With cutting-edge research reshaping treatment paradigms, Taiwan stands at a crossroads — will it lead the region in next-generation treatment or fall behind global standards?

Boston, Shanghai, and Leiden share an unexpected distinction. Each is home to groundbreaking research that could edge medicine closer to a cure for type 1 diabetes.

Researchers in these cities are exploring two promising approaches to restoring insulin production: either by replacing destroyed pancreatic islet cells with lab-grown ones or by regenerating new islet tissue from the patient’s stem cells.

Clinical trials suggest that these methods could allow patients to stop daily insulin injections — a once-unthinkable achievement. Although still in the early stages, the results indicate a potential paradigm shift in managing a disease that affects millions.

In addition to these breakthroughs, two classes of medications are revolutionizing the treatment of type 2 diabetes. GLP-1 receptor agonists — including several well-known brands of semaglutide — help manage blood sugar levels while also promoting significant weight loss, offering a dual benefit for those with both diabetes and obesity.

SGLT2 inhibitors, meanwhile, lower blood sugar levels and provide cardiovascular benefits, notably reducing the risk of heart failure — a major concern for diabetes patients.

In Taiwan, the central question is when patients will be able to benefit from these treatments. Despite having one of the world’s most accessible healthcare systems, with universal coverage and relatively low out-of-pocket costs, gaps remain in reimbursement policies and the public perception of diabetes and metabolic diseases.

An estimated 2.2 to 2.6 million people, or between 10% and 12% of the population, live with diabetes in Taiwan. It remains a leading cause of death and disability, placing mounting pressure on the public health system and affecting quality of life.

In response, Taiwan is advancing national health reforms aimed at expanding access to next-generation therapies and promoting public-private partnerships to scale up digital health solutions. Educational campaigns are also helping patients take a more active role in managing their condition.

Among other efforts, the Metabolic Syndrome Management (MetS) Program, directed by the Health Promotion Administration, emphasizes lifestyle changes — including improved diet, increased physical activity, and smoking cessation — through existing outpatient and health check-up services. The program has enrolled more than 270,000 individuals across 2,800 clinics nationwide since 2022.

Still, major obstacles persist. Patient reimbursement policies often trail behind clinical innovation, stigma surrounding both obesity and diabetes remains deeply rooted, and access to advanced care is uneven, particularly in rural and remote communities.

“We must move from excellence in coverage to excellence in outcomes,” says Dr. Wayne Huey-herng Sheu, vice president of the National Health Research Institutes, former superintendent at Taipei and Taichung Veterans General Hospitals, and supervisor of the Asian Association for the Study of Diabetes.

Dr. Sheu notes that Taiwan possesses the data, infrastructure, and policy momentum to lead the region. However, realizing that potential will require strategic investment, stakeholder collaboration, and a new understanding of what effective care looks like.

Outcome-driven approaches

In recent years, innovations like continuous glucose monitors (CGMs) have revolutionized diabetes care, offering a fingerstick-free way to monitor blood sugar around the clock. These small sensors, inserted just beneath the skin, measure glucose levels in the body’s interstitial fluid and transmit real-time data to a receiver or smartphone app. With this technology, users can track patterns, anticipate dangerous highs and lows, and make timely adjustments to their treatment — empowering more informed, responsive diabetes management.

Increasingly considered the gold standard for diabetes management, CGMs are now reimbursed under Taiwan’s National Health Insurance (NHI) for patients with type 1 diabetes and certain pregnant women. But insulin pumps, which work in tandem with CGMs to automatically regulate insulin levels, remain uncovered. As a result, those who want access to the more comprehensive care approach already widely used in North America and Western Europe must pay out of pocket.

“The ideal system integrates CGM with a smart pump to create an artificial pancreas,” says Dr. Sheu. “We hope both technologies will eventually be covered under NHI in the future. The cost has come down, and the long-term value is clear.”

In general, Taiwan’s reimbursement system lags behind advances in the development of innovative medications. While GLP-1 receptor agonists and SGLT2 inhibitors are globally recognized as game-changing therapies — in terms of both reducing blood glucose and protecting the heart and kidneys — their use in Taiwan is constrained by restrictive coverage criteria.

“To truly meet glycemic control goals, earlier intervention with these medicines would help patients achieve better outcomes,” says Lauren Lazowski, Taiwan general manager of Eli Lilly, a leading American multinational pharmaceutical company.

Dr. Sheu agrees. “This is not an added cost — it’s a strategic investment in public health,” he says. “We must consider the long-term value of reducing complications and hospitalizations.”

While Taiwan’s limited healthcare budget continues to pose challenges, meaningful progress is underway. A recent reform allows for parallel submission of new drug applications, enabling reimbursement reviews to proceed alongside regulatory approvals. This streamlined approach is expected to shorten the wait for innovative treatments, giving patients quicker access to the latest therapies.

Jimmy Chiu, Taiwan director of Medical and Regulatory Affairs at Novo Nordisk, a Danish multinational pharmaceutical company, explains the benefits of the change.

