For years, diabetes has remained among the top 10 causes of mortality in Taiwan, and the prevalence rate remains alarmingly high. This year the number of individuals with diabetes in Taiwan surpassed 2.5 million – a 14% increase compared with 2019. A startling 30% of these cases occur in individuals under the age of 60, and more than 90% of the newly diagnosed cases are type 2 diabetes patients, signifying a concerning trend.
“This is without a doubt a national health concern,” Says Dr. Huang Chieb-Ning, President of DAROC in AmCham’s Investing in Health Forum. “It’s a problem that needs to be tackled using a holistic approach that involves the joint effort of several government agencies.”
Diabetes is a systemic disease associated with complex risks and comorbidities. It serves as a root cause for a myriad of other health issues, including cardiovascular disease, nephropathy, dementia, and even cancer. Alarming numbers from the 2022 Cause of Death Statistics by the Health Promotion Administration (HPA) indicate that more than 12,000 people in Taiwan died from diabetes last year, a 7.3% increase from 2021.
According to the National Health Insurance Administration (NHIA), diabetes now ranks third among the top 20 diseases in terms of medical expenses for Taiwan. Expenditure related to diabetes treatment has risen from NT$26.4 billion in 2016 to NT$40.1 billion in 2022.
The impending super-aging society, expected to manifest in 2025 with over 20% of Taiwan’s population aged 65 or older, poses a substantial threat to the situation. Diabetes prevalence is highest among this elderly demographic, and the rate of increase is exponential. Still, a concerning trend has also been noticed among the younger demographic.
“Between 2000 and 2019, the number of type 2 diabetes patients under 50 years old nearly doubled,” says Dr. Huang. Youth onset diabetes is projected to increase 3.6 times for those aged 6-39 and a staggering 9.2 times for those under 20 years old by 2045. “This trend not only makes the disease more chronic but also heightens the risk of complications, reducing life expectancy by four to five years.”
One of the contributing factors to the diabetes epidemic is the escalating rates of overweight and obesity among Taiwanese adults. The prevalence of these conditions has risen from 32.7% in 1993 to 50.7% in 2020. A higher BMI is directly associated with an increased prevalence of diabetes among individuals under 35 years old.
Taiwan has made commendable efforts in diabetes management, including the establishment of a pay-for-performance diabetes care program and initiatives like the Integrated Diabetes and Early CKD Care Program and the Metabolic Syndrome Prevention and Management Program. However, Dr. Huang notes that these measures are still insufficient to address the impending challenges, which include the growing prevalence of diabetes, rising comorbidity risks in an aging society, the surge in youth onset diabetes, and the worrisome trend of increasing obesity.
“Currently, diabetes management goals in Taiwan mainly focus on care quality metrics, but we need to adopt a more holistic approach,” says Dr. Huang. “Over the past century, diabetes has evolved from a treatable single disease into a systemic health crisis.”
Diabetes prevention and management demand a multifaceted approach, spanning education, prevention, screening, and treatment. Dr. Huang highlights the collaborative effort of the DAROC and other societies in the “2021 Taiwan Declaration on Diabetes.” This declaration encompasses six action plans aiming to address diabetes comprehensively, from prevention to treatment, requiring cross-ministry resource integration and a robust tracking mechanism.
By establishing a national diabetes office, the government could more effectively tackle diabetes by establishing treatment guidelines following international research, a national screening and intervention plan, the national patient registry programs, and programs focusing on the quality of life and psychological needs of diabetic patients and caregivers. Furthermore, a national office could lead education efforts and preventive treatment of children and adolescents.
“It’s time to elevate our response to the national level and establish outcome-based goals and a systematic approach from prevention to treatment,” says Dr. Huang. “Taiwan urgently needs a national diabetes office to integrate resources across various ministries and effectively manage diabetes.”
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