The overlooked link between malaria and diabetes

As the world marks World Malaria Day 2025 on 25 April, we are reminded of the global toll of this infectious disease. With 263 million new cases and 597,000 deaths in 2023 alone—95% of which occurred in the WHO African Region—malaria remains a leading cause of illness and death in many low- and middle-income countries (LMICs).

While malaria and diabetes may seem like vastly different health challenges—one infectious, the other chronic—they increasingly overlap. The regions most affected by malaria are primarily in countries where rapid urbanisation, limited healthcare infrastructure and rising diabetes prevalence collide with persistent infectious disease burdens. Managing both adds pressure to already stretched health systems.

Health systems address the differing needs of rural and urban communities while also trying to manage the complex challenges of malaria and diabetes. These regions are shifting their focus from infectious diseases to managing chronic conditions, which requires more resources and better care integration. Dual-disease screening, adjusting treatment protocols, and training providers to handle comorbidities are part of the solution.

While malaria and diabetes may seem like vastly different health challenges—one infectious, the other chronic—they increasingly overlap.

Regions facing a dual malaria and diabetes challenge

Sub-Saharan Africa is the region most acutely affected by this dual burden, accounting for approximately 95% of global malaria cases and deaths, and an estimated 25 million people living with diabetes, the highest proportion of people living with undiagnosed diabetes and the highest predicted diabetes increase by 2050.

Countries like Nigeria, Ethiopia, Tanzania, Ghana and Kenya are dealing with a surge in non-communicable diseases (NCDs) like diabetes, even as malaria continues to exert a heavy toll. Health systems in this region often remain underfunded and heavily oriented toward infectious disease control, leaving significant gaps in the capacity to manage chronic conditions and their interactions with diseases like malaria.

While malaria is less widespread than in Africa or Asia, it remains a serious concern in rural and forested areas of South America.

In South East Asia, the double burden of malaria and diabetes is becoming increasingly common. India, for example, has close to 90 million people living with diabetes and still experiences endemic malaria in several states. Countries such as Bangladesh, Myanmar and Indonesia also face an overlap, particularly in populations that span both urban areas, where diabetes is more prevalent, and rural or forested areas where malaria remains endemic.

This is also true in parts of South America—especially in Amazon basin countries like Brazil, Colombia, Venezuela, and Peru. While malaria is less widespread than in Africa or Asia, it remains a serious concern in rural and forested areas. At the same time, diabetes prevalence is growing in urban populations. Brazil stands out for its efforts to distribute diabetes medications at the federal level. Still, it continues to battle malaria outbreaks in its northern regions, highlighting the complex geographic disparities within a single country.

A hidden comorbidity: when malaria meets diabetes

The relationship between diabetes and malaria is often overshadowed by more widely recognised comorbidities. However, emerging research suggests this connection deserves much greater attention, especially in regions where both conditions are rising.

People with diabetes have weakened immune systems due to chronic high blood glucose (hyperglycaemia), making them more vulnerable to severe malaria. Studies show that diabetes can prolong parasite clearance times and increase the risk of complications like cerebral malaria and acute kidney injury.

Both malaria and diabetes are inflammatory conditions. This dual burden may worsen outcomes, particularly in vulnerable groups such as pregnant women and ageing populations.

People living with type 1 and type 2 diabetes are sometimes misdiagnosed with malaria, particularly in regions where malaria is common and health resources are limited. This can happen because early symptoms of diabetes can closely mimic those of malaria, leading to misinterpretation in clinical settings where advanced diagnostic tools are absent.

The impact of recent funding cuts

Many countries facing high diabetes rates are also grappling with infectious diseases like malaria, tuberculosis, or HIV. When international aid is reduced—such as the 2025 US funding cuts impacting malaria programmes—it doesn’t just affect infectious disease management. It also diverts resources away from NCDs like diabetes, weakens the health infrastructure needed to manage chronic conditions and increases competition for already limited medical staff and supplies.

Treatment challenges and drug interactions

Antimalarial drugs like quinine and artemisinin derivatives can significantly alter blood glucose levels, triggering either low or high blood glucose. For people living with diabetes, these fluctuations can be dangerous, requiring close monitoring and personalised treatment protocols.

Some studies suggest that malaria during pregnancy may raise the risk of gestational diabetes. Repeated malaria infections may contribute to insulin resistance, potentially linking malaria exposure to an increased risk of developing type 2 diabetes over time.

Policy and practice: rethinking our approach

Stronger policies and long-term planning that prioritise people and prevention can ensure an effective response to malaria and diabetes.

A fresh approach to care can better address the connection between malaria and diabetes. That means screening for both conditions, especially in people at higher risk. th conditions simultaneously. Finally, raising community awareness about how chronic and infectious diseases can interact is just as important.

Ending malaria benefits everyone

In the 1960s, rates of malaria were decreasing until global eradication efforts were abandoned entirely in 1969, causing the loss of millions of lives. During this time, lifestyles and dietary habits began to shift, especially in wealthier nations, and diabetes, especially type 2 diabetes, began to emerge as a chronic condition.

It took the world 30 years to renew momentum to fight malaria, starting with a key milestone in 1998, when the Roll Back Malaria (RBM) Partnership was launched by WHO, UNICEF, UNDP and the World Bank to coordinate global action against malaria.  Today, malaria still claims lives in many regions, while diabetes continues to rise worldwide.

Eliminating malaria will free up strained healthcare resources in endemic regions, allowing for better diabetes screening, treatment and prevention programmes. It also reduces infection risks and related complications for people with diabetes, improving overall health outcomes. Ending malaria benefits everyone.

World Malaria Day 2025 - Malaria Ends with Us: Reinvest, Reimagine, Reignite

On World Malaria Day 2025, the World Health Organization (WHO) joins the RBM Partnership to End Malaria and other partners in promoting “Malaria Ends With Us: Reinvest, Reimagine, Reignite”, a grassroots campaign that aims to re-energise efforts at all levels, from global policy to community action, to accelerate progress towards malaria elimination. 

Follow the campaign at www.who.int/campaigns/world-malaria-day/2025