Diabetes in South-East Asia: An update

doi:10.1016/j.diabres.2013.11.011

Diabetes Research and Clinical Practice

Volume 103, Issue 2, February 2014, Pages 231-237

https://doi.org/10.1016/j.diabres.2013.11.011 Get rights and content

Abstract

According to the recent estimates by the International Diabetes Federation (IDF), South East-Asia (SEA) Region consisting of India, Sri Lanka, Bangladesh, Bhutan, Mauritius and Maldives, is home to more than 72 million adults with diabetes in 2013 and is expected to exceed 123 million in 2035. Nearly 95% of people with diabetes have type 2 diabetes (T2DM). Although type 1 diabetes (T1DM) is relatively rare in these countries, its prevalence is also rising. Furthermore, a large number (24.3 million) of people also have impaired glucose tolerance (IGT). Several characteristic differences are seen in the clinical and immunological presentation of these people when compared with their European counterparts.

A sharp increase in the prevalence of T2DM has been observed in the SEA Region, both in urban and rural areas, which is mostly associated with the lifestyle transitions towards urbanisation and industrialisation. Evidence suggests that a large portion of T2DM may be preventable by lifestyle modification. However, morbidity and early mortality occur as a result of inadequate healthcare facilities for early detection and initiation of therapy, as well as suboptimal management of diabetes and associated morbidities. This is largely preventable by primary prevention of diabetes and enhancing awareness about the disease among the public and the healthcare providers. There is an urgent need for concerted efforts by government and non-governmental sectors to implement national programmes aimed at prevention, management and surveillance of the disease.

Introduction

The global prevalence of diabetes, and especially type 2 diabetes (T2DM), is increasing at an alarming rate. According to the recent update by the International Diabetes Federation (IDF) more than 382 million adults aged 20–79 years had diabetes in 2013 [1]. The prevalence is increasing in every country, and major economic, social and healthcare impacts will be seen in developing countries, as these countries are home to as much as 80% of people with diabetes [1].

Prevalence estimates of diabetes and Impaired Glucose Tolerance (IGT) are high for all South-East Asia countries and are expected to increase further in the next two decades [2]. The South-East Asia (SEA) Region is estimated to have more than 72 million adults with diabetes and 24.3 million with IGT. The present trend indicates that more than 60% of the world's population of people with diabetes will be in Asia. The number of people with diabetes will exceed 123 million in 2035 unless drastic steps are taken to curb this trend [1].

Section snippets

Rising prevalence of type 1 diabetes

The estimates of the global incidence of type 1 diabetes (T1DM) have mainly been based on limited epidemiological studies [3]. Given the relatively rare occurrence of T1DM in Asian populations, as well as the heterogeneity of phenotype in young people with diabetes, data collection has not been as systematic as those in Western countries, where national registries of patients with T1DM are available [3]. Most countries in Asia do not have established registries for T1DM, making data collection

Risk factors

The rising trend in diabetes prevalence in Asian countries in general and the SEA Region in particular, is associated with the risk factors shown in Fig. 1. Several peculiar genetic characteristics and acquired risk factors heighten the predisposition to the disease, and environmental and social conditions accelerate development of metabolic disorders. The adverse metabolic profile that is often seen in obese and elderly white populations is often manifested in young and non-obese SEA

Healthcare burden

Nineteen percent of people with diabetes live in SEA, yet one quarter of the 12 million deaths worldwide due to diabetes occur in this Region. More than 55% of people with diabetes in the region die under the age of 60 years [2]. Major contributory factors for development of complications include delayed diagnosis, sub-optimal control of glycaemia and hypertension, and inadequate medical facilities. There is a need for greater awareness of the benefits of early detection and tight control of

Morbidity and mortality

The evaluation of prevalence of complications in Asian countries has been hindered by the lack of national data, and there are only a few systematic comparisons between countries or people of different ethnic backgrounds. However, the research that has been conducted suggests that South Asians have a general predisposition to renal disease and cardiovascular disease compared to Europeans. Cardiovascular disease susceptibility has been attributed to visceral adiposity and the “thin-fat”

Prevention of diabetes

Prevention of diabetes and obesity are cost effective strategies. Several systematic clinical trials have shown the effectiveness and safety of lifestyle modification in preventing T2DM in varied ethnic populations [47]. Lifestyle intervention was found to be effective in Asian Indian subjects with IGT, with a risk reduction in incident diabetes of approximately 30% in 3 years compared with standard care [17]. The metabolic benefits were seen in non-obese subjects, independent of weight

The way forward

The challenges lie in improving the awareness level among the public on the risk factors for diabetes and then taking steps to prevent the disease. Empowering and educating self-care by patients and improving the training of medical community are also urgent requirements for countries in the SEA Region. Efforts to improve diabetes care and screening of complications have utilised different approaches. Several regional studies are examining the use of information technology such as mobile phone

Conclusions

SEA countries are facing a huge healthcare and economic burden from the rising prevalence of diabetes and its complications in both urban and rural communities. Adverse gene-environmental interactions due to rapid urbanisation and Westernisation have further escalated the prevalence of obesity and diabetes in most of these countries. The regional prevalence of diabetes among adults in SEA is estimated at 8.2% in 2013, which is projected to increase to 10.1% in 2035. The prevalence of IGT will

Conflicts of interest

There are no conflicts of interest.

