A COMMON CHRONIC DISEASE IN SOUTHEAST ASIA – DIABETES

Description: Diabetes in Southeast Asia is rising fast. Explore prevalence, causes, treatments, policy trends, prevention, and an EU-GMP Vietnam Hub.

Keywords: diabetes in Southeast Asia, chronic disease Southeast Asia, diabetes prevalence Southeast Asia, undiagnosed diabetes, type 2 diabetes SEA, diabetes treatment Southeast Asia, GLP-1 Southeast Asia, SGLT2 inhibitors Southeast Asia, WHO Global Diabetes Compact, diabetes prevention SEA, EU-GMP Vietnam, Audace Pharma

Introduction

Diabetes has become one of the most common chronic diseases in Southeast Asia, reshaping public-health priorities and straining budgets already stretched by infectious-disease control and aging populations. The latest International Diabetes Federation (IDF) Diabetes Atlas estimates about 107 million adults (20–79) in the South-East Asia Region are living with diabetes in 2024—roughly one in ten—and nearly one in two (≈43%) are undiagnosed. IDF projects the regional burden to climb to ~185 million by 2050, mirroring a global surge that continues to concentrate in low- and middle-income countries. These headline numbers explain the intensifying focus on primary care, screening, and affordable access to quality therapies across the region.

2. Diabetes in Southeast Asia: prevalence and trajectory

Measured two ways—by the sheer number of people affected and by age-standardized prevalence—diabetes is moving steadily upward across Southeast Asia. Large pooled analyses by the NCD Risk Factor Collaboration show that from 1990 to 2022, age-standardized diabetes prevalence rose in most countries for both men and women, confirming a long-running epidemiologic shift rather than a short-term fluctuation. In other words, even after adjusting for differences in population age structures, the underlying risk has been climbing for decades. (The Lancet)

Most global datasets track “Southeast Asia” through adjacent WHO/IDF regions, and both point in the same direction. In the IDF South-East Asia Region (which includes several South Asian countries alongside parts of Southeast Asia), the number of adults with diabetes is projected to grow from today’s base to ~185 million by 2050, with an estimated 42.7% of adults currently living with diabetes remaining undiagnosed—a signal of missed screening and late presentation. Meanwhile, the IDF Western Pacific Region (which covers many Southeast Asian countries plus East Asia) reports the highest regional total worldwide and an undiagnosed share of ~50%. These figures are not directly interchangeable with ASEAN-only estimates, but together they describe the same reality for Southeast Asian health systems: a large and still partly invisible burden. (Diabetes Atlas)

Crucially, the caseload will keep rising even if per-person risk stopped increasing today—which it has not—because of population growth, urbanization, and longer life expectancy. More people are reaching ages where type 2 diabetes becomes common; more are exposed to urban food and activity environments that promote weight gain and insulin resistance; and more are living long enough to develop and live with chronic disease. The result is a compound trajectory: expanding populations at risk, higher age-specific prevalence, and persistently high rates of undiagnosed diabetes, all of which translate into heavier demand for screening, primary care, and long-term treatment across Southeast Asia.

3. The treatment landscape in Southeast Asia

Managing diabetes in Southeast Asia anchors on the same clinical foundations used globally, but real-world delivery is shaped by affordability, formularies, and primary-care capacity. Most ministries of health align with evidence-based guidance: begin with lifestyle intervention plus metformin for type 2 diabetes (except where contraindicated), then individualize add-on therapy by A1C target, comorbidities, hypoglycemia risk, weight goals, and patient preference. This stepwise approach, spelled out in the ADA Standards of Care 2025 and the ADA/EASD consensus framework, is increasingly reflected in national practice—though implementation varies widely across resource settings.

The big shift – not only glucose, but organs

Care is moving from “just lower A1C” to “protect the heart and kidneys.” If a person already has heart disease, heart failure, or chronic kidney disease, doctors try to add a GLP-1 receptor agonist and/or an SGLT2 inhibitor early. These medicines lower the risk of heart attacks, strokes, hospitalizations for heart failure, and kidney decline. Whether metformin is on board or not, the priority is the organ benefit; budgets and formularies decide how widely this can be used.

Insulin – when to start, how to keep it simple

Start basal insulin when blood sugar is very high, when there are catabolic symptoms (e.g., weight loss, excessive urination/thirst), or when pills/injectables don’t reach target. Begin with a simple once-daily dose and small step-ups every few days. If still above target, add small mealtime doses (basal-plus) or move to basal-bolus. In many public systems, human insulin (NPH/regular) is the affordable, reliable option. Analogue insulins can reduce low-sugar episodes and simplify dosing, but their higher cost limits access.

Blood pressure control (ACE inhibitor/ARB if albuminuria is present)

Cholesterol control (a statin for most adults ≥40, intensity matched to risk).Kidney protection (prefer SGLT2 inhibitor and/or GLP-1 RA when CKD/CVD is present).
Metformin usually stays first-line unless kidney function is very low (eGFR <30); teams monitor eGFR and adjust drugs as needed.

