What is the trend of increasing diabetes in South Asia, especially in countries like India, Pakistan, Sri Lanka, and Bangladesh?

Rising Diabetes Epidemic in South Asian Countries: Trends and Determinants

South Asian countries are experiencing a significant epidemic of diabetes with at least a 2-fold higher prevalence of type 2 diabetes mellitus (T2DM) compared to non-Hispanic whites, with projections indicating the number of people with T2DM in South Asia will reach approximately 120 million by 2030. 1

Epidemiological Trends

• The prevalence of diabetes varies across South Asian countries, with recent estimates ranging from 4.0% in Nepal to 8.8% in India according to the International Diabetes Federation 2017 data 2
• An alarming increasing trend in diabetes prevalence has been observed in both urban and rural areas of India and rural Sri Lanka over the past two decades 3
• The rise of type 2 diabetes in South Asia is estimated to increase by more than 150% between 2000 and 2035, representing one of the steepest regional increases globally 4
• Urban populations consistently demonstrate higher prevalence rates of diabetes compared to rural populations across South Asian countries 3

Biological Risk Factors and the "South Asian Phenotype"

• South Asians present with a unique "South Asian phenotype" characterized by greater metabolic risk at lower BMI levels compared to other ethnic groups 2

• This population demonstrates disproportionately high prevalence of insulin resistance and metabolic syndrome that contributes to the higher T2DM rates 1

• South Asians show evidence of altered metabolic profiles from young adulthood, including:

  • Elevated plasma insulin levels and greater insulin resistance 1
  • Altered lipid profiles (higher triglycerides, lower HDL-C) 1
  • Higher truncal skin-fold thickness and abdominal adiposity 1
  • Lower adiponectin and higher resistin levels 1

• Despite similar or lower BMI values compared to other ethnic groups, South Asians have:

  • Higher body fat percentage 1
  • Greater amounts of visceral and deep subcutaneous fat 1
  • Less total lean abdominal muscle mass 1

• Waist-to-hip ratio (WHR) has been shown to be a stronger predictor of cardiovascular risk than BMI in South Asians 1

Environmental and Lifestyle Determinants

• Major lifestyle changes associated with economic transition, industrialization, urbanization, and globalization have been key drivers of the diabetes epidemic 2
• Specific lifestyle factors contributing to increased diabetes risk include:
  • Declining nutrition quality with diets high in refined carbohydrates and saturated fat 1
  • Lower physical activity rates compared to other ethnic groups (only 52% meeting recommended guidelines in one cohort) 1
  • Increased sedentary behaviors 2
  • Migration to urban areas or Western countries is associated with higher BMI and diabetes risk 1

Special Considerations for South Asian Populations

• Type 2 diabetes in South Asians tends to develop at younger ages compared to other ethnic groups 5
• South Asian women with gestational diabetes have 3.2 times higher risk of developing diabetes compared to those without gestational diabetes 1
• The International Diabetes Federation recommends ethnicity-specific waist circumference cut points for diagnosing metabolic syndrome: >90 cm (35.4 in) for South Asian men and >80 cm (31.5 in) for South Asian women 1
• South Asians with diabetes manifest with higher glycemia, dyslipidemia, nephropathy, and cardiovascular diseases 5

Challenges in Diabetes Management in South Asia

• Poor awareness of the disease and delayed diagnosis 5
• Inadequate treatment and frequent non-compliance with lifestyle recommendations and medications 5
• Use of ineffective and sometimes harmful alternative medicines 5
• Limited healthcare resources and substantial inequalities in healthcare access 6
• Early development of severe complications and premature mortality due to delayed diagnosis and inadequate management 5

Prevention and Management Strategies

• Urgent implementation of effective primary prevention strategies targeting risk factors from preconception through childhood and adolescence 6
• Aggressive management of risk factors from diagnosis to reduce microvascular and macrovascular complications 5
• Community-level education, training, and capacity building to enable more widespread use of non-physician care 6
• Strengthening primary care models and developing national clinical management guidelines 5
• Targeting community gathering areas such as temples and cultural events to raise awareness about increased diabetes risk 1

The diabetes epidemic in South Asia represents a significant public health challenge requiring coordinated efforts in prevention, early detection, and management to mitigate its impact on population health and healthcare systems.