“It used to take a year or more between regulatory approval and NHI listing,” he says. “Now, companies can prepare earlier, and patients don’t have to wait as long. It’s a meaningful improvement.”

Still, both Chiu and Lazowski stress that more systemic reform is needed, particularly when it comes to treatment of obesity, a key risk factor for type 2 diabetes. Although obesity has recently been included in the Healthy Taiwan initiative (a national effort to overhaul the healthcare system), it is not yet classified as a disease by health authorities. As a result, physicians face limits on the treatments they can offer, and patients have fewer options for managing their condition.

“When we asked doctors whether obesity should be treated as a chronic disease, most said yes,” says Chiu.

Tackling metabolic syndrome

More than 80% of type 2 diabetes patients in Taiwan are also clinically overweight or obese — a dangerous combination sometimes referred to as “diabesity.” If left untreated, this dual burden significantly raises the risk of cardiovascular disease, kidney failure, and stroke. Research shows that even modest weight loss can make a meaningful difference: shedding just 5% of body weight can reverse prediabetes and lead to substantial improvements in metabolic health.

GLP-1 receptor agonists have proven particularly effective in achieving weight loss. Even so, access to these drugs remains limited in Taiwan, especially for individuals who are overweight but not yet diabetic. While the drugs are approved for use, they are reimbursed only under narrow conditions — typically only after first-line treatments, such as lifestyle changes and standard medications, have failed to produce results.

“To reduce the prevalence of obesity from 50% to 40% by 2030 — as the Healthy Taiwan initiative aims to do — we need multi-stakeholder engagement,” says Lazowski. “It’s not enough to tell people to exercise or eat better. We need a system that supports behavior change, medical intervention, and public awareness.”

Lilly has taken a proactive role in advancing public education and awareness, working closely with medical societies to promote understanding of both diabetes and obesity as chronic diseases. The company focuses its public-facing efforts on disease awareness, empowering patients to recognize risk factors and seek timely care.

For its part, Novo Nordisk has launched a dedicated patient solution team — unique among pharmaceutical companies in Taiwan — that designs tools, apps, and campaigns to educate patients about obesity and diabetes. These range from culturally adapted BMI calculators for Indigenous communities to Line-integrated reminders for healthy eating and medication adherence.

“We’re investing in both science and public education,” says Chiu. “We want to help people build lasting, healthy habits — not just take medication.”

Next-gen tools and therapies

Taiwan’s government is now betting on digital tools to scale care more efficiently. One of the most ambitious examples is AI-on-DM, a system developed by the National Health Insurance Administration and Google Health that uses AI to identify patients at highest risk of complications. Physicians are then alerted to intervene earlier.

“It’s a way to reduce health inequity,” says Dr. Sheu. “Rural areas and underserved groups can be reached more effectively when technology helps identify who needs help the most.”

AI integration is made possible by Taiwan’s centralized medical data infrastructure. With the right policies, it could serve as a model for other nations seeking to digitize chronic disease care, Dr. Sheu says. At the same time, consumer-facing tools like the My Health Bank app, an online system that allows users to check their medical information and monitor and manage their health, are being upgraded to provide personalized advice and reminders based on individual health records.

Companies are also exploring how to upgrade and improve patient-facing tools like mobile health apps and AI-driven reminders. “We see this as a way to close the last mile,” says Lazowski. “It’s about reaching people where they are, with information and support that is timely, relevant, and respectful.”

Beyond stem cell-derived islet transplants, researchers worldwide are now pursuing glucose-responsive insulin — formulations that activate only when blood sugar rises, reducing the risk of hypoglycemia and eliminating the need for frequent monitoring. In preclinical studies, these “smart insulins” have demonstrated the potential to revolutionize daily diabetes management. Several candidates are advancing through early trials.

“Glucose-sensitive insulin would eliminate the need for constant monitoring,” says Novo Nordisk’s Chiu. “You inject it, and it only activates when blood sugar levels require it. That would be transformative.”

At Lilly, researchers are developing once-monthly or longer-acting treatments to reduce the burden of daily care. “Convenience plays a critical role in treatment adherence,” says Lazowski. “Whether it’s a weekly injection or an AI-integrated app, innovations that make care easier are essential.”

Taiwan itself is playing a growing role in this pipeline. Both Lilly and Novo Nordisk conduct clinical trials on the island and partner with major medical centers, including National Taiwan University Hospital and China Medical University Hospital.

“There’s a big opportunity for Taiwan to punch above its weight,” Lazowski says. “The healthcare infrastructure here is excellent, and the research quality is very high. Streamlining the trial process would make Taiwan even more attractive as a research hub.”

Ultimately, Taiwan’s response to diabetes cannot rest on a single institution. Public agencies, medical societies, industry leaders, and patients themselves all have a role to play.

“We see ourselves not just as medicine providers, but as partners in public health,” says Chiu. “Whether it’s supporting awareness campaigns, designing educational tools, or building local research capacity, we want to be part of the solution.”

Lazowski echoes that view. “To reach Taiwan’s 2030 targets, we need open dialogue, mutual trust, and a shared commitment to health,” she says. “Progress is coming faster here than in many countries — but the work isn’t finished.”