The Asian-centric approach to diabetes

By Mary Kan and Will Greene

A “diabetes clinic of the future” and other innovations could change diabetes management and treatment in Singapore.

Image: Nate RobertCC BY 2.0

An epidemic of diabetes is raging across Asia. Nearly a quarter of a billion diabetics now live in the region, placing strain on healthcare systems and putting policymakers on edge.

Singapore is looking to tackle this mounting regional health crisis by developing new medical technologies and digital health platforms. The Ministry of Health has recently launched a “war on diabetes” to engage the public and promote healthy lifestyles; increase public sector investment in diabetes research; and co-create solutions with companies.

This is why the Agency for Science, Technology and Research (A*STAR) has partnered with SingHealth, Singapore’s largest healthcare system, to develop a “diabetes clinic of the future”, according to Dr Danny Soon, a senior director in A*STAR’s Biomedical Research Council. He leads Singapore Biodesign, a biomedical talent development and innovation programme under A*STAR.

Diabetes in Asia vs the west

Singapore Biodesign made diabetes a key theme for its 2018 Fellowship Programme, which sponsored four aspiring innovators to conduct immersive research in China, Indonesia, and Singapore to understand the epidemiology and socioeconomic dimensions of the disease in Asia. Earlier this year, Singapore Biodesign hosted an event bringing together experts from across the industry to share innovative ideas to tackle the challenge.

Due to genetic and cultural differences, diabetes technologies developed in the west are not always applicable in Asia, noted Dr Andrew Chou, a physician-engineer and 2018 Singapore Biodesign Fellow. Asians are genetically more susceptible to diabetes than westerners, leading to higher rates of complications such as diabetic retinopathy, heart disease, and foot amputations, the Biodesign Fellows revealed.

Singapore, for example, has the world’s highest rate of diabetic kidney failure, and Indonesia has roughly 470,000 diabetes-related cardiovascular deaths per year. These complications are one of the major reasons why the cost of diabetes treatment is increasing at double-digit rates throughout much of the region, putting massive pressure on healthcare systems everywhere.

Moreover, patient needs can vary significantly between Asian countries. While public awareness of diabetes in Singapore is relatively high, for example, health literacy in Indonesia is low, Dr Chou continued. Differences like these may make it hard to build scalable diabetes technologies in Asia—presenting a major challenge for aspiring innovators.

Another key finding was that many Asians face cultural roadblocks to effective treatment, according to Biodesign Fellow Shanaz Rauff. In China, for example, patients are less inclined to consult primary care physicians and dieticians, and prefer to see busy specialists in overcrowded tertiary care facilities. Some patients also subscribe to traditional medicine practices that are not clinically validated, and delay access to proper treatment, said Rauff, who is also a healthcare finance specialist. Poor diet and other factors across the region add to the problem.

The role of digital health

Digital health platforms will play a role in disease management for diabetes, according to Michael Kloss, CEO of Ascensia Diabetes Care. There is a growing global ecosystem of medtech multinationals, startups, consumer technology firms, and other players that are developing digital solutions to simplify diabetes management and drive behavioural change of individuals and societies alike, he said.

Improved data collection on Singapore’s diabetic patient population may help drive further innovation, noted Dr Yong Mong Bee, a senior consultant in the Department of Endocrinology at Singapore General Hospital (SGH) and head of the SingHealth Duke-NUS Diabetes Centre. He shared how he helped develop the country’s largest diabetes registry, which now covers roughly 200,000 patients and includes over a decade of historical data. These data are being used to evaluate quality of diabetes care in Singapore and develop clinical decision support systems.
As digital approaches to diabetes screening and management become more effective and widely-used, cybersecurity concerns are also growing.
However, it is important to note that while new technologies may help, they also present their own challenges with regards to security, observed Dr David Klonoff, an endocrinologist and diabetes technology specialist who currently serves as the chairman of the US Diabetes Technology Society. As digital approaches to diabetes screening and management become more effective and widely-used, cybersecurity concerns are also growing.

This is one reason why many of the most cutting-edge medical technologies – such as “closed-loop” systems that automate the insulin delivery process by combining continuous glucose monitoring with insulin pumps – are still out of reach for healthcare systems, due to high costs and complexity.

The scale of the diabetes problem will likely require greater cooperation between healthcare stakeholders - which is partly why Singapore Biodesign recently embarked on a partnership with the National Health Innovation Centre in Singapore to provide on-the-ground training for its fellows. Through multi-stakeholder initiatives like these, we expect to see a proliferation of new solutions in Singapore in the fight against Asia’s diabetes epidemic and other key diseases.

Mary Kan is deputy director of Singapore Biodesign, a talent development and innovation programme under the Agency for Science, Technology and Research (A*STAR) that seeks to identify unmet clinical needs in Asia and inspire commercially-viable health technologies to address them.

Will Greene is a resident guest writer with Singapore Biodesign. A healthcare journalist and marketing consultant with eight years of experience in Asia, he writes regularly about the region’s emerging health innovation ecosystems.