in Nepal: A Silent Public Health Risk and the Need for a New Approach to Detection and Control

# Adrian Mercer

Diabetes is still commonly understood simply as a “sugar disease.” But elevated blood glucose is only one of its defining features. When diabetes remains uncontrolled over a long period, it can gradually damage the heart, kidneys, eyes, blood vessels and nervous system. A particularly challenging aspect is that Type 2 diabetes can develop for years without obvious symptoms, and by the time it is diagnosed, complications may already have begun in some patients.

Global data show that diabetes has become a major public health challenge. According to the World Health Organization, around 830 million people worldwide were living with diabetes in 2022. Among adults aged 18 years and above, prevalence increased from about 7 percent in 1990 to 14 percent in 2022. The rise has been particularly rapid in low- and middle-income countries.

Diabetes, however, is not a single type of disease. In Type 1 diabetes, the body is unable to produce the insulin it needs, and there is currently no proven method of prevention. In Type 2 diabetes, the body becomes less able to use insulin effectively. Most people with diabetes worldwide have Type 2, and measures such as a healthy diet, regular physical activity, maintaining a healthy body weight and avoiding tobacco can help reduce the risk or delay its onset.

Nepal’s situation must be interpreted with similar care. The STEPS 2019 survey, conducted by the Nepal Health Research Council with technical support from the World Health Organization, included more than 5,500 people aged 15 to 69. Elevated blood glucose was identified in 5.8 percent of participants.

That figure, however, should not be interpreted as the direct national prevalence of clinically diagnosed diabetes. STEPS is primarily a population-level survey of risk factors for noncommunicable diseases. Elevated blood glucose is an important indicator of diabetes risk and possible disease burden, but it does not represent a confirmed clinical diagnosis for every participant.

The distribution of risk was also uneven. Analysis of STEPS 2019 showed that elevated blood glucose was found in around 10 percent of participants in metropolitan areas and about 8 percent in the Tarai. The proportion was comparatively lower in rural municipalities and hill regions. Risk also increased substantially with age.

These patterns underline why diabetes cannot be understood simply as a consequence of eating too much sugar.

Urbanization, declining levels of daily physical activity, growing consumption of energy-dense and highly processed foods, excess body weight, ageing and genetic predisposition all influence the risk of Type 2 diabetes. In STEPS 2019, around one-quarter of participants were classified as overweight or obese. High blood pressure, elevated blood glucose, abnormal blood lipids and excess body weight are often interconnected components of the broader burden of noncommunicable disease.

Why Is Diabetes Often Detected Late?

One of the major challenges of Type 2 diabetes is its early stage. Symptoms may include excessive thirst, frequent urination, fatigue, blurred vision or unexplained weight loss. But these signs are not always obvious. In some people, the disease can progress for a long time without producing noticeable symptoms.

The absence of symptoms therefore does not mean that diabetes is absent.

For people with risk factors such as increasing age, a family history of diabetes, excess body weight, low levels of physical activity, high blood pressure or other metabolic risks, blood glucose testing may be appropriate following assessment by a healthcare professional.

The greatest danger of diabetes often lies not in immediate discomfort but in its long-term effects. Persistently high blood glucose can damage both small and large blood vessels. This can contribute to retinal damage, impaired kidney function, nerve injury and an increased risk of heart attack and stroke.

The relationship between diabetes and kidney health is particularly important. Diabetes and high blood pressure are among the major causes of chronic kidney disease. When kidney disease progresses to its final stages, dialysis or transplantation may become necessary. Health systems therefore need not only to expand dialysis capacity, but also to detect kidney damage at an earlier stage in people with diabetes and hypertension.

Detection Before Complications

The debate over diabetes control in Nepal should not be limited to ensuring the availability of medicines in hospitals. Primary healthcare services need to be able to identify people at risk, provide appropriate testing, initiate treatment when needed and ensure continuous follow-up.

Depending on the clinical situation, diabetes can be identified using fasting blood glucose, HbA1c or other accepted diagnostic tests. A single laboratory result, however, should not be interpreted independently as a reason to start or stop medication. Diagnosis should be confirmed by healthcare professionals based on the type of test, the individual’s health condition and, where necessary, repeat testing.

Once diabetes is diagnosed, the goal of treatment should not be limited to lowering one blood glucose number. Long-term care may also require assessment of blood pressure, blood lipids, kidney function, eye health, and possible problems affecting the feet and nervous system.

This comprehensive approach can help prevent or delay complications.

The Myth That “Avoiding Sugar Is Enough”

Another common misconception is that diabetes can be controlled simply by avoiding sugar. Limiting sugary foods may be useful, but diabetes management is far more complex.

The overall quality and quantity of food, body weight, physical activity, sleep, tobacco use and a person’s wider health condition all matter. For Type 2 diabetes in particular, healthy eating, regular physical activity and maintaining a healthy body weight are important foundations for reducing risk.

But responsibility cannot be placed entirely on individuals.

Public policy also shapes whether people can make healthier choices. Affordable access to nutritious food, safe spaces for walking and physical activity, clear information on food products, and accessible testing at primary healthcare facilities all influence diabetes prevention and control.

Nepal’s Main Challenges

Nepal’s diabetes challenge can be understood at three levels. First, many people at risk do not undergo testing because they have no symptoms. Second, even after diagnosis, maintaining long-term treatment and regular follow-up can be difficult for both patients and the health system. Third, when treatment is sought only after complications involving the eyes, heart or kidneys have developed, both the health burden and financial cost increase sharply.

The solution does not lie only in building more specialist hospitals.

Nepal needs a system in which primary healthcare facilities and local governments can identify diabetes, hypertension, excess body weight and other noncommunicable disease risks in an integrated manner. The care pathway should be clear: where a person goes after screening, how frequently follow-up is required, and when tests for complications should be performed.

Health education is equally important. Blaming people with diabetes for a supposed lack of dietary discipline is not scientifically justified. Genetic predisposition, age, environment, physical activity, body weight, and social and economic conditions all contribute to the risk of Type 2 diabetes.

What Should Nepal Prioritize?

The first requirement is reliable and regularly updated national data. Rather than continuing to estimate the current situation from older surveys, Nepal needs periodic population-level surveillance and stronger disease-monitoring systems.

Second, risk assessment and testing should be institutionalized within primary healthcare. Once diabetes is diagnosed, patients need more than medication. Treatment should be linked with continued monitoring of blood pressure, kidney function, eye health and other complications.

Third, prevention should not be treated as the responsibility of the health ministry alone. Urban planning, food policy, education, schools, workplaces and local governments all have a role. A multisectoral approach is therefore essential.

The greatest danger of diabetes is not simply a single high blood glucose reading. The deeper risk lies in the damage that can accumulate over years when the disease remains undetected or inadequately controlled.

For that reason, the foundation of diabetes control is not fear but accurate information. The starting point of treatment should not be the appearance of complications, but timely detection. And the long-term solution is not merely more hospital beds or medicines, but a capable health system that connects prevention, early diagnosis, continuous treatment and monitoring of complications into a single continuum of care.