Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations

Unjali P Gujral, R Pradeepa, Mary Beth Weber, K M Venkat Narayan, V Mohan, Unjali P Gujral, R Pradeepa, Mary Beth Weber, K M Venkat Narayan, V Mohan

Abstract

Type 2 diabetes mellitus (T2DM) is one of the leading causes of morbidity and mortality. While all ethnic groups are affected, the prevalence of T2DM in South Asians, both in their home countries and abroad, is extremely high and is continuing to rise rapidly. Innate biological susceptibilities coupled with rapid changes in physical activity, diet, and other lifestyle behaviors are contributing factors propelling the increased burden of disease in this population. The large scope of this problem calls for investigations into the cause of increased susceptibility and preventative efforts at both the individual and population level that are aggressive, culturally sensitive, and start early. In this review, we outline the biological and environmental factors that place South Asians at elevated risk for T2DM, compared with Caucasian and other ethnic groups.

© 2013 New York Academy of Sciences.

Figures

Figure 1
Figure 1
Projected number of people with diabetes (millions) by year—2011 and 2013.
Figure 2
Figure 2
Differences in prevalence among South Asians and other ethnic groups.

References

    1. Whiting DR, et al. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes. Res. Clin. Pract. 2011;94:311–321.
    1. Mohan V. Why are Indians more prone to diabetes. J. Assoc. Physicians India. 2004;52:468–474.
    1. International Diabetes Federation. IDF Diabetes Atlas. 5th ed. Brussels, Belgium: International Diabetes Federation; 2011. 2011.
    1. Hwang CK, et al. Rural diabetes prevalence quintuples over twenty-five years in low-and middle-income countries: a systematic review and meta-analysis. Diabetes Res. Clin. Pract. 2012;96:271–285.
    1. Anjana RM, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdiaDIABetes (ICMR-INDIAB) study. Diabetologia. 2011;54:3022–3027.
    1. Gupta L, et al. Prevalence of Diabetes in New York City, 2002–2008: comparing foreign-born South Asians and other Asians with U.S.-born whites, blacks, and Hispanics. Diab. Care. 2011;34:1791–1793.
    1. Oza-Frank R, et al. Asian Americans: diabetes prevalence across U.S. and World Health Organization weight classifications. Diab. Care. 2009:1644–1646.
    1. Misra R, et al. Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study. J. Diab. Complicat. 2010;24:145–153.
    1. Mather HM, Keen H. The Southall Diabetes Survey: prevalence of known diabetes in Asians and Europeans. Br. Med. J. (Clin. Res. Ed.) 1985;291:1081–1084.
    1. Zimmet P, et al. Prevalence of diabetes and impaired glucose tolerance in the biracial (Melanesian and Indian) population of Fiji: a rural-urban comparison. Am. J. Epidemiol. 1983;118:673–688.
    1. Omar MA, et al. South African Indians show a high prevalence of NIDDM and bimodality in plasma glucose distribution patterns. Diab. Care. 1994;17:70–73.
    1. Seedat YK, et al. Risk factors for coronary heart disease in the white community of Durban. South Afr. Med. J. 1994;84:257–262.
    1. Jenum AK, et al. Ethnicity and sex are strong determinants of diabetes in an urban Western society: implications for prevention. Diabetologia. 2005;48:435–439.
    1. Lee WR. The changing demography of diabetes mellitus in Singapore. Diab. Res. Clin. Pract. 2000;50(Suppl 2):S35–S39.
    1. Mohan V, et al. Incidence of diabetes and pre-diabetes in a selected urban south Indian population (CUPS-19) J. Assoc. Physicians India. 2008;56:152–157.
    1. Geiss L, et al. Changes in incidence of diabetes in U.S. adults, 1997–2003. Am. J. Prev. Med. 2006;30:371–377.
    1. Bonora E, et al. Population-based incidence rates and risk factors for type 2 diabetes in white individuals: the Bruneck study. Diabetes. 2004;53:1782–1789.
    1. Valdes S, et al. Population-based incidence of type 2 diabetes in northern Spain: the Asturias Study. Diab. Care. 2007;30:2258–2263.
    1. Kasuga M. Insulin resistance and pancreatic beta cell failure. J. Clin. Invest. 2006;116:1756–1760.
    1. Kahn SE, et al. The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of Type 2 diabetes. Diabetologia. 2003;46:3–19.
