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Diabetes in South Asians: Phenotype, Clinical Presentation, and Natural History

  • Other Forms of Diabetes and Its Complications (JJ Nolan and H Thabit, Section Editors)
  • Published:
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Abstract

Purpose of Review

South Asia is one of the epicenters of the global diabetes pandemic. Diabetes in south Asians has certain peculiar features with respect to its pathophysiology, clinical presentation, and management. This review aims to summarize some of the recent evidence pertaining to the distinct diabetes phenotype in south Asians.

Recent Findings

South Asia has high incidence and prevalence rates of diabetes. The progression from “pre-diabetes” to diabetes also occurs faster in this population. Pancreatic beta cell dysfunction seems to be as important as insulin resistance in the pathophysiology of diabetes in south Asians. Recent evidence suggests that the epidemic of diabetes in south Asia is spreading to rural areas and to less affluent sections of society.

Summary

Diabetes in south Asians differs significantly from that in white Caucasians, with important implications for prevention, diagnosis, and management.

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References

Papers of particular interest, published recently, have been highlighted as:• Of importance •• