The Western Pacific is not a footnote in the global diabetes story. It is home to an estimated 55 million people living with diabetes-related foot disease—the largest regional burden in the world.
A review as big as the region
A major new manuscript in The Lancet Regional Health – Western Pacific brings together an extraordinary team led by Byron M. Perrin and Peter A. Lazzarini: 24 authors from 13 countries and territories spanning East Asia, Southeast Asia, and Oceania.
The team combined an updated systematic search of disease-burden studies with expert-informed reviews of current care accessibility and future strategy. The result is more than a map of epidemiology. It is a health-systems diagnosis—and a practical regional agenda.
For many of us, this author list is also wonderfully familiar. These are friends and colleagues who have spent years building services, data systems, guidelines, training programs, and professional networks across the Western Pacific. This is what regional science should look like: collaborative, candid about uneven evidence, and focused on what countries can do next.
The burden—and the paradox
The headline number is staggering: about 55 million people in the Western Pacific are estimated to live with diabetes-related foot disease (DFD). Across the region, median DFD prevalence and DFD hospitalization incidence were higher than global medians, yet major, minor, and overall diabetes-related amputation incidence rates were comparatively lower.
That regional headline conceals enormous variation. Oceania had the highest DFD prevalence, hospitalization, and amputation burdens, with many reported trends increasing. East Asia had the lowest rates, with most reported trends decreasing. Southeast Asia showed a more mixed picture.
This is not simply a story of geography. It is a reminder that the Western Pacific contains vastly different cultures, economies, workforces, care pathways, and data systems—and that a regional average can hide the places where need is most intense.
From guidelines and pilots to durable systems
The care review found encouraging building blocks: national guidelines were widely adopted, and many countries had local innovation, research, or emerging policy. But access to multidisciplinary foot teams varied sharply, workforce and referral barriers remained common, national registries were unusual, and relatively few innovations had been scaled across entire countries.
The paper points to models that may be adapted rather than merely admired: Australia’s national multidisciplinary foot-team accreditation, the Republic of Korea’s nationwide DFD registry, Singapore’s widely integrated multidisciplinary services, New Zealand’s Indigenous Peoples DFD policies, and Thailand’s mandated screening and care-reimbursement policies.
The recurring lesson is that good clinical ideas need a delivery system. A guideline without implementation tools, a pilot without scale, or a multidisciplinary team without a referral pathway can only travel so far.
Eight recommendations for the Western Pacific
Perrin, Lazzarini, and colleagues propose that each country aim to:
- Establish a national DFD organization to lead care and strategy.
- Develop or adapt a culturally responsive national DFD strategy—or suite of policies—that strengthens care and the skilled workforce.
- Develop or adapt culturally responsive national DFD guidelines and implementation tools.
- Develop or adapt culturally responsive standards for multidisciplinary foot-team models of care.
- Monitor and report national diabetes-related amputation and DFD hospitalization incidence.
- Build national DFD registries that track foot screening and access to multidisciplinary teams.
- Share innovation, research, and policy strategies across countries.
- Consider a Western Pacific or subregional alliance of national DFD organizations.
An important evidence boundary
The review does not show that stronger system capacity causes lower DFD burden. The authors appropriately describe a potential association. Their synthesis draws on heterogeneous studies, expert-informed narrative assessments, and aggregated national data; much of the hospitalization and amputation evidence predates 2020 and comes from high-income countries.
That limitation does not weaken the call to action. It sharpens it: countries need better surveillance, more representative registries, more standardized reporting, and stronger studies capable of testing which system changes actually improve outcomes.
Congratulations—and onward
Warmest congratulations to Byron, Pete, and this remarkable Western Pacific team. They have given the field both a clearer map and a practical compass.
The variation is real. So is the transferable know-how. The next step is to build the organizations, data systems, culturally responsive strategies, and multidisciplinary pathways that let good ideas travel farther than a pilot site.
References
In a region carrying the world’s largest DFD burden, collaboration is not decoration—it is infrastructure. Congratulations to the team for this superb work.
Leave a Reply