    1. Saad MF, et al. A two-step model for development of non-insulin-dependent diabetes. Am. J. Med. 1991;90:229–235.
    1. Cnop M, et al. Progressive loss of beta-cell function leads to worsening glucose tolerance in first degree relatives of subjects with type 2 diabetes. Diabet. Care. 2007;30:677–682.
    1. Cali AM, et al. Primary defects in beta-cell function further exacerbated by worsening of insulin resistance mark the development of impaired glucose tolerance in obese adolescents. Diabet. Care. 2009;32:456–461.
    1. Motala AA, et al. Evidence for impaired pancreatic beta cell function in South African Indians with impaired glucose tolerance. Diab. Med. 1994;11:437–444.
    1. Kahn SE. Clinical review 135: the importance of β-cell failure in the development and progression of type 2 diabetes. J. Clin. Endocrinol. Metabol. 2001;86:4047–4058.
    1. Polonsky K, et al. Seminars in Medicine of the Beth Israel Hospital, Boston: non-Insulin-Dependent Diabetes Mellitus—A Genetically Programmed Failure of the Beta Cell to Compensate for Insulin Resistance. N. Engl. J. Med. 1996;334:777–783.
    1. Torrens JI, et al. Ethnic differences in insulin sensitivity and beta-cell function in premenopausal or early perimenopausal women without diabetes: the Study of Women's Health Across the Nation (SWAN) Diab. Care. 2004;27:354–361.
    1. Bi Y, et al. Association of β-cell function and insulin sensitivity with fasting and 2-h plasma glucose in a large Chinese population. Diab. Obesity Metabol. 2012;14:174–180.
    1. Abdul-Ghani MA, et al. The relative contributions of insulin resistance and beta cell failure to the transition from normal to impaired glucose tolerance varies in different ethnic groups. Diab. Met. Syn. Res. Rev. 2007;1:105–112.
    1. Chiu KC, et al. Insulin sensitivity differs among ethnic groups with a compensatory response in beta-cell function. Diab. Care. 2000;23:1353–1358.
    1. Mohan V, et al. Serum immunoreactive insulin responses to a glucose load in Asian Indian and European Type 2 (non-insulin dependent) diabetic patients and control subjects. Diabetologia. 1986;29:235–237.
    1. Sharp PS, et al. Insulin resistance in patients of Asian Indian and European origin with non-insulin dependent diabetes. Hormone Metabol. Res. 1987;19:84–85.
    1. Raji A, et al. Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. J. Clin. Endocrinol. Metabol. 2001;86:5366–5371.
    1. Banerji MA, et al. Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J. Clin. Endocrinol. Metabol. 1999;84:137–144.
    1. Indulekha K, et al. Association of visceral and subcutaneous fat with glucose intolerance, insulin resistance, adipocytokines and inflammatory markers in Asian Indians (CURES-113) Clin. Biochem. 2011;44:281–287.
    1. Sandeep S, et al. Visceral & subcutaneous abdominal fat in relation to insulin resistance & metabolic syndrome in non-diabetic south Indians. Indian J. Med. Res. 2010;131:629–635.
    1. Szuszkiewicz-Garcia M, et al. Fat distribution and insulin resistance in young adult nonobese Asian Indian women. Metabol. Syndrome Related Disorders. 2012;10:326–330.
    1. Petersen KF, et al. Increased prevalence of insulin resistance and nonalcoholic fatty liver disease in Asian-Indian men. Proc. Nat. Acad. Sci. USA. 2006;103:18273–18277.
    1. Hales CN, et al. Fetal and infant growth and impaired glucose tolerance at age 64. BMJ. 1991;303:1019–1022.
    1. Jaquet D, et al. No evidence for a major beta-cell dysfunction in young adults born with intra-uterine growth retardation. Pediatric Diab. 2000;1:181–185.
    1. Bavdekar A, et al. Insulin resistance syndrome in 8-year-old Indian children: small at birth, big at 8 years, or both. Diabetes. 1999;48:2422–2429.
    1. Pilgaard K, et al. Low birthweight and premature birth are both associated with type 2 diabetes in a random sample of middle-aged Danes. Diabetologia. 2010;53:2526–2530.
    1. Kooner JS, et al. Genome-wide association study in individuals of South Asian ancestry identifies six new type 2 diabetes susceptibility loci. Nature Genet. 2011;43:984–989.
