RT Journal Article
SR Electronic
T1 Incidence of diabetes in South Asian young adults compared to Pima Indians
JF BMJ Open Diabetes Research & Care
JO BMJ Open Diab Res Care
FD American Diabetes Association
SP e001988
DO 10.1136/bmjdrc-2020-001988
VO 9
IS 1
A1 Narayan, K M Venkat
A1 Kondal, Dimple
A1 Kobes, Sayuko
A1 Staimez, Lisa R
A1 Mohan, Deepa
A1 Gujral, Unjali P
A1 Patel, Shivani A
A1 Anjana, Ranjit Mohan
A1 Shivashankar, Roopa
A1 Ali, Mohammed K
A1 Chang, Howard H
A1 Kadir, Masood
A1 Prabhakaran, Dorairaj
A1 Daya, Natalie
A1 Selvin, Elizabeth
A1 Tandon, Nikhil
A1 Hanson, Robert
A1 Mohan, Viswanathan
YR 2021
UL http://drc.bmj.com/content/9/1/e001988.abstract
AB Introduction South Asians (SA) and Pima Indians have high prevalence of diabetes but differ markedly in body size. We hypothesize that young SA will have higher diabetes incidence than Pima Indians at comparable body mass index (BMI) levels.Research design and methods We used prospective cohort data to estimate age-specific, sex, and BMI-specific diabetes incidence in SA aged 20–44 years living in India and Pakistan from the Center for Cardiometabolic Risk Reduction in South Asia Study (n=6676), and compared with Pima Indians, from Pima Indian Study (n=1852).Results At baseline, SA were considerably less obese than Pima Indians (BMI (kg/m2): 24.4 vs 33.8; waist circumference (cm): 82.5 vs 107.0). Age-standardized diabetes incidence (cases/1000 person-years, 95% CI) was lower in SA than in Pima Indians (men: 14.2, 12.2–16.2 vs 37.3, 31.8–42.8; women: 14.8, 13.0–16.5 vs 46.1, 41.2–51.1). Risk of incident diabetes among 20–24-year-old Pima men and women was six times (relative risk (RR), 95% CI: 6.04, 3.30 to 12.0) and seven times (RR, 95% CI: 7.64, 3.73 to 18.2) higher as compared with SA men and women, respectively. In those with BMI <25 kg/m2, however, the risk of diabetes was over five times in SA men than in Pima Indian men. Among those with BMI ≥30 kg/m2, diabetes incidence in SA men was nearly as high as in Pima men. SA and Pima Indians had similar magnitude of association between age, sex, BMI, and insulin secretion with diabetes. The effect of family history was larger in SA, whereas that of insulin resistance was larger in Pima IndiansConclusions In the background of relatively low insulin resistance, higher diabetes incidence in SA is driven by poor insulin secretion in SA men. The findings call for research to improve insulin secretion in early natural history of diabetes.