Why it Matters Who Gets GLP-1 Based Receptor Agonists in Southeast Asia

Uneven access to GLP-1 based receptor agonists risk widening existing health gaps unless a balance is struck between affordability, clinical need and responsible prescribing.

Diabetes care in Southeast Asia has evolved significantly in recent years. Treatment once focused almost exclusively on glycaemic control but clinical practice has now expanded to address the broader risks associated with type 2 diabetes (T2DM).  

This reflects a global shift in understanding that diabetes is not merely a disorder of elevated blood glucose but a complex cardiometabolic condition that includes, but not limited to, obesity, cardiovascular disease, kidney disease, and liver disease.

This is particularly relevant in Southeast Asia, where the prevalence of diabetes continues to rise across all major economies. In 2024, an estimated one in 10 adults, or 107 million people, were living with diabetes in the region. The International Diabetes Federation (IDF) projects that this number will grow by 73%, reaching 185 million by 2050; one of the fastest growth rates globally.

The region faces a uniquely challenging combination of rapid urbanisation, evolving dietary patterns, and sedentary living. Consequently, many Southeast Asian nations, including Singapore and Malaysia, are reporting rising diagnoses among adults in their 30s, 40s and 50s. Diabetes is no longer concentrated in older populations; it has become a burden affecting working-age adults, families and national productivity.

In this evolving landscape, glucagon-like peptide-1-based receptor agonists or GLP-1-based receptor agonists (RA) have emerged as one of the most important additions to the therapeutic arsenal. Their ability to address both glycaemic control and weight management places the medications at the centre of metabolic disease management. 

Meanwhile, their growing prominence raises pressing questions about affordability, access, and the future direction of diabetes management in Southeast Asia.

The role of GLP-1-based receptor agonists (RAs)

GLP-1-based RAs are a class of medications used primarily to treat T2DM and obesity. These include dulaglutide, liraglutide, semaglutide, lixisenatide, and tirzepatide which contains a combination of GLP-1 agonists and glucose-dependent insulinotropic polypeptide or GIPs.

GLP-1-based RAs lower blood glucose by enhancing insulin secretion in response to meals, reducing glucagon levels, slowing gastric emptying and promoting satiety. These effects contribute to meaningful and sustained weight loss, an especially important benefit in Southeast Asia, where individuals often develop diabetes at lower body mass indices than Western populations.

Beyond glycaemic reduction and weight loss, robust cardiovascular-kidney outcome trials have demonstrated significant cardioprotective and kidney-protective benefits across multiple GLP-1 agonists used. As evidence continues to expand, GLP-1-based RA therapies are increasingly viewed not only as glucose-lowering agents but as central components of comprehensive metabolic disease management.

Dr Ben Ng, Senior Consultant Endocrinologist at Arden Endocrinologist Specialist Clinic Singapore

According to Dr Ben Ng, Senior Consultant Endocrinologist at Arden Endocrinologist Specialist Clinic Singapore, GLP-1-based RAs have played a pivotal role in reframing clinical priorities. “We have seen a shift from treating diabetes as an isolated glucose abnormality. Instead, treatment increasingly aims to address metabolic dysfunction in general, including weight, cardiovascular risk and long-term organ protection. With the recent availability of GLP-1 therapies, including GIP therapy, the benefits to patients are even more substantial.”

Professor Dr Lim Lee-Ling, Senior Consultant Endocrinologist and Head of Department, Research, Development, and Innovation at the Universiti Malaya Medical Centre

Professor Dr Lim Lee-Ling, Senior Consultant Endocrinologist and Head of Department, Research, Development, and Innovation at the Universiti Malaya Medical Centre, notes the expanding breadth of medical need. “GLP-1 therapies serve multiple purposes depending on the patient’s profile. We use them for glucose control in T2DM, for clinically supervised weight reduction, and increasingly for additional health gains such as cardiovascular, kidney and stroke protection. Some higher-dose formulations are also being studied for conditions such as metabolic dysfunction-associated liver disease and sleep apnoea. Their value extends well beyond glycaemic control.”

Determining the suitability of GLP-1-based RA therapy

The expanding burden of metabolic disease across Southeast Asia has profound implications. Diabetes-related complications including heart disease, stroke and kidney failure, remain among the most expensive and resource-intensive conditions for public healthcare systems.

As a result, the potential benefits of effective metabolic therapies extend far beyond individual patient outcomes; they influence national healthcare expenditure, workforce productivity and overall population health.

Dr Ng emphasises that patient selection remains key. “From a clinical standpoint, the patients who benefit most from GLP-1-based RA therapy are those with T2DM or who have significant metabolic risks. This includes individuals who are overweight or obese, established heart disease, microalbuminuria, fatty liver disease or those who struggle with appetite control or hypoglycaemia on older agents such as insulin or sulfonylureas. When prescribing, I will consider the patient’s cardiac and kidney risk profile, degree of excess weight, hypoglycaemia risk, cost or insurance coverage and their preference for injectable versus oral therapies.”