    1. Cho YS, et al. Meta-analysis of genome-wide association studies identifies eight new loci for type 2 diabetes in east Asians. Nat. Genet. 2012;44:67–72.
    1. Rees SD, et al. Replication of 13 genome-wide association (GWA)-validated risk variants for type 2 diabetes in Pakistani populations. Diabetologia. 2011;54:1368–1374.
    1. Chauhan G, et al. Impact of common variants of PPARG, KCNJ11, TCF7L2, SLC30A8, HHEX, CDKN2A, IGF2BP2, and CDKAL1 on the risk of type 2 diabetes in 5,164 Indians. Diabetes. 2010;59:2068–2074.
    1. Yajnik CS, et al. FTO gene variants are strongly associated with type 2 diabetes in South Asian Indians. Diabetologia. 2009;52:247–252.
    1. Sanghera DK, et al. Impact of nine common type 2 diabetes risk polymorphisms in Asian Indian Sikhs: PPARG2 (Pro12Ala), IGF2BP2, TCF7L2 and FTO variants confer a significant risk. BMC Med. Genet. 2008;9:59.
    1. Ramya K, et al. Genetic variations in the FTO gene are associated with type 2 diabetes and obesity in south Indians (CURES-79) Diab. Technol. Therap. 2011;13:33–42.
    1. Frayling TM, et al. A common variant in the FTO gene is associated with body mass index and predisposes to childhood and adult obesity. Science. 2007;316:889–894.
    1. Chauhan G, et al. Common variants of FTO and the risk of obesity and type 2 diabetes in Indians. J. Hum. Genet. 2011;56:720–726.
    1. Wasim H, et al. Relationship of serum adiponectin and resistin to glucose intolerance and fat topography in South-Asians. Cardiovasc. Diabetol. 2006;5:10.
    1. Vimaleswaran KS, et al. Peroxisome proliferators-activated receptor-co-activator-1 (PGC-1) gene polymorphisms and their relationship to Type 2 diabetes in Asian Indians. (CURES-14) Diab. Med. 2005;22:1516–1521.
    1. Qiao Q, et al. Age- and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts. Diab. Care. 2003;26:1770–1780.
    1. Ramachandran A, et al. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia. 2001;44:1094–1101.
    1. Center for Disease Control and Prevention. Diabetes Data & Trends. Available at . Accessed on June 1, 2012.
    1. Chiu M, et al. Deriving ethnic-specific BMI cutoff points for assessing diabetes risk. Diab. Care. 2011;34:1741–1748.
    1. Mohan V, et al. Epidemiology of type 2 diabetes: Indian scenario. Indian J. Med. Res. 2007;125:217–230.
    1. Chandalia M, et al. Relationship between generalized and upper body obesity to insulin resistance in Asian Indian men. J. Clin. Endocrinol. Metabol. 1999;84:2329–2335.
    1. Rush EC, et al. Body size, body composition and fat distribution: comparative analysis of European, Maori, Pacific Island and Asian Indian adults. Br. J. Nutr. 2009;102:632–641.
    1. Shaw NJ, et al. Ethnic and gender differences in body fat in British school children as measured by DXA. Arch. Dis. Child. 2007;92:872–875.
    1. Krishnaveni GV, et al. Truncal adiposity is present at birth and in early childhood in South Indian children. Indian Pediatr. 2005;42:527–538.
    1. Yajnik CS, et al. Neonatal anthropometry: the thin-fat Indian baby. The Pune Maternal Nutrition Study. Int. J. Obes. Relat. Metabol. Disord. 2003;27:173–180.
    1. Chan J, et al. Diabetes in Asia: epidemiology, Risk Factors, and Pathophysiology. JAMA. 2009;301:2129–2140.
    1. Ramachandran P. Nutrition and child survival in India. Indian. J. Pediatr. 2010;77:301–305.
    1. Ramakrishnan U. Nutrition and low birth weight: from research to practice. Am. J. Clin. Nutr. 2004;79:17–21.
    1. Sachdev HS, et al. Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort. Am. J. Clin. Nutr. 2005;82:456–466.
    1. Bhargava SK, et al. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. New England J. Med. 2004;350:865–875.
    1. Levy-Marchal C, Jaquet D. Long-term metabolic consequences of being born small for gestational age. Pediatric Diab. 2004;5:147–153.
