gautam samadder, md - American Association of Physicians of ...

Being “Indian”:
A risk factor for type 2 diabetes mellitus?
Type 2 diabetes mellitus (“diabetes”) was traditionally considered
an age-related disease predominantly affecting individuals
living in developed countries. While its global prevalence
has steadily increased throughout modern times; it has reached
epidemic proportions in the developing world over the past 3
decades for reasons that are not fully understood.
Sumit Bhagra, MBBS
Bhagra.Sumit@mayo.edu
Currently, India is home to the largest number of diabetic individuals in the world. People of Indian origin living outside India,
regardless of when and where they migrated, have a high risk of developing diabetes. Studies from Fiji, Mauritius, Malaysia, Singapore,
Kenya, United Kingdom and United States of America have reported a higher risk of diabetes in people of Indian origin
living in those countries compared to local people and even other immigrant ethnic groups.
Prevalence of diabetes in India: Based on projections from a recent study (phase 1 of the ICMR-INDIAB); India has 62 million
diabetic individuals and 77 million people with prediabetes (Anjana, Diabetologia, 2011). Indian people develop diabetes at a
younger age and lower body mass index (BMI) than their western counterparts. A study from Chandigarh in northern India
showed that 11.1% people surveyed had diabetes (Ravikumar, Diabetes Metab, 2011). A study from Chennai in southern India
showed that the number of diabetics had nearly doubled (72% increase) over a short span of 14 years (Ramachandran, Diabetologia,
2001).
Prevalence of diabetes in Asian-Indians living in the United States: A survey conducted on randomly selected Asian-Indian
people living in various cities within the United States showed that nearly 1 in 5 people had diabetes. Surprisingly, the average
age of those surveyed was just 45 years and these people were not markedly overweight (Misra, J Diabetes Complications, 2010).
Diabetes in Indians: Nature vs. Nurture?: How do we explain the high risk of diabetes in Indian people? What factors can explain
the rapid increase in diabetes seen over the past 3 decades? Is it our genes or the environment... or both?
It is reasonable to assume that Indians have a genetic predisposition for diabetes, being that Indians living in different parts of
the world share that risk. However, studies from India show that city-dwellers and people with a higher income are affected with
diabetes more often than lower-income rural counterparts. Moreover, healthy people from villages that migrate to an urban setting
within India show adverse metabolic changes including diabetes. While genes may play a permissive role, it appears that the
recent epidemic of diabetes ought to be explained by invoking environmental factors such as changes in diet, activity and other
lifestyle patterns.
Nutritional Imbalance: A variety of dietary factors could explain the development of diabetes (a) increased omega-6 fatty
acid intake (b) increased intake of saturated fat (c) increased sugar consumption. One or more of above factors may be partly
responsible for the higher prevalence of diabetes in Asian-Indians. Alternatively, Asian-Indians may be ill-suited to “western”
dietary patterns due to genetic factors.
Physical inactivity: Data regarding leisure activity and physical fitness in Asian-Indian children and adolescents are sparse.
Asian-Indian children may have lower level of activity and fitness due to nutritional, social and cultural factors. Cross-sectional
data from Asian-Indians living in the United States shows that 65% of those interviewed did not get the recommended minimum
daily exercise.
Prevention: The first step towards prevention is the recognition that being “Indian” is a risk factor for diabetes. Summarized
below is a list of interventions that can potentially decrease the burden of diabetes on Asian-Indian populations.
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