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Type 2 Diabetes Exploding in Asia

Posted: Wednesday, June 10, 2009

New research suggests diabetes is becoming a global problem, with more than 60% of all cases likely to occur in Asia. What is so unusual is that many affected individuals are not technically overweight or obese. That is, they are "metabolically obese," defined as having a normal body weight, but increased abdominal obesity.

In the West, Type 2 diabetes is often seen as a consequence of diet, age and obesity but researchers say those affected in Asia are relatively young and less likely to be struggling with weight gain.

Citing figures from the International Diabetes Federation, researchers say while people from Japan to Pakistan generally have lower rates of fat, they can have a similar or even higher prevalence of diabetes than in the West.

The problem is that although Asian obesity rates are low, changing diets and sedentary lifestyles, associated with rapid economic development, are taking their toll.

"Type 2 diabetes is an increasing epidemic in Asia, characterized by rapid rates of increase over short periods and onset at a relatively young age and low body mass index," Dr. Chan, lead investigator notes.

To examine the epidemiology, risk factors, and pathophysiology of Type 2 diabetes in Asia, the researchers conducted a search of MEDLINE for relevant studies. Only studies published between January 1980 and March 2009 were included in the review, and studies that looked solely at Type 1 diabetes were excluded.

The review found that the prevalence of Type 2 diabetes has risen from 1% in 1980 to 5.5% in 2001 in China, for example; it rose from 3% in the 1970s to 12% in 2000 among Indian adults, and from 2.3% to 6.8% in rural Bangladesh.

The authors also found evidence that the diabetes epidemic is being fueled, in part, by "diabetes begetting diabetes." They explain that an elevated risk of gestational diabetes coupled with poor nutrition in utero and overnutrition later in life may be a contributing factor in some populations.

Asians, on average, are still far less fat than Westerners, but they are gaining weight around their waists, which is often a precursor for diabetes.

Another alarming aspect of the findings is that young people in Asia seem much more prone to diabetes than young people in the West. A large proportion of victims are between 20 and 59. In the West, the disease tends to strike people between 60 and 79.

With the young age of onset and the long disease duration that follows, the researchers note that the Asian diabetic population is at high risk for cardiorenal complications. At the same time, cancer is increasing as a key cause of morbidity and mortality in this population.

A study published by the Journal of the American Medical Association predicts that cases of diabetes worldwide will grow from 240 million in 2007 to 380 million in 2025. About 60 percent of those cases will be in Asia.

"To curb this epidemic," the authors conclude, "an integrated strategy combining population-wide preventive policies, early detection, and multidisciplinary care programs may reduce the risk of diabetes and associated complications in the general population and in high-risk individuals."

Source: Diabetes In Control: JAMA 2009;301:2129-2140.

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