Mauritius is the first country to show it is reversing the type 2 diabetes epidemic using gold-standard testing
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New research presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy, Sept. 28–Oct. 2 and published in The Lancet Diabetes & Endocrinology shows that the small island nation of Mauritius is the first country to demonstrate that it is reversing the type 2 diabetes epidemic using the gold-standard two-hour oral glucose tolerance test (2 hour OGTT).
The authors, who include Jaakko Tuomilehto of the Department of Public Health at the University of Helsinki in Finland, say the achievement offers hope to countries battling the human and economic costs of type 2 diabetes.
Testing methods can miss diabetes cases
The prevalence of type 2 diabetes has been increasing globally for decades. Estimates are based primarily on population surveys conducted in some countries and routine administrative data sources, while no survey data are available for most countries. Only a few countries have conducted repeated diabetes surveys over many years.
Moreover, survey methods have varied across countries, and most studies have not followed the standard recommended by the World Health Organization (WHO): the 2-hour OGTT.
Studies that have not relied on OGTTs have likely produced biased and underestimated prevalence estimates for diabetes and intermediate hyperglycemia (also called prediabetes). Today, including in many high-income countries, initial testing for type 2 diabetes often measures fasting plasma glucose or glycated hemoglobin (HbA1c) in the blood. But these tests have been shown to miss many asymptomatic cases that a 2-hour OGTT can detect.
The OGTT requires fasting—consuming nothing except water—for at least eight to 10 hours before the test. A health care professional then takes a blood sample to test the person's fasting blood sugar level. The person drinks a sweet liquid containing a specific amount of glucose, usually 75 grams for adults, and additional blood samples are taken, typically one hour and two hours after the drink is finished. Until the final blood sample is taken, the person must remain sedentary and avoid eating, drinking anything else, smoking and exercising.
Decades of surveys document a reversal
Mauritius, an island nation in the Indian Ocean east of Madagascar with a population of 1.2 million, has undergone a profound socioeconomic transition. Changing living conditions and lifestyles have shifted its disease burden from infectious to chronic noncommunicable diseases (NCDs), including type 2 diabetes. In this respect, Mauritius is similar to many other island nations, including those in the Pacific Ocean, that have seen obesity and type 2 diabetes surge since the 1980s.
Unlike other nations, however, Mauritius has monitored this transition and diabetes prevalence through seven cross-sectional surveys conducted since 1987.
Paul Zimmet, currently a professor of diabetes at Monash University in Melbourne, Australia, initiated the surveys, which were conducted by staff at the Ministry of Health and Wellness. Teams led by Zimmet, Tuomilehto and Sir George Alberti of the U.K. supported the surveys, and more recently, so did Stefan Söderberg of Umeå, Sweden.
Each survey assessed type 2 diabetes and intermediate hyperglycemia using the OGTT. Mauritius is the only country that has systematically used the OGTT to monitor both conditions over time. In this study, the authors investigated long-term changes in their prevalence using population-based OGTT data. The results for each year were as follows:
- 1987—overall, 14.7%; women, 14.0%; men, 15.3%
- 1992—overall, 17.3%; women, 16.6%; men, 18.0%
- 1998—overall, 20.2%; women, 19.3%; men, 21.1%
- 2004—overall, 18.6%; women, 18.3%; men, 18.7%
- 2009—overall, 23.3%; women, 22.0%; men, 24.7%
- 2015—overall, 23.1%; women, 23.7%; men, 22.6%
- 2021—overall, 19.9%; women, 18.1%; men, 21.7%
Type 2 diabetes prevalence increased between 1987 and 2009 by 61% in men and 56% in women. Between 2009 and 2021, it decreased by 11% in men and 16% in women.
Prevention policies and free public care
The authors examine several possible reasons for Mauritius' success. They say the results highlight the potential effect of initiatives to prevent and manage type 2 diabetes.
These multisectoral approaches include:
- Prevention measures, including an action plan; policy measures, including advocacy and legislation; NCD risk-factor screening, including mobile clinics; and community engagement and participation, including national action plans for nutrition, physical activity and tobacco control
- A national integrated NCD action plan, providing a road map to improve health and well-being throughout life
- A national service framework for NCDs, setting standards of care and quality within a service protocol. Public-sector health services, including essential medicines, are free of charge
The authors conclude, "Mauritius is the first country to show a sustained decrease in the prevalence of type 2 diabetes and prediabetes, based on long-term data using the WHO-recommended gold-standard oral glucose tolerance test–based diagnostic criteria.
"It is encouraging to learn that the continuous increase in type 2 diabetes occurring in almost all countries around the world could be halted and even reversed. Previous experiences with other major public health problems, such as cardiovascular diseases and lung cancer, have shown that it is possible to tackle chronic NCD epidemics."
Publication details
Trends in prevalence of type 2 diabetes and intermediate hyperglycaemia in Mauritius from 1987 to 2021 based on results from the oral glucose tolerance test: a repeated cross-sectional study, The Lancet Diabetes & Endocrinology (2026). DOI: 10.1016/S2213-8587(26)00127-0. www.thelancet.com/journals/lan … (26)00127-0/fulltext
What Mauritius teaches us about diabetes surveillance, The Lancet Diabetes & Endocrinology (2026). DOI: 10.1016/S2213-8587(26)00159-2. www.thelancet.com/journals/lan … (26)00159-2/fulltext
Journal information: The Lancet Diabetes & Endocrinology
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EndocrinologyCommon illnesses & PreventionPreventive medicineHealthy living Provided by European Association for the Study of Diabetes Who's behind this story?
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