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THE TYPE 2 DIABETES EPIDEMIC IN ASIA

So prevalent is type 2 diabetes these days that we probably don’t need to spend long describing its causes and symptoms. In short, type 2 diabetes (by far the most common type of diabetes) is where the body is unable to produce enough insulin, or when the insulin produced does not work properly. This is known as insulin resistance. Why is this a problem? Insulin is a chemical used throughout the body to manage levels of sugar in the blood, and convert glucose to energy.

Insulin resistance and in turn type 2 diabetes is thought to have several causes, with genetics and lifestyle leading the way. Among the lifestyle risk factors are poor diet and sedentary lifestyle, both of which often lead to insulin not working in the body as it should, allowing the disease to develop.

Cases of type 2 diabetes are increasingly common throughout the world – the number of people globally with the disease has risen from 108 million in 1980 to 422 million in 2014, according to the World Health Organization (WHO).

But there is one area of the globe where the issue is particularly prevalent: Asia. As recently highlighted in Nature Reviews Endocrinology, some 60% of the world’s diabetic population is Asian. So how does this problem break down by country, and what can be done to reverse this worrying trend? 

The number of people globally with
type 2 diabetes has risen from
108 million in 1980 to 422 million in 2014,
according to the World Health Organization.

 

Type 2 diabetes in Asia: A regional overview

So let’s take a quick look at the problem in Asia by region.

In Southeast Asia, over 25 million adults are thought to have the disease. Indonesia leads with over 10 million diabetics among its population, followed by Thailand (4 million), the Philippines (3.5m), Vietnam (3.5m) and Malaysia (3.3m). What’s most worrying is that according to recent data from the International Diabetes Federation, cases are set to rise sharply in each of these countries between now and 2040.

Aside from the devastating health consequences of such an epidemic throughout the region, there is also a huge financial liability. The Southeast Asia type 2 diabetes burden is set to be an incredible $2.7 billion annually by the year 2022 – with corporations, insurers and governments set to foot the bill.

As for East Asia, China is incredibly significant is its place in the diabetes epidemic. The country is home to over 114 million diabetics and has recently overtaken the USA in terms of the disease’s prevalence. China spends around $26 billion on diabetes-related medical costs every year – equating to around 13% of the country’s total health spend.

Moving to South Asia, research presented at the UK’s Diabetes Professional Conference in 2014 found that those of South Asian descent in the UK were up to six times more likely to have diabetes than their counterparts of European heritage. In India itself, research has shown that due to body composition (where fat is stored) many Indians are at increased risk.

So the current picture for the various regions is not positive, but this does not mean it is hopeless.

The question of genetics versus lifestyle

Genetics certainly plays a role. But this is just one small part of the puzzle. What we are talking about here is lifestyle, and we can start with urbanisation and modernisation in the entire region which has led to more sedentary lifestyles. What’s more, the traditional Asian diet contains many foods – rice and other grains, excessive trans fats, etc. – that are all linked to increased risk for diabetes. Then there’s the fact that nearly 50% of adult men throughout Asia regularly smoke, which according to the American Diabetes Association is linked with a 45% increased risk of developing the disease.

The traditional Asian diet contains many
foods – such as grains and trans fats – that
are all linked to increased risk for diabetes.

This all starts to create a perfect storm of factors that are linked to an increase in the likelihood of developing diabetes. So the next question is how can we be proactive in tackling this situation, and what are the practical steps that everyone can take? 

From government to insurers: A role for everyone

Perhaps the most troubling aspect of Asia’s type 2 diabetes problem is the fact that the vast majority of cases of the disease are preventable – up to nine out of ten, according to the Harvard School of Public Health. This is hardly surprising given that all-too-common lifestyle factors such as smoking, drinking, eating poor foods, and inactivity are all proven to increase risk for the disease.

Although these activities are matters of choice, many are heavily ingrained in our way of life, and making positive changes to slow the rate of diabetes will most certainly not happen overnight. In fact, it can only happen through the collective effort of everyone from government and large corporations to doctors and parents.

With that in mind, let’s take a look at what we can all do to get a handle on Asia’s diabetes problem.  

Government: As with any medical epidemic, the first place we look is to government. Of course, the lifestyle factors that lead to diabetes are a personal choice. However, governments can play a huge role in influencing these choices by providing education on diet and overall nutrition, exercise, and many other lifestyle factors. This is particularly true in the case of young expectant mothers, as several studies have shown that poor diet during pregnancy can lead to children having high blood sugar in later life. Additionally, several countries around the world including the UK have looked into the possibility of levying a tax on high-fat and high-sugar foods to deter unhealthy lifestyles.  

Medical professionals: The medical profession also has a duty to educate. The onus here should be firmly on prevention rather than cure. Not only are a huge number of cases of type 2 diabetes preventable but there is also a growing body of evidence to suggest that in some cases the disease can be reversed, providing it is caught early. Therefore, medical professionals should be warning patients of the risk of developing type 2 diabetes when they present as overweight or obese – as well as promoting regular health checks.  

Corporations: While it may seem like the health of a country’s citizens is out of a corporation’s control, it is clear that employers are actually well-placed to change habits and behaviours considering how long the average person spends at work. The most effective way to do this is through corporate wellness programs, which can range from gym memberships and weight loss clubs through to healthy lunch options and nutritional advice. A comprehensive wellness program should also encompass access to nutritionists and other health professionals, as well as regular medical screening.  

Insurance companies: This is pretty straightforward: Screening. Insurers could easily implement thorough health screenings for all policyholders – not just at commencement, but throughout employment. Screenings can check for early indicators of pre-diabetes, as well as issues such as overweight and obesity. It’s getting ahead of the problem, rather than always being in a reactive state, that is going to help everyone concerned.

Screenings can check for earlier indicators of
pre-diabetes, as well as issues such as
overweight and obesity.

 

Getting a grip on Asia’s type 2 diabetes problem

In the face of statistics such as those above, it is easy to feel helpless to stop the rise of type 2 diabetes. However, the evidence is clear that the majority of type 2 diabetes cases can be prevented. For this to happen will require sweeping changes in society – particularly in how food and nutrition is viewed. Ultimately, what has to change is the way this disease is thought about – not as something that happens to us, but as something that we have a huge amount of control over.

On a similar note, we must change the way we think about administering treatment. Waiting for diagnosis and then treating the symptoms is not enough. We must catch potential cases much earlier and work to prevent or even reverse the situation rather than just manage symptoms.

Ultimately, the answer to the growing diabetes crisis is a simple one: Proactive healthcare and the promotion of a healthy diet and active lifestyle by governments, healthcare providers, corporations, insurers and individuals.

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