Diabetes Indians Overview
- Epidemiological studies show a significant and escalating burden of type 2 diabetes in India. This could be attributed to a high genetic risk and lower risk thresholds for acquired risk factors such as age, obesity, abdominal adiposity and a high percentage of body fat compared to Europids.1
- Recent identification of genetic polymorphisms provides evidence of genetic predisposition to diabetes among Indians.2, 3
- For a given BMI, Asian Indians have higher central adiposity which is an important determinant of several metabolic abnormalities, clinically referred to as metabolic syndrome. A large proportion of urban adults have the metabolic syndrome which predisposes them to both diabetes and cardiovascular diseases.
- Asian Indians accumulate a disproportionate amount of visceral fat so that the thin fat Indian baby grow up to be a thin fat Indian adult with thin legs and big belly.4-8 This can be easily detected by measuring the waist circumference (see Asian Indian Phenotype).
- Even modest amounts of weight gain during adulthood increases the risk of diabetes in Indians.9 Asian Indians and all Asians develop diabetes at a lower body mass index (BMI) and waist circumference compared to Europids.1, 10-19 The risk of diabetes increases with a body mass index (BMI) of >23 kg/m2 and waist circumference of 85 cm for men and 80 cm for women in Asian Indians.1
- There is also evidence of higher insulin resistance amongst Indians, and this is partly explained by higher body fat percentage. Both prediabetes and diabetes are the endpoint of long standing Insulin resistance, which appears to play a significant role for these conditions among Asian Indians. South Asians have decreased sensitivity to insulin when compared to other ethnic groups even in the absence of diabetes possibly due to comparatively increased levels of visceral fat resulting in a blunted response to insulin.20-23
- Indians develop diabetes at least 10-15 years earlier compared to people of non-Indian origin.1, 24
- The prevalence of diabetes among the Indian Diasporas worldwide is greater than 20% and three to six times higher than the host population after standardizing for age. 25, 26Asian Indians have the highest rates of diabetes in the US. Compared with whites, Asian Indians have three times the risk of diabetes, when adjusted for age, and sex, and BMI.27-29
- There are large regional disparities in prevalence of diabetes in India with low prevalence in rural and high prevalence in urban subjects. The disease is more prevalent in southern regions as compared to northern and eastern parts of the country.
- Diabetes Epidemiology Study Group in India (DESI) investigators reported from several urban locations in India: age and gender-standardized prevalence of diabetes ranged from 9% in Mumbai to 12% Delhi, 12% Calcutta, 12% Bangalore, 14% Chennai and 17% in Hyderabad.30
- The principal reason for escalating diabetes and regional disparities appears to be rapidly occurring socioeconomic changes and affluence associated with dietary excess and reduced physical activity. Most of the regional variations in diabetes prevalence could be explained by lifestyle factors.30
- Asian Indians and all South Asian diabetics have a 2-4-fold higher CAD mortality compared to whites and Chinese diabetics.25, 26 This is in sharp contrast to African Americans and Afro-Caribbeans, Hispanics, and other Asian diabetics who have a lower risk of heart disease.31
- Recognition of these special features and institution of early preventive measures are urgently needed.
1. Ramachandran A., Snehalatha C, Vijay V. Low risk threshold for acquired diabetogenic factors in Asian Indians. Diabetes Res Clin Pract. Sep 2004;65(3):189-195.
2. Abate N, Carulli L, Cabo-Chan A, Jr., Chandalia M, Snell PG, Grundy SM. Genetic polymorphism PC-1 K121Q and ethnic susceptibility to insulin resistance. The Journal of clinical endocrinology and metabolism. Dec 2003;88(12):5927-5934.
3. Radha V, Mohan V. Genetic predisposition to type 2 diabetes among Asian Indians. Indian J Med Res. Mar 2007;125(3):259-274.
4. Chandalia M, Abate N, Garg A, Stray-Gundersen J, Grundy SM. Relationship between generalized and upper body obesity to insulin resistance in Asian Indian men. The Journal of clinical endocrinology and metabolism. 1999;84(7):2329-2335.
5. Raji A, Seely EW, Arky RA, Simonson DC. Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. The Journal of clinical endocrinology and metabolism. 2001;86(11):5366-5371.
6. Abate N, Chandalia M, Snell PG, Grundy SM. Adipose tissue metabolites and insulin resistance in nondiabetic Asian Indian men. The Journal of clinical endocrinology and metabolism. Jun 2004;89(6):2750-2755.
7. Yajnik CS, Fall CH, Coyaji KJ, et al. Neonatal anthropometry: the thin-fat Indian baby. The Pune Maternal Nutrition Study. Int J Obes Relat Metab Disord. Feb 2003;27(2):173-180.
