Elsevier

Annals of Epidemiology

Volume 25, Issue 2, February 2015, Pages 77-83
Annals of Epidemiology

Original article
Correlates of prediabetes and type II diabetes in US South Asians: findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study

https://doi.org/10.1016/j.annepidem.2014.10.013Get rights and content

Highlights

  • Cross-sectional analysis of large cohort of US South Asians without cardiac disease

  • There was a high prevalence of prediabetes (33%) and diabetes (25%)

  • Significant difference in diabetes prevalence between the two study sites

  • Lower income, less education, and more time watching television associated with diabetes

  • More exercise; fasting monthly/annually associated with lower diabetes prevalence

Abstract

Purpose

In this study, we aim to elucidate the role of sociodemographic, lifestyle, and cultural factors in prediabetes and diabetes in South Asian immigrants to the United States, a population at high risk of type II diabetes.

Methods

We performed a cross-sectional analysis of a community-based cohort of 899 South Asians without known cardiovascular disease from the Mediators of Atherosclerosis in South Asians Living in America study. Glycemic status was determined by fasting glucose, 2-hour postchallenge glucose, and use of diabetes medication. We used multinomial logistic regression models to estimate the independent associations of sociodemographic, lifestyle, and cultural factors with prediabetes and diabetes, adjusting for confounders identified using directed acyclic graphs.

Results

Approximately 33% of participants had prediabetes and 25% had diabetes. In multivariate analyses, an independent correlate of prediabetes was low exercise. Additional covariates associated with diabetes included lower family income, less education, high chronic psychological burden score, and greater time spent watching television; and fasting monthly or annually was inversely associated with diabetes prevalence.

Conclusions

We found several modifiable risk factors associated with prediabetes and diabetes that may help guide diabetes prevention interventions for South Asian immigrants to the United States.

Introduction

The prevalence of type II diabetes in individuals of South Asian origin is rising [1]. In India alone, there are more than 65 million people with diabetes, making it the country with the second highest number of cases worldwide [2]. South Asians have a higher diabetes prevalence compared to most other racial/ethnic groups [3], as well as more cardiovascular disease (CVD) complications with diabetes [4], [5], and a higher mortality rate mainly due to higher rates of CVD [6]. Understanding the drivers of increased diabetes risk in South Asians is important for improving prevention and treatment options for this high-risk population.

South Asians' increased cardiometabolic risk is multifactorial reflecting a mixture of genetic, environmental, and lifestyle factors [7]. Greater visceral adiposity, insulin resistance (IR) and impaired β-cell function are known to contribute to the increased diabetes risk in South Asians [7]. Urbanization and immigration are also contributory factors with an observed gradient of higher diabetes prevalence in urban Indian settings compared with rural areas [8], and even higher diabetes prevalence with immigration to more affluent countries such as the United States and the United Kingdom, which may be attributed to diet and physical activity changes and psychosocial stressors [7]. However, few studies have measured several lifestyle, behavioral, psychosocial, and biologic factors concurrently in immigrant South Asians in the United States (US).

Less is known about the association between nonbiologic factors and diabetes risk among South Asians. Therefore, we aimed to determine the nonbiologic correlates of prediabetes and type II diabetes in a community-based cohort of middle-aged South Asians in the United States, which is representative of the US South Asian population [9]. We hypothesized that sociodemographic, cultural, lifestyle, and psychological factors would be associated with diabetes in South Asians. Gaining a better understanding of modifiable risk factors for diabetes in US South Asians can help guide the delivery of tailored interventions to decrease their diabetes risk.

Section snippets

Study design

We performed a cross-sectional analysis of a community-based cohort of South Asians without known CVD from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. The MASALA study is modeled on the Multi-Ethnic Study of Atherosclerosis (MESA) study with similar recruitment methods, eligibility criteria, questionnaire, and clinical measurements. Detailed MASALA study methods have been published [9].

Study subjects

To be eligible for the study, participants had to self-report South

Results

Among the 899 participants with categorized glycemic status, the mean age was 55 ± 9 years and 54% were men. Forty-two percent of participants had NGT, 33% had prediabetes, and 25% had type II diabetes. Of those with type II diabetes, 65% had known diabetes and were taking diabetes medications, whereas 35% were newly diagnosed. Baseline characteristics of the study participants by glycemic category are shown in Table 1. Participants with prediabetes and diabetes were older, more likely to be

Discussion

In this cross-sectional analysis of a large community-based cohort of US South Asians without known CVD, there was a high prevalence of prediabetes (33%) and diabetes (25%). In multinomial logistic regression models, lower income, less education, increased chronic psychological burden, and greater time spent watching television were associated with a greater prevalence of prediabetes and diabetes. On the other hand, more exercise and fasting monthly or annually were associated with a lower

Acknowledgments

None.

The MASALA study was supported by the NIH grant no. 1R01 HL093009. Data collection at UCSF was supported by NIH/NCRR UCSF-CTSI Grant Number UL1 RR024131. A.M.K. was also supported by NIH grant 1K24HL112827.

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  • Cited by (0)

    The authors have no conflicts of interest to disclose.

    Publication (in abstract form): A.D.S., E.V., N.R.K. and A.M.K. “Correlates of IGT and Diabetes in South Asians: Results from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study.” Diabetes – 74th Scientific Sessions. 2014; 63 (Suppl 1): A642.

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