Diabetes cases are likely to skyrocket over the next few decades, new research out this week has found. The study estimates that more than a billion people worldwide will be living with the chronic condition by 2050—roughly double the amount of cases seen today. The prevalence of diabetes is expected to be especially high in parts of Africa and the Middle East, but dozens of countries could experience substantial increases.

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In the simplest terms, diabetes is defined as having chronically high levels of blood sugar. This usually happens due to a breakdown in our production of or response to insulin, a hormone that helps move sugar from the bloodstream to our cells. People with type 1 diabetes, for instance, have an overzealous immune system that attacks the cells responsible for making insulin. And those with type 2 diabetes develop a resistance to insulin’s effects and can eventually stop producing it altogether.

Thanks to medications and better blood sugar monitoring, diabetes is no longer the death sentence it once was. But it can still lead to serious complications like nerve damage and chronic kidney disease, especially if not managed probably. It also often raises the odds of many other health conditions, including heart attacks, stroke, and dementia. And according to the authors of a study published Thursday in the Lancet, the burden of diabetes will only go up from here.

The research comes from scientists at the Institute for Health Metrics and Evaluation (IHME), based at the University of Washington’s School of Medicine. To come up with their predictions, the team used the latest data from the Global Burden of Diseases study, a long-running research project also managed by the IHME that tries to track the prevalence of and harm caused by many health conditions and illnesses.

Based on the GBD data, there were about 529 million people living with diabetes worldwide in 2021. After adjusting for age, the current global prevalence was around 6.1%. But by 2050, 1.31 billion people will have some form of diabetes, the authors found. The highest age-standardized prevalence rate for a large region is projected to be in North Africa and the Middle East, at 16.8%, but nearly half of the world’s over 200 countries and territories will have rates higher than 10%.

“The rapid rate at which diabetes is growing is not only alarming but also challenging for every health system in the world, especially given how the disease also increases the risk for ischemic heart disease and stroke,” said lead author Liane Ong, a lead research scientist at the IHME, in a statement released by the organization.

Over 95% of these cases are expected to be type 2 diabetes. And the single most significant risk factor associated with type 2 was high body mass index. But the authors note that many other important factors, including low levels of exercise, poor diet, and a person’s genetics, can influence the risk of developing diabetes and the potential harm or death it can cause. So preventing or managing diabetes cases now and in the future will require widespread improvements in our environment and availability of health care, the authors say.

“Some people might be quick to focus on one or a few risk factors, but that approach doesn’t take into account the conditions in which people are born and live that create disparities worldwide,” said study author Lauryn Stafford, a research fellow at IHME. “Those inequities ultimately impact people’s access to screening and treatment and the availability of health services. That’s precisely why we need a more complete picture of how diabetes has been impacting populations at a granular level.”