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Diabetes Diasporas

Diabetes among Asian Indian Diasporas  

  • Over the past 50 years, the incidence and prevalence of diabetes has increased more rapidly among the South Asian Diasporas compared with indigenous populations, irrespective of the country of origin or immigration.1-6
  • Diabetes prevalence is 2-6 times higher among Indian Diasporas compared to people of other ethnic origins in several countries regardless of cultural or religious differences.7-10
  •  Indian vegetarians appear to have a higher risk of diabetes, possibly due to a high glycemic load.11 12
  • Asian Indians develop diabetes at a lower body mass index (BMI) and waist circumference (WC) than whites that led the World Health Organization (WHO) to set lower threshold for these measurements in Asian Indians.13-15
  • Asians develop diabetes at least 10 years earlier than whites predisposing them to greater long-term complications.13-15
  • Asian Indians risk of diabetes is 3-fold higher than whites when adjusted for age, BMI and other risk factors and the risk is substantially higher than all other Asians.16 The risk of diabetes is related  to higher amounts of visceral fat, truncal fat, and large dysfunctional subcutaneous fat cells.17
  • Asian Indians with diabetes have a 3-4 fold higher risk of coronary artery disease (CAD) than whites with diabetes (after adjustment for gender, age, education level, hypertension, alcohol intake, and obesity).18-20
  • The heightened risk of CAD among South Asians with diabetes is in sharp contrast to the 32-44% lower risk observed among blacks, Hispanics, and other Asians.7, 21
  • Most studies have shown Asian Indian diabetics achieve poor control of risk factors such as hypertension and dyslipidemia.22

Sources

1. Barnett AH, Dixon AN, Bellary S, et al. Type 2 diabetes and cardiovascular risk in the UK south Asian community. Diabetologia. Oct 2006;49(10):2234-2246.

2. 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.

3. 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.

4. Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. Bmj. Mar 9 1991;302(6776):560-564.

5. Wild SH, McKeigue P. Cross sectional analysis of mortality by country of birth in England and Wales, 1970-92. Bmj. 1997;314(7082):705-710.

6. UKPDS 32. Ethnicity and cardiovascular disease. The incidence of myocardial infarction in white, South Asian, and Afro-Caribbean patients with type 2 diabetes (U.K. Prospective Diabetes Study 32). Diabetes Care. 1998;21(8):1271-1277.

7. Ramachandran A, Ma RC, Snehalatha C. Diabetes in Asia. Lancet. Jan 30 2010;375(9712):408-418.

8. 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.

9. 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.

10. Abate N, Chandalia M. The impact of ethnicity on type 2 diabetes. Journal of diabetes and its complications. Jan-Feb 2003;17(1):39-58.

11. Enas EA, Garg A, Davidson MA, Nair VM, Huet BA, Yusuf S. Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America. Indian heart journal. Jul-Aug 1996;48(4):343-353.

12. Mohan V, Radhika G, Sathya RM, Tamil SR, Ganesan A, Sudha V. Dietary carbohydrates, glycaemic load, food groups and newly detected type 2 diabetes among urban Asian Indian population in Chennai, India (Chennai Urban Rural Epidemiology Study 59). The British journal of nutrition. Jul 9 2009:1-9.

13. Asia  Pacific Perspective:Redefing obesity and its treatment   World Health Organization, Western Pacific  Region;2000.

14. Mohan V., Venkatraman JV, Pradeepa R. Epidemiology of cardiovascular disease in type 2 diabetes: the Indian scenario. J Diabetes Sci Technol. 2010;4(1):158-170.

15. Ramachandran  A. Epidemiology of Diabetes in India In: Mohan V, Rao G, eds. Type 2 Diabetes in South Asians: Epidemiology risk factors and prevention. New Delhi: JAYPEE; 2007.

16. Kanaya AM, Wassel CL, Mathur D, et al. Prevalence and correlates of diabetes in South asian indians in the United States: findings from the metabolic syndrome and atherosclerosis in South asians living in america study and the multi-ethnic study of atherosclerosis. Metabolic syndrome and related disorders. Apr 2010;8(2):157-164.

17. Chandalia M, Lin P, Seenivasan T, et al. Insulin resistance and body fat distribution in South Asian men compared to Caucasian men. PLoS ONE. 2007;2(8):e812.

18. Chaturvedi N, Fuller JH. Ethnic differences in mortality from cardiovascular disease in the UK: do they persist in people with diabetes? J Epidemiol Community Health. 1996;50(2):137-139.

19. Mather HM, Chaturvedi N, Fuller JH. Mortality and morbidity from diabetes in South Asians and Europeans: 11- year follow-up of the Southall Diabetes Survey, London, UK. Diabet Med. 1998;15(1):53-59.

20. 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.

21. 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.

22. Mukhopadhyay B, Forouhi NG, Fisher BM, Kesson CM, Sattar N. A comparison of glycaemic and metabolic control over time among South Asian and European patients with Type 2 diabetes: results from follow-up in a routine diabetes clinic. Diabet Med. Jan 2006;23(1):94-98.

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