The Burden and Phenotype of Type 2 Diabetes in the Western Pacific Region

The International Diabetes Federation estimated that in 2024, 215 million adults-more than one-third of the global diabetes population-were living with diabetes within the Western Pacific Region (WPR), which includes nations with some of the highest prevalence worldwide. Rapid urbanization and economic development have profoundly reshaped lifestyles, which interact with biological predispositions resulting in an earlier onset of type 2 diabetes. These predispositions are not uniform across the heterogeneous populations within the WPR. Asian individuals tend to have a β-cell secretory failure phenotype with type 2 diabetes arising at lower adiposity, distinct from the high-adiposity phenotype with pronounced insulin resistance common among Pacific peoples. Improvements in diabetes care in high-income countries have reduced vascular complications and improved survival, shifting the clinical profile of individuals with type 2 diabetes toward an older population characterized by multimorbidity. In contrast, low-income settings continue to face a high prevalence of type 2 diabetes, compounded by limited access to medications and diagnostic tools, shortage of trained health care professionals, and other logistical barriers to care. In this diverse region where countries are at different stages of health care development, there are considerable opportunities for sharing of best practices through collaborative and translational research. These may include social and public health policies, health care delivery, use of registers to track disease patterns and care standards, and use of technologies to support self-management. For implementation of these actions, a major shift is required, toward prevention, capacity building, and demonstrating the impact of value-based prevention and data-driven care.