Education and monitoring make results stick

People do better with Diabetes Self-Management Education and Support (DSMES)—at diagnosis, when treatment changes, and when complications appear. Daily monitoring is often finger-stick (SMBG) in the public sector. CGM is growing where it’s reimbursed or affordable, especially for insulin users. Tele-education and app-based coaching help busy clinics keep patients on track.

A practical “ladder” when budgets are tight

A common pathway in ASEAN systems looks like this:
Lifestyle + metformin → add a low-hypoglycemia medicine (SGLT2 inhibitor where indicated/available; if not, DPP-4 inhibitor or careful sulfonylurea) → start basal insulin if targets aren’t met or symptoms appear.
As formularies expand, add GLP-1 RA for people with obesity or CVD, and prioritize SGLT2 inhibitors for CKD/heart failure.

The real constraint – coverage and continuity

Science is not the problem; access is. Progress depends on stable financing, procurement that avoids stock-outs, coverage for essential and organ-protective drugs, and DSMES embedded in primary care. When these system pieces are in place, outcomes improve—even before the newest therapies reach everyone.

4. Policy and market trends reshaping diabetes in Southeast Asia

Fiscal and labeling policies to curb sugar intake

Across Southeast Asia, governments are using taxes and labels to shift purchasing toward lower-sugar options.

Thailand introduced a tiered excise tax on sugar-sweetened beverages (SSBs) in 2017, structured with progressive sugar bands and phased rate changes to encourage reformulation and reduce consumption. Evaluations and policy briefs describe it as a health-motivated levy designed to nudge both producers and consumers over multiple implementation phases.
In the Philippines, the TRAIN Act (2018) set per-liter excise rates (a lower rate for beverages sweetened with caloric/non-caloric sweeteners and a higher rate for those using high-fructose corn syrup)—a design that modelling studies and policy reviews associate with reductions in SSB intake.
Singapore complements fiscal tools with front-of-pack nutrition grading. Its Nutri-Grade system started with pre-packaged drinks and, from 30 December 2023, extended to freshly prepared beverages across retail and non-retail settings, combining visible grading with advertising restrictions for the least healthy categories.

Global targets anchoring national plans

Policy levers now sit within a shared results framework. In May 2022, Member States at the 75th World Health Assembly endorsed the WHO Global Diabetes Compact coverage targets for 2030—including goals for diagnosis, glycemic control, blood-pressure control, statin use in adults over 40, and universal insulin access for type 1 diabetes. These targets help ministries align financing, procurement, and workforce planning around clear, trackable outcomes.

Guidelines moving toward person-centered care

Clinical guidance is converging on a more person-centered approach that balances glucose control with cardiovascular and kidney protection. The ADA Standards of Care 2025 and ADA/EASD updates reinforce early, risk-based use of GLP-1 receptor agonists and SGLT2 inhibitors for people with established CVD, heart failure, or CKD, alongside lifestyle therapy and metformin where appropriate. Summary updates also emphasize weight management, hypoglycemia safety, and stepwise intensification tailored to individual risk and preference—an evolution beyond “A1C only” toward therapies that improve hard outcomes.

5. Prevention: what works for diabetes in Southeast Asia

Population-level measures

Taxes on sugary drinks, front-of-pack labels, and restrictions on marketing of high-sugar beverages alter purchasing incentives at scale. Early evidence from Thailand and regulatory expansions in Singapore show how price signals and labelling can catalyze both consumer behavior change and industry reformulation—foundational steps for lowering diabetes risk over time.

Risk-based screening at primary care

The fastest wins often come from finding diabetes earlier among adults with hypertension, dyslipidemia, a history of gestational diabetes, or Asian-range BMI (using the WHO’s Asian action points). Structured referral and follow-up pathways, as emphasized by the WHO Global Diabetes Compact and ADA Standards, help keep people in care and reduce complications.

Conclusion

The rise of diabetes in Southeast Asia is a generational health challenge—large, persistent, and costly if left unchecked. Yet the path forward is clear: build strong primary-care screening and continuity, secure reliable access to essential and advanced therapies (from metformin and insulin to GLP-1 and SGLT2 where indicated), and shape healthier food environments with fiscal and labeling policies. With global targets now in place and clinical guidance increasingly oriented to organ protection, the region has both the policy compass and the therapeutic tools to bend the curve.

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References

IDF Diabetes Atlas 11th ed., Global Factsheet (2025)
IDF — South-East Asia regional page (2024/2050)
Lancet 2024, NCD-RisC pooled analysis (1990–2022)
WHO Diabetes Fact Sheet & Diabetes Programme/Compact — five 2030 coverage targets
Thailand SSB tax
Philippines TRAIN SSB tax (2018)
Singapore Nutri-Grade (2023)
Vietnam STEPS 2021 (WHO)
ADA/EASD & ADA 2025 Standards
WHO/Asian BMI Action Points

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