IDF Diabetes AtlasDiabetes in South-East Asia: An update
Introduction
The global prevalence of diabetes, and especially type 2 diabetes (T2DM), is increasing at an alarming rate. According to the recent update by the International Diabetes Federation (IDF) more than 382 million adults aged 20–79 years had diabetes in 2013 [1]. The prevalence is increasing in every country, and major economic, social and healthcare impacts will be seen in developing countries, as these countries are home to as much as 80% of people with diabetes [1].
Prevalence estimates of diabetes and Impaired Glucose Tolerance (IGT) are high for all South-East Asia countries and are expected to increase further in the next two decades [2]. The South-East Asia (SEA) Region is estimated to have more than 72 million adults with diabetes and 24.3 million with IGT. The present trend indicates that more than 60% of the world's population of people with diabetes will be in Asia. The number of people with diabetes will exceed 123 million in 2035 unless drastic steps are taken to curb this trend [1].
Section snippets
Rising prevalence of type 1 diabetes
The estimates of the global incidence of type 1 diabetes (T1DM) have mainly been based on limited epidemiological studies [3]. Given the relatively rare occurrence of T1DM in Asian populations, as well as the heterogeneity of phenotype in young people with diabetes, data collection has not been as systematic as those in Western countries, where national registries of patients with T1DM are available [3]. Most countries in Asia do not have established registries for T1DM, making data collection
Risk factors
The rising trend in diabetes prevalence in Asian countries in general and the SEA Region in particular, is associated with the risk factors shown in Fig. 1. Several peculiar genetic characteristics and acquired risk factors heighten the predisposition to the disease, and environmental and social conditions accelerate development of metabolic disorders. The adverse metabolic profile that is often seen in obese and elderly white populations is often manifested in young and non-obese SEA
Healthcare burden
Nineteen percent of people with diabetes live in SEA, yet one quarter of the 12 million deaths worldwide due to diabetes occur in this Region. More than 55% of people with diabetes in the region die under the age of 60 years [2]. Major contributory factors for development of complications include delayed diagnosis, sub-optimal control of glycaemia and hypertension, and inadequate medical facilities. There is a need for greater awareness of the benefits of early detection and tight control of
Morbidity and mortality
The evaluation of prevalence of complications in Asian countries has been hindered by the lack of national data, and there are only a few systematic comparisons between countries or people of different ethnic backgrounds. However, the research that has been conducted suggests that South Asians have a general predisposition to renal disease and cardiovascular disease compared to Europeans. Cardiovascular disease susceptibility has been attributed to visceral adiposity and the “thin-fat”
Prevention of diabetes
Prevention of diabetes and obesity are cost effective strategies. Several systematic clinical trials have shown the effectiveness and safety of lifestyle modification in preventing T2DM in varied ethnic populations [47]. Lifestyle intervention was found to be effective in Asian Indian subjects with IGT, with a risk reduction in incident diabetes of approximately 30% in 3 years compared with standard care [17]. The metabolic benefits were seen in non-obese subjects, independent of weight
The way forward
The challenges lie in improving the awareness level among the public on the risk factors for diabetes and then taking steps to prevent the disease. Empowering and educating self-care by patients and improving the training of medical community are also urgent requirements for countries in the SEA Region. Efforts to improve diabetes care and screening of complications have utilised different approaches. Several regional studies are examining the use of information technology such as mobile phone
Conclusions
SEA countries are facing a huge healthcare and economic burden from the rising prevalence of diabetes and its complications in both urban and rural communities. Adverse gene-environmental interactions due to rapid urbanisation and Westernisation have further escalated the prevalence of obesity and diabetes in most of these countries. The regional prevalence of diabetes among adults in SEA is estimated at 8.2% in 2013, which is projected to increase to 10.1% in 2035. The prevalence of IGT will
Conflicts of interest
There are no conflicts of interest.
Acknowledgements
The authors would like to thank Ram Jagannathan and Mary Simon for helping in literature collection. The authors would also like to thank Vijaya L for secretarial assistance.
The 6th edition of the IDF Diabetes Atlas was supported by the following sponsors: Lilly Diabetes, Merck and Co, Inc., Novo Nordisk A/S supported through an unrestricted grant by the Novo Nordisk Changing Diabetes® initiative, Pfizer, Inc., and Sanofi Diabetes.
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