    1. Veena SR, et al. Newborn size and body composition as predictors of insulin resistance and diabetes in the parents: Parthenon Birth Cohort Study, Mysore, India. Diab. Care. 2012;35:1884–1890.
    1. Maritim AC, et al. Diabetes, oxidative stress, and antioxidants: a review. J. Biochem. Mol. Toxicol. 2003;17:24–38.
    1. Evans JL, et al. Are oxidative stress-activated signaling pathways mediators of insulin resistance and beta-cell dysfunction. Diabetes. 2003;52:1–8.
    1. Pou KM, et al. Visceral and subcutaneous adipose tissue volumes are cross-sectionally related to markers of inflammation and oxidative stress: the Framingham Heart Study. Circulation. 2007;116:1234–1241.
    1. Indulekha K, et al. Association of visceral and subcutaneous fat with glucose intolerance, insulin resistance, adipocytokines and inflammatory markers in Asian Indians (CURES-113) Clin. Biochem. 2011;44:281–287.
    1. Mohan V, et al. Association of C-reactive protein with body fat, diabetes and coronary artery disease in Asian Indians: the Chennai Urban Rural Epidemiology Study (CURES-6) Diab. Med. 2005;22:863–870.
    1. Pradhan AD, et al. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA. 2001;286:327–334.
    1. Abate N, et al. Adipose tissue metabolites and insulin resistance in nondiabetic Asian Indian men. J. Clin. Endocrinol. Metabol. 2004;89:2750–2755.
    1. Forouhi NG, et al. Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians. Int. J. Obes. Relat. Metabol. Disord. 2001;25:1327–1331.
    1. Chambers JC, et al. C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk in Indian Asians from the United Kingdom compared with European whites. Circulation. 2001;104:145–150.
    1. Chandalia M, et al. Elevated plasma high-sensitivity C-reactive protein concentrations in Asian Indians living in the United States. J. Clin. Endocrinol. Metabol. 2003;88:3773–3776.
    1. Shetty PS. Nutrition transition in India. Public Health Nutr. 2002;5:175–182.
    1. Helmrich SP, et al. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. New England J. Med. 1991;325:147–152.
    1. Laaksonen DE, et al. Physical activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study. Diabetes. 2005;54:158–165.
    1. Mohan V, et al. Association of physical inactivity with components of metabolic syndrome and coronary artery disease—the Chennai Urban Population Study (CUPS no. 15) Diabet. Med. 2005;22:1206–1211.
    1. Williams ED, et al. Assessment of physical activity levels in South Asians in the UK: findings from the Health Survey for England. J. Epidemiol. Commun. Health. 2011;65:517–521.
    1. Lip GY, et al. Ethnic differences in public health awareness, health perceptions and physical exercise: implications for heart disease prevention. Ethn. Health. 1996;1:47–53.
    1. Fischbacher CM, et al. How physically active are South Asians in the United Kingdom? A literature review. J. Public Health (Oxf.) 2004;26:250–258.
    1. Hayes L, et al. Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population. J. Public Health Med. 2002;24:170–178.
    1. Hu FB, et al. Diet and risk of Type II diabetes: the role of types of fat and carbohydrate. Diabetologia. 2001;44:805–817.
    1. Mohan V, et al. Dietary carbohydrates, glycemic load, food groups and newly detected type 2 diabetes among urban Asian Indian population in Chennai, India (Chennai Urban Rural Epidemiology Study 59) Br. J. Nutr. 2009;102:1498–1506.
    1. Misra A, et al. South Asian diets and insulin resistance. Br. J. Nutr. 2009;101:465–473.
    1. Burden ML, et al. A comparison of the glycemic and insulinaemic effects of an Asian and a European meal. Pract. Diab. Int. 1994;11:208–211.
    1. Raj S, et al. Dietary habits of Asian Indians in relation to length of residence in the United States. J. Am. Diet. Assoc. 1999;99:1106–1108.
    1. Kulkarni K. Food, culture, and diabetes in the United States. Clin. Diab. 2004;22:190–192.
    1. Wandel M, et al. Changes in food habits after migration among South Asians settled in Oslo: the effect of demographic, socio-economic and integration factors. Appetite. 2008;50:376–385.