In Malaysia, Dr Lim highlights the importance of adhering to established clinical guidelines. “We draw on international standards when assessing eligibility, which remain essential reference points until country-specific and population-specific thresholds are defined,” she explains. “For obesity, GLP-1-based RA therapy is usually considered when a patient has a BMI above 30 kg/m², or above 27 kg/m² with a related condition such as hypertension, dyslipidaemia, cardiovascular disease or osteoarthritis. For T2DM, the common indication is diabetes with a BMI over 25 kg/m². These criteria ensure that therapy is prioritised for those most likely to achieve the greatest metabolic or organ-protective benefit.”

Affordability and access: the emerging divide

While GLP-1-based RAs’ efficacy in managing weight and improving clinical outcomes makes them particularly relevant for Southeast Asian populations where T2DM-linked metabolic risks are escalating, the benefits can only be realised if the people who would gain most from such therapies are able to access them.

Across Southeast Asia, GLP-1-based RA therapies remain expensive relative to median household income. Despite rising global production, The World Health Organisation (WHO) estimates that by 2030, less than 10% of patients worldwide will have access to GLP-1 therapies, underscoring affordability constraints. 

In Singapore, access varies widely between public and private care settings. Even within public institutions, co-payments can be substantial unless patients qualify for means-tested subsidies. This creates an uneven distribution of uptake, where early adoption tends to occur among patients with greater financial means or insurance support.

Dr Ng explains, “Out-of-pocket costs for GLP-1-based RA therapies can reach several hundred dollars each month in Singapore, so affordability inevitably shapes access. In the public sector, eligibility depends on government and means-tested subsidy criteria. In the private sector, prescribing is less restricted, but treatment is almost entirely self-funded unless covered by an insurer, so we tend to see higher uptake among those with stronger financial means or those who meet the criteria for public-sector subsidy support.”

A similar dynamic is seen in Malaysia, where GLP-1-based RAs are available but not yet universally incorporated into public hospital formularies due to cost constraints. This limits access for patients who depend on government healthcare services, where the majority of diabetes management occurs.

Prof Lim elaborates, “GLP-1-based RAs therapies have generally been available in selected public teaching hospitals, which fall under the purview of the Ministry of Higher Education (MoHE). Patients who meet the clinical criteria can be prescribed GLP-1-based RAs therapies depending on availability. The Ministry of Health (MOH) is currently working to strengthen access to these therapies.”

Shifting demand and the challenge of non-medical use

Another trend influencing access is the growing public interest in weight-loss medications. As global attention on GLP-1-based RA therapies accelerates, clinicians have reported increasing enquiries from individuals seeking pharmacological support for weight loss, sometimes without underlying diabetes or meaningful obesity-related risks. 

While GLP-1-based RAs use for obesity management under defined clinical criteria is permitted in the recent WHO guidelines, inappropriate or aesthetic-driven demand risks diverting supply away from medically vulnerable individuals.

“It is essential to differentiate medically justified treatment from cosmetic use. We should discourage purely aesthetic demand. At the same time, obesity itself carries substantial health risks, so careful screening is critical to ensure we treat individuals who will truly benefit and who otherwise face a high likelihood of progressing to conditions such as

diabetes, heart disease or other metabolic complications,” says Dr Ng.

Prof Lim adds that rising consumer-driven demand may deepen existing inequities. “If GLP-1-based RA therapies are diverted toward individuals seeking weight loss for non-medical reasons, it may exacerbate disparities in access and undermine the goal of supporting those with the greatest clinical need.”

Broadening access and prioritising the vulnerable

These dynamics underscore the need for clear clinical guidelines and responsible prescribing practices across Southeast Asia. Without these safeguards, rising consumer interest may complicate equitable distribution and redirect therapeutic focus away from high-need populations.

The recent inclusion of GLP-1-based RAs on WHO’s Essential Medicines List (EML) provides a timely opportunity for regional governments. This designation strengthens the foundation for evaluating subsidy models, negotiating prices and potentially integrating GLP-1 therapies into national reimbursement systems, particularly for high-risk groups with demonstrated cardiovascular or renal vulnerability.

Prof Lim explains Malaysia’s evolving policy response, “The government has announced that more GLP-1-based RAs will be available from 2026 onwards in selected public hospitals, subject to budget considerations. Additionally, MOH will be establishing integrated obesity care clinics to expand access, as obesity is often the main driver for diseases such as diabetes.”

Dr Ng emphasises, “From a health-system perspective, there is a strong case for targeted subsidies, especially for high-risk, low-income patients with T2DM. These individuals are most vulnerable to cardiac and renal complications, and supporting access to effective metabolic therapies can reduce hospitalisations and long-term healthcare costs. A tiered, outcomes-oriented subsidy model would be ideal. If GLP-1-based RA therapy can help prevent progression to cardiovascular or renal disease, then it should be considered as part of a broader preventive-care strategy.”