8. Krishnaveni GV, Hill JC, Veena SR, et al. Truncal adiposity is present at birth and in early childhood in South Indian children. Indian pediatrics. Jun 2005;42(6):527-538.
9. Hu FB. Globalization of Diabetes: The role of diet, lifestyle, and genes. Diabetes Care. Jun 2011;34(6):1249-1257.
10. McKeigue PM, Ferrie JE, Pierpoint T, Marmot MG. Association of early-onset coronary heart disease in South Asian men with glucose intolerance and hyperinsulinemia. Circulation. 1993;87(1):152-161.
11. Abate N, Chandalia M. Ethnicity and type 2 diabetes: focus on Asian Indians. Journal of diabetes and its complications. Nov-Dec 2001;15(6):320-327.
12. Anand SS, Yusuf S, Vuksan V, et al. Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE). Lancet. 2000;356(9226):279-284.
13. McKeigue PM, Pierpoint T, Ferrie JE, Marmot MG. Relationship of glucose intolerance and hyperinsulinaemia to body fat pattern in south Asians and Europeans. Diabetologia. Aug 1992;35(8):785-791.
14. Chowdhury T. A., Lasker SS, Mahfuz R. Ethnic differences in control of cardiovascular risk factors in patients with type 2 diabetes attending an Inner London diabetes clinic. Postgraduate medical journal. Mar 2006;82(965):211-215.
15. Mather HM, Keen H. The Southall Diabetes Survey: prevalence of known diabetes in Asians and Europeans. Br Med J (Clin Res Ed). 1985;291(6502):1081-1084.
16. Samanta A, Burden AC, Fent B. Comparative prevalence of non-insulin-dependent diabetes mellitus in Asian and white Caucasian adults. Diabetes Res Clin Pract. Nov 1987;4(1):1-6.
17. Ramachandran A, Jali M, Mohan V, Snehalatha C, Viswanathan M. High prevalence of diabetes in an urban population of south India. BMJ. 1988;297:587 – 590.
18. McKeigue PM, Marmot MG, Syndercombe Court YD, Cottier DE, Rahman S, Riemersma RA. Diabetes, hyperinsulinaemia, and coronary risk factors in Bangladeshis in east London. Br Heart J. 1988;60(5):390-396.
19. Nakagami T, Qiao Q, Carstensen B, et al. Age, body mass index and Type 2 diabetes-associations modified by ethnicity. Diabetologia. Aug 2003;46(8):1063-1070.
20. Raji A, Gerhard-Herman MD, Warren M, et al. Insulin resistance and vascular dysfunction in nondiabetic asian indians. The Journal of clinical endocrinology and metabolism. Aug 2004;89(8):3965-3972.
21. Palaniappan LP, Kwan AC, Abbasi F, Lamendola C, McLaughlin TL, Reaven GM. Lipoprotein abnormalities are associated with insulin resistance in South Asian Indian women. Metabolism. Jul 2007;56(7):899-904.
22. Hodge AM, Dowse GK, Collins VR, et al. Abdominal fat distribution and insulin levels only partially explain adverse cardiovascular risk profile in Asian Indians. J Cardiovasc Risk. 1996;3(3):263-270.
23. Banerji MA, Faridi N, Atluri R, Chaiken RL, Lebovitz HE. Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. The Journal of clinical endocrinology and metabolism. 1999;84(1):137-144.
24. Bhargava SK, Sachdev HS, Fall CH, et al. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med. Feb 26 2004;350(9):865-875.
25. Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia. Nov 2006;49(11):2580-2588.
26. Ma S, Cutter J, Tan CE, Chew SK, Tai ES. Associations of diabetes mellitus and ethnicity with mortality in a multiethnic Asian population: data from the 1992 Singapore National Health Survey. Am J Epidemiol. Sep 15 2003;158(6):543-552.
27. Oza-Frank R, Ali MK, Vaccarino V, Narayan KM. Asian Americans: diabetes prevalence across U.S. and World Health Organization weight classifications. Diabetes Care. Sep 2009;32(9):1644-1646.
28. Mohanty SA, Woolhandler S, Himmelstein DU, Bor DH. Diabetes and cardiovascular disease among Asian Indians in the United States. J Gen Intern Med. May 2005;20(5):474-478.
29. Misra R, Patel T, Kotha P, et al. Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: results from a national study. Journal of diabetes and its complications. Mar 18 2009.
30. Ramachandran A, Snehalatha C, Kapur A, et al. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia. 2001;44(9):1094-1101.
31. Karter AJ, Ferrara A, Liu JY, Moffet HH, Ackerson LM, Selby JV. Ethnic disparities in diabetic complications in an insured population. Jama. 2002;287(19):2519-2527.