DIABETES CARE

DIABETES IN SOUTH-EAST ASIA 

In 2019, there were an estimated 88 million people in South-East Asia living with diabetes and the number of people with diabetes is projected to increase to 153 million by 2045 unless successful preventative measures are implemented. There is mounting evidence that Asians have higher postprandial (after-meal) blood glucose levels and poorer insulin sensitivity than Caucasians for the same foods, which puts them at increased risk of developing type 2 diabetes. Improved prevention and management of diabetes are therefore now public health priorities in South-East Asian countries such as India, Malaysia, Singapore and Thailand. 

South-East Asians consume approximately 60% of their total energy intake from carbohydrates compared with 42% for Caucasians living in the region. Rice and noodles are the main carbohydrate staples in the South-East Asian diet, and studies have shown that consumption of rice and noodles has been linked to hyperglycemia and risk of developing type 2 diabetes. In addition to rice and noodles, the traditional Asian diet is heavily represented by foods derived from cereals, flours, and other starches such as rice porridge, steamed buns (bao), and glutinous rice cakes (kuehs). 

The challenge many people living in South-East Asia face with regard to managing their carbohydrate consumption is that high-carbohydrate foods are not just sustenance, but are an important part of South-East Asian culture. Foods such as rice are part of the region’s cultural identity, meal, and habits, and individuals may choose to compromise health over food. Therefore, an effective approach toward managing diabetes in South-East Asia would be to improve carbohydrate quality in addition to reducing carbohydrate quantity. In other words, reducing the glycemic load of the South-East Asian diet. 

Glycemic load can be reduced by substituting lower GI options for regular high GI varieties. From a food perspective, it is possible to modify the food composition and structure through ingredients and processing to reduce the amount of carbohydrate, limit the rate of digestion by controlling enzymatic activity/accessibility, or slow down the rate of glucose absorption. Specific examples of what can be done are discussed next in PERSPECTIVES. 

Read more: 

• IDF DIABETES ATLAS Ninth edition 2019  

Alan Barclay, PhD is a consultant dietitian and chef (Cert III). He worked for Diabetes Australia (NSW) from 1998–2014 . He is author/co-author of more than 30 scientific publications, and author/co-author of  The good Carbs Cookbook (Murdoch Books), Reversing Diabetes (Murdoch Books), The Low GI Diet: Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment, New York).
Contact: You can follow him on Twitter, LinkedIn or check out his website.