    1. Garduno-Diaz SD, Khokhar S. Prevalence, risk factors and complications associated with type 2 diabetes in migrant South Asians. Diab. Metabol. Res. Rev. 2012;28:6–24.
    1. Isharwal S, et al. Diet & insulin resistance: a review & Asian Indian perspective. Indian J. Med. Res. 2009;129:485–499.
    1. Donin AS, et al. Nutritional composition of the diets of South Asian, black African-Caribbean and white European children in the United Kingdom: the Child Heart and Health Study in England (CHASE) Br. J. Nutr. 2010;104:276–285.
    1. Shah T, et al. Prevalence of metabolic syndrome risk factors among young adult Asian Indians. Jimmigr. Health. 2005;7:117–126.
    1. Rimm EB, et al. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ. 1995;310:555–559.
    1. Rimm EB, et al. Cigarette smoking and the risk of diabetes in women. Am. J. Public Health. 1993;83:211–214.
    1. Frati AC, et al. Acute effect of cigarette smoking on glucose tolerance and other cardiovascular risk factors. Diab. Care. 1996;19:112–118.
    1. Persson PG, et al. Cigarette smoking, oral moist snuff use and glucose intolerance. J. Intern. Med. 2000;248:103–110.
    1. Baris E, et al. Research priorities for tobacco control in developing countries: a regional approach to a global consultative process. Tob. Control. 2000;9:217–223.
    1. Rani M, et al. Tobacco use in India: prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob. Control. 2003;12:e4.
    1. Gupta PC, Ray CS. Smokeless tobacco and health in India and South Asia. Respirology. 2003;8:419–431.
    1. Govino G. Epidemiology of tobacco use in the United States. Oncogene. 2002;21:7326–7340.
    1. Spiegel K, et al. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann. Int. Med. 2004;141:846–850.
    1. Beihl DA, et al. Sleep duration as a risk factor for incident type 2 diabetes in a multiethnic cohort. Ann. Epidemiol. 2009;19:351–357.
    1. Nilsson PM, et al. Incidence of diabetes in middle-aged men is related to sleep disturbances. Diab. Care. 2004;27:2464–2469.
    1. Roopa M, et al. Prevalence of sleep abnormalities and their association with metabolic syndrome among Asian Indians: Chennai Urban Rural Epidemiology Study (CURES-67) J. Diab. Sci. Technol. 2010;4:1524–1531.
    1. Bhushan B, et al. Obstructive sleep apnea is independently associated with the metabolic syndrome in obese Asian Indians in northern India. Metabol. Syndrome Related Disord. 2010;8:431–435.
    1. Barone MT, Menna-Barreto L. Diabetes and sleep: a complex cause-and-effect relationship. Diab. Res. Clin. Pract. 2011;91:129–137.
    1. Carpenter DO. Environmental contaminants as risk factors for developing diabetes. Rev. Environ. Health. 2008;23:59–74.
    1. Lee DH, et al. A strong dose-response relation between serum concentrations of persistent organic pollutants and diabetes: results from the National Health and Examination Survey 1999–2002. Diab. Care. 2006;29:1638–1644.
    1. Monirith I, et al. Asia-Pacific mussel watch: monitoring contamination of persistent organochlorine compounds in coastal waters of Asian countries. Mar. Pollut. Bull. 2003;46:281–300.
    1. Minh NH, et al. Contamination by persistent organic pollutants in dumping sites of Asian developing countries: implication of emerging pollution sources. Arch. Environ. Contaminat. Toxicol. 2006;50:474–481.
    1. Weber MB, et al. Lifestyle interventions and the prevention and treatment of Type 2 diabetes. Am. J. Lifestyle Med. 2010;4:468–480.
    1. Narayan KM, Williamson DF. Prevention of type 2 diabetes: risk status, clinic, and community. J. Gen. Internal Med. 2010;25:154–157.
    1. deVegt F, et al. Relation of impaired fasting and postload glucose with incident type 2diabetes in a Dutch population: the Hoorn study. JAMA. 2001;285:2109–2113.
    1. Knowler WC, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N. Engl. J. Med. 2002;346:393–403.
    1. Lindstrom J, et al. The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity. Diab. Care. 2003;20:537–544.
    1. Weber MB, et al. A model of translational research for diabetes prevention in low and middle-income countries: The Diabetes Community Lifestyle Improvement Program (D-CLIP) trial. Primary Care Diab. 2012;6:3–9.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere