Diabetes in Bangladesh: The Role of Sugar-Sweetened Beverages

Dear Editor, Over the past two decades, Bangladesh has experienced a marked epidemiological transition characterized by the growing burden of cardiometabolic diseases. The prevalence of diabetes in Bangladeshi adults has more than doubled from 5% in 2001 to nearly 13% in 2024.[1] While the underlying factors of increasing urbanization and sedentary lifestyles are well known, real-world drivers such as widespread consumption of sugar-sweetened beverages (SSBs) require closer attention. In Bangladesh’s urban centers, such as Dhaka, the prevalence of regular SSB consumption is alarming. A recent population-based analysis suggests that 44% of adolescents in Bangladesh drink SSBs at least once daily and that household consumption of SSBs has increased from 13% in 2016 to nearly 37% in 2022. [2,3] This suggests that SSBs constitute a core component of the Bangladeshi household’s nutritional intake. As SSB consumption is strongly associated with an increased risk of diabetes, this is particularly concerning for a population that already bears a disproportionately high global burden of diabetes.[2] A key driver of SSB consumption is the widespread availability and affordability of SSBs across Bangladesh, with an almost 50% decrease in the inflation-adjusted prices over the last two decades.[4] However, a practical challenge is the limited availability of sugar-free or low-calorie beverages for consumers, which often makes SSBs the default choice. In many local stores across Dhaka, sugar-free soft drinks or low-calorie beverages are either unavailable or inconsistently stocked. Although long-term replacement of SSBs with artificially sweetened beverages is not endorsed, recent national guidelines suggest that they may be an option for short-term substitution among people with high intake of SSBs.[5] Advocating for a wider selection of sugar-free alternatives is important as the increased visibility of these options can influence consumers away from SSBs. Ultimately, from a clinician’s perspective, advising patients to reduce sugar intake becomes challenging when there are fewer practical alternatives. This mismatch between medical advice and environmental reality may partly explain why lifestyle interventions remain difficult to sustain. Therefore, addressing diabetes in Bangladesh requires policy action that extends beyond individual behavior change. An essential component of a national diabetes strategy should include comprehensive measures to reduce SSB consumption. Strategies may include (1) marketing regulations to restrict targeting children and adolescents, particularly via social media; (2) implementing school-based nutritional policies such as restricting the availability of SSBs in school canteens; (3) considering the utility of taxation on SSBs; and finally (4) improving the availability of sugar-free alternatives, including safe drinking water in public spaces. As clinicians, advocating for our patients through brief interventions during clinic visits and championing broad policy changes will be critical to addressing the growing burden of diabetes in Bangladesh. Author contributions MRM conceived the letter, drafted the letter, and approved the final version for submission. Data availability statement This correspondence does not contain original research data. All cited statistics are derived from publicly available published sources referenced in the letter. Ethical policy and Institutional Review Board statement No ethical issues to declare. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.