Acknowledgements

The authors would like to thank Ram Jagannathan and Mary Simon for helping in literature collection. The authors would also like to thank Vijaya L for secretarial assistance.

The 6th edition of the IDF Diabetes Atlas was supported by the following sponsors: Lilly Diabetes, Merck and Co, Inc., Novo Nordisk A/S supported through an unrestricted grant by the Novo Nordisk Changing Diabetes^® initiative, Pfizer, Inc., and Sanofi Diabetes.

References (49)

L. Guariguata et al.
Global estimates of diabetes prevalence for 2013 and projections for 2035
Diabetes Res Clin Pract
(2014)
C.C. Patterson et al.
Diabetes in the young – a global view and worldwide estimates of numbers of children with type 1 diabetes
Diabetes Res Clin Pract
(2014)
A. Ramachandran et al.
Diabetes in Asia
Lancet
(2010)
J.E. Shaw et al.
Global estimates of the prevalence of diabetes for 2010 and 2030
Diabetes Res Clin Pract
(2010)
P. Misra et al.
A review of the epidemiology of diabetes in rural India
Diabetes Res Clin Pract
(2011)
L. Guariguata et al.
Global estimates of the prevalence of hyperglycaemia in pregnancy
Diabetes Res Clin Pract
(2014)
M. Carolan
Gestational diabetes mellitus among women born in South East Asia: a review of the evidence
Midwifery
(2013)
K.-H. Yoon et al.
Epidemic obesity and type 2 diabetes in Asia
Lancet
(2006)
V. Mohan et al.
Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: the Chennai Urban Population Study (CUPS No. 5)
J Am Coll Cardiol
(2001)
T.Y. Wong et al.
Prevalence and risk factors for diabetic retinopathy: the Singapore Malay Eye Study
Ophthalmology
(2008)

H. Noto et al.

Substantially increased risk of cancer in patients with diabetes mellitus: a systematic review and meta-analysis of epidemiologic evidence in Japan

J Diabetes Complicat

(2010)

A. Ramachandran et al.

Diabetes prevention programs

Prediabetes Diabetes Prev

(2011)

G. Li et al.

The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study

Lancet

(2008)

A. Ramachandran et al.

Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial

Lancet Diabetes Endocrinol

(2013)

IDF Diabetes Atlas

(2013)

C.Y. Pan et al.

Metabolic, immunological and clinical characteristics in newly diagnosed Asian diabetes patients aged 12–40 years

Diabet Med

(2004)

R. Mazumder et al.

Clinical assessment of obesity and insulin resistance in type 1 diabetes subjects seen at a center in Kolkata

J Assoc Physicians India

(2009)

Y. Xiang et al.

Latent autoimmune diabetes in adults in Asians: similarities and differences between East and West

J Diabetes

(2013)

A. Ramachandran et al.

High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India

Diabetes Care

(2008)

World Population Prospects: The 2012 Revision. New York;...

World Urbanization Prospects 2011 Revision

(2012)

D.J. Magliano et al.

Explaining the increase of diabetes prevalence and plasma glucose in Mauritius

Diabetes Care

(2012)

R. Jayawardena et al.

Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-analysis

BMC Public Health

(2012)

R.M. Anjana et al.

Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study

Diabetologia

(2011)

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IDF Diabetes AtlasDiabetes in South-East Asia: An update

Abstract

Introduction

Section snippets

Rising prevalence of type 1 diabetes

Risk factors

Healthcare burden

Morbidity and mortality

Prevention of diabetes

The way forward

Conclusions

Conflicts of interest

Acknowledgements

Diabetes Res Clin Pract

Diabetes Res Clin Pract

Lancet

Diabetes Res Clin Pract

Diabetes Res Clin Pract

Diabetes Res Clin Pract

Midwifery

Lancet

J Am Coll Cardiol

Ophthalmology

J Diabetes Complicat

Prediabetes Diabetes Prev

Lancet

Lancet Diabetes Endocrinol

IDF Diabetes Atlas

Metabolic, immunological and clinical characteristics in newly diagnosed Asian diabetes patients aged 12–40 years

Diabet Med

Clinical assessment of obesity and insulin resistance in type 1 diabetes subjects seen at a center in Kolkata

J Assoc Physicians India

Latent autoimmune diabetes in adults in Asians: similarities and differences between East and West

J Diabetes

High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India

Diabetes Care

World Urbanization Prospects 2011 Revision

Explaining the increase of diabetes prevalence and plasma glucose in Mauritius

Diabetes Care

Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-analysis

BMC Public Health

Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study

Diabetologia

IDF Diabetes Atlas
Diabetes in South-East Asia: An update