Diabetes is one of the biggest medical concerns in developing nations. It is a chronic disease that is generally of two types: Type 1, when the pancreas doesn't produce enough insulin or Type 2, when the body can't use the insulin it produces effectively enough.
According to the World Health Organisation (WHO), an estimated 96 million people were suffering from diabetes in Southeast Asia in 2017. By 2030, the number is projected to reach over 119 million.
Data provided by the International Diabetes Federation also paints a grim picture. As per the IDF, 82 million adults in the age-group of 20-79 years were living with diabetes in the Southeast Asia region in 2017. This includes countries like Singapore, Indonesia, Malaysia, Thailand, and India. Almost 20% (159 million) of the world's diabetic population, which is currently at 450 million, live in these developing countries.
The region indicates a prevalence of 8.5%. The IDF also observed that over 45% of these cases were not even diagnosed. This is a cause for concern for governments and citizens alike.
What causes this prevalence of diabetes in Southeast Asian Countries?
Firstly, experts feel that people living in these countries naturally produce a lower amount of insulin in the body. According to KM Venkat Narayan, expert researcher of diabetes at the US-based Rollins School of Public Health at Emory University, once the glucose levels of those living in Southeast Asian countries reach pre-diabetic levels, they quickly develop diabetes.
Growing obesity in Southeast Asia is one of the reasons for the hike in adult-onset or Type 2 diabetes. Obesity greatly increases the risk of high blood pressure and Type 2 Diabetes. Between 2010 and 2014, obesity surged 24% in Singapore, Malaysia saw a jump of 27% in the same period while Vietnam saw a 38% rise in cases of obesity.
How is Southeast Asia fighting the war on diabetes?
However, countries are finally stepping up and taking charge of the situation. As part of its "War on diabetes", Singapore recently banned the advertising of sugary drinks such as aerated colas and others to curb the growth of diabetes. Singapore's Health Ministry has also said that it is exploring the idea of banning sugar or taxing to reduce consumption.
Singapore has also asked SSB (sugar-sweetened beverages) manufacturers to use less sugar while producing drinks and mandated colour-coded nutrition labels on packages of drinks with high sugar content. It is the first country in the world to have taken such a radical step.
This measure could prove to be beneficial for Singapore, which had over 606,000 people suffering from diabetes in 2017, as studies have linked an increase in diabetes with increased consumption of colas and packaged juices.
To address the problem of growing diabetes and related NCD risks, Sri Lanka has also set up hundreds of healthy "lifestyle centres". Such centres can solve the problems of a lack of structured screening of patients at the primary level of healthcare. Currently, there are over 800 lifestyle centres in Sri Lanka that can screen patients for high blood pressure, cholesterol, blood sugar, and obesity as well as overweight, all of which are factors that contribute to diabetes and other cardiovascular diseases.
In India, which has over 70 million diabetic patients, the government is implementing the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) to increase awareness of diabetes at a district level. It provides testing, diagnosis and treatment facilities for diabetes at different levels. It is also trying to reduce the cost and increase the availability of insulin to enhance treatment.
However, at an administrative level, providing early diagnosis and testing facilities is not enough. The scope of efforts to diabetics should also include refurbishing transport, urban planning, economic and fiscal policies. Including increased spaces to walk in the city and incentivising healthy modes of transport such as cycling could be a way forward.
The Role of Public Health Intervention in Treating Diabetes
Nearly half (48.8%) of all adults with diabetes in Southeast Asian countries live in urban areas, as per IDF data.
While countries are trying to implement policies to curb production and consumption of sugar-rich products and increasing early screening facilities to detect diabetes at an early stage, experts have many suggestions that individuals and families can implement at their level.
This includes adopting a healthy lifestyle that consists of a balanced diet and regular exercise. A diabetic meal plan would include monitoring one's calorie, fat and carbohydrate intake that can ensure there are no spikes in calorie consumption.
Sugary drinks such as colas or packaged juices along with sugar-rich foods such as confectionery items should be avoided to the maximum extent.
If developing countries are unable to manage the level of diabetes in the population, the consequences can be grave. Experts warn that high blood sugar levels can damage the large blood vessels in the brain, heart, and legs, causing macro-vascular complications. It can also damage small blood vessels that can lead to poor or failing ye-sight, kidneys, nerves and feel, resulting in microvascular complications.
Not treating the prevalence of diabetes at a national level could spell catastrophe for any nation. High rates of diabetes reduce the morbidity and mortality rate of a population and even result in decreased life expectancy. An unhealthy workforce also means lower productivity and increased expenditure on public health.
Public health interventions at national as well as district and local levels as well as increased awareness of the risks and causes of diabetes within families and organisations could greatly impact the prevalence of diabetes in Southeast Asia.