The world’s most populous region contains 39 disparate countries and territories with populations ranging from 1.3 billion for China to less than 5,000 in the smallest Pacific island nations of Niue and Tokelau. Similarly the economic profile varies from per capita GDPs of over US$30,000 for Australia, Hong Kong, Japan and Singapore to less than $3,000 in one-third of the other countries.

The less economically advanced countries struggle with the double burden of managing infectious diseases and the diabetes epidemic with limited resources. Many also face the lack of government awareness of the seriousness of the diabetes threat to their populations. 

At a glance

Diabetes and IGT prevalence
Not surprisingly there is a great diversity in the prevalence of diabetes, with the world’s highest found in the Micronesian population of Nauru (30.7% of the adult population).

Several new studies have been included since the second edition of the Diabetes Atlas, incorporating data from urban and rural areas of Cambodia   1 , Philippines   2  and Thailand   3 , and new surveys from South Korea   4 , Viet Nam   5 , Singapore   6  and China   7 . The age specific prevalence estimates of these studies were also applied to several other countries of the region.

The use of these studies led to higher prevalence estimates for all of the countries in which they were performed, except Singapore. For Cambodia, this was a doubling in national prevalence, for the Philippines a tripling, and for Thailand more than tripling; all of these countries had prevalence estimates previously based on a 1996 report from Thailand   8 . For Viet Nam, the estimates based on the Ho Chi Minh City survey of 2001 are twice those from the survey a decade previously from Hanoi   9 . For South Korea, the new survey   4  showed a 25% higher prevalence than of that used previously   10 . The new Singapore data led to slightly lower overall prevalence than the 1998 data   11 .

The new Chinese data have the largest impact on overall prevalence and case number estimates, as 60% of the region’s population live there. The national prevalence estimate is 60% higher than that derived from the previously used survey   12 . Whereas that survey from 1994 was OGTT-based, with classification based on 1985 WHO criteria   13 , the current report based diagnosis (of diabetes, or IFG) on fasting glucose levels   14  as well as self-report. The current report is also more nationally representative, albeit with fewer participants. In addition to the fasting criterion indicating a higher diabetes prevalence than previously estimated, the Chinese IFG prevalence of 6.9% is double that of the previous IGT estimate. There was no evident urban/rural IFG gradient, but diabetes prevalence was about 50% higher in urban areas. Only 25% of diabetes had been previously diagnosed.

The diabetes epidemic has the greatest potential to explode in China, simply because of its population size. Although the current national prevalence there of 4.3% is among the region’s lowest, the high prevalence among Chinese populations in the more urbanized and affluent cities of Hong Kong and Singapore indicate what may develop as China rapidly urbanizes and expands economically. The data indicated for 2025 in Table 2 are likely to represent an underestimate of China’s diabetes problem if it continues to develop economically faster than almost any other country in the world.