BACKGROUND: Pakistan has one of the highest diabetes prevalence rates globally, yet limited research exists on endocrinologists' perspectives regarding drivers, barriers, and solutions. METHODS: This qualitative study conducted semi-structured interviews with 21 endocrinologists across Islamabad, Rawalpindi, and Peshawar from March to April 2026. Purposive sampling was used to recruit participants. Inductive thematic analysis following Braun & Clarke's framework identified four main themes and nineteen subthemes. RESULTS: Endocrinologists perceived a drastic rise in diabetes prevalence, with most estimating that one in three adults is now affected (based on their clinical observations) and reported a 50% increase in cases over 2-3 years and early onset type 2 diabetes in patients as young as 17-20 years. Urban-rural disparities were evident: urban areas have higher prevalence driven by sedentary lifestyles and unhealthy diets, while rural populations present with advanced disease and limited access to care. Factors contributing to diabetes prevalence included unhealthy dietary habits, sedentary lifestyle, obesity (with one participant estimating 52% central obesity), genetic predisposition, and stress/sleep disturbances. Major barriers comprised poor treatment adherence, financial constraints (insulin unaffordable for many), low health literacy (with most participants estimating approximately 98% of patients lacking basic knowledge), cultural misconceptions (insulin phobia, traditional remedies), medication shortages, and healthcare system limitations (2-3 min per patient). Strategies identified were patient education (with one participant estimating 80% of disease management), early screening, primordial prevention from childhood, government support for affordable medications, and the pharmacist as an underutilized diabetes educator. CONCLUSION: Pakistan faces an accelerating diabetes epidemic with a concerning shift to younger populations. Multi-level interventions addressing financial barriers, health literacy, cultural beliefs, systemic constraints, and expanding the pharmacist's role as educator are urgently needed. CLINICAL TRIAL REGISTRATION: Not applicable.
Khan et al. (Thu,) studied this question.