Diabetes in South-East Asia: insights and advocacy efforts

The International Diabetes Federation (IDF) South-East Asia (SEA) region is experiencing a disproportionate rise in people with diabetes. An estimated 1 in 11 adults live with the condition, while over half (46 million) are undiagnosed, and 1 in 4 live births are affected by hyperglycaemia in pregnancy. The number of people with diabetes is projected to surge to 152 million by 2045, highlighting the pressing need for comprehensive, region-wide action.

The IDF SEA region includes seven countries and territories, each with unique socioeconomic and healthcare challenges. However, one common thread is the rising diabetes impact. According to the latest estimates released by IDF in 2021, India alone accounts for 1 in 7 (90 million) of all adults living with diabetes globally, with a prevalence rate of 8.3%, while Mauritius (26.5%)  is among the top 10 countries for diabetes prevalence worldwide.

The diabetes advocacy community in South-East Asia is leading comprehensive campaigns to undertake the issue head-on. Efforts by the 11 IDF Members in the region range from improving access to quality healthcare and affordable treatment options to promoting awareness and tackling stigma and discrimination.

Access to quality healthcare and education

Outcomes from a panel organised by the T1D Foundation of India detailed the challenges people with diabetes face in the region. Drawing upon their experiences and inviting audience members to share theirs, the event delved into every aspect of living with diabetes. The major challenges identified were access to care, medicines and technology and a greater need for diabetes education.

A pervasive lack of awareness and understanding about diabetes among the general population in South-East Asia has fuelled stigma and misconceptions, which can result in delayed diagnosis and poor management of the condition.

One of the obstacles faced by the diabetes community in SEA is the limited access to quality healthcare services, particularly in rural and underserved areas. Many struggle to find affordable and comprehensive care, including access to paediatric diabetes specialists, endocrinologists and diabetes educators.

Advocacy actions undertaken in Bangladesh

In Bangladesh, much of the population lives below the poverty threshold and in rural areas. People with diabetes must travel to a city for treatment and follow-up care. Although the government has endeavoured to provide free insulin and diabetes care for everyone with diabetes, the shortage of trained healthcare professionals means that some people with diabetes do not receive the education and guidance to manage their condition.

To fill this gap, the Diabetic Association of Bangladesh (BADAS) has built an extensive network of centres nationwide to support people living with diabetes.

This achievement inspired Tazul Islam, an advocate and former IDF Young Leader in Diabetes and other young people living with diabetes to organise awareness, education and counselling activities for people recently diagnosed. When Tazul was diagnosed with type 1 diabetes at 16, there were limited services and facilities available for children with type 1 diabetes in Bangladesh, so he was grouped with type 2 diabetes, ultimately affecting his diabetes management.

The cost of insulin and supplies

The region’s total diabetes-related expenditure in 2021 was USD10 billion, the second lowest globally.

The economic burden of managing type 1 diabetes can be overwhelming because it requires lifelong, uninterrupted treatment. Often, the prohibitive cost of insulin and supplies create a barrier to care and treatment for many people and families in the region.

Advocates have called for pharmaceutical companies and government authorities to regulate prices and facilitate access to these resources. One solution being developed is access to affordable, locally manufactured products, which could alleviate the financial burden.

Bridging the infrastructure and technology gap

Access to advanced diabetes management technologies, such as continuous glucose monitoring (CGM) devices and insulin pumps, remains limited in many parts of the South-East Asia region. Even when available, affordability and infrastructure, such as reliable electricity and internet access, can hinder their widespread adoption.

This additional disadvantage underpins the need for more affordable and accessible healthcare technology, not only in the region but globally. Collaboration between public, private, and international sectors and organisations could facilitate equitable access to these life-changing technologies.

In the past, activities such as fundraising campaigns and partnerships with corporate sponsors have enabled the diabetes community to channel resources towards improving access to insulin, medical supplies and essential technologies.

Empowering children and youth with diabetes

Children and adolescents living with type 1 diabetes face unique challenges, particularly in the school setting. Advocates have voiced the need for targeted support and training for teachers, support staff and school nurses to ensure the safe and effective management of the condition.

Initiatives like the  Kids and Diabetes in School (KiDS)  programme, which was successfully piloted in India in 2013 and recently launched in the Indian states of Goa and Uttar Pradesh, can help fill this gap.

Addressing psychosocial impacts

Living with a chronic condition like diabetes can also take a toll on a person’s mental well-being. The stress of managing the condition, fear of complications and social stigma all contribute to increased levels of anxiety and depression.

Increasingly, healthcare professionals and advocates are calling for the integration of psychosocial support services into comprehensive diabetes care.

As found worldwide, people living with type 1 diabetes in SEA often face barriers to employment and encounter discrimination in the workplace. This dilemma demonstrates the need for workplace awareness-raising for employers and employees that living with diabetes does not hinder professional success.

In the SEA region, marriage is considered a major life milestone and a requirement for societal inclusion. However, the diabetes community has experienced finding suitable partners for marriage to be a daunting task. To counteract these difficulties, advocates have worked to connect marriage prospects with existing diabetes-focused matrimonial platforms and support groups while also emphasising the need to destigmatise the condition in the context of relationships and family planning.

Nutrition, fitness and diabetes management

Eating healthy, balanced meals is not always possible in SEA countries, particularly in low-income communities. This nutritional precarity makes blood glucose management difficult for people with diabetes and increases the risk of type 2 diabetes.

However, food poverty is only one part of the challenge. Parth Guragain, an IDF Blue Circle Voice advocate from Nepal, noticed that societal aspirations can also hinder healthy eating. In his country, people tend to believe that not exercising and eating junk food are signs of affluence. Part of the work done by diabetes educators, like Parth, is to dispel the common fear of hypoglycaemia and encourage people to incorporate healthy eating and fitness into their daily routines.

Collaborative efforts and advocacy initiatives

Through forums, panel discussions, and grassroots initiatives, advocates have amplified the voices of the diabetes community, shared their lived experiences and supported solutions to the region’s most pressing challenges. By fostering collaboration and facilitating open dialogues, they have made tangible improvements in diabetes care, access to resources and public awareness and are paving the way for a brighter, healthier future for all in the region.