Changing landscape of diabetes in Asia – What are the unmet needs?

Abstract

The incidence rates of type 2 diabetes among adults in Asia have been stable, but the rates in youth and young adults have increased. In territory‐wide surveillance in Hong Kong, Special Administrative Region of People's Republic of China, all‐cause mortality rates among people with diabetes have exhibited a declining trend in the past 15 years, with a narrowing in the mortality gap between people with and without diabetes. At the same time, the improvement in survival resulted in a changing age structure and disease profile of people with diabetes, towards an increasing proportion of older people with long diabetes duration and multi‐morbidities. Reductions in event rates were not observed in the youngest age group who also had the least gains in risk factor control and uptake in organ protective drugs over time. A young age at diabetes diagnosis, associated with exposure to high glycemic burden from an early age, predicted higher risks of complications and premature mortality compared with later‐onset of diabetes. People presenting with type 2 diabetes below 40 years of age were 5‐fold more likely to die and their life expectancy was shortened by 8 years than age‐matched counterparts without diabetes. Analysis of population‐based data in Hong Kong Chinese identified hypertension followed by chronic kidney disease as the leading contributor to mortality in young people, indicating that efforts to optimize non‐glycemic risk factors and organ protection are as important in young individuals as it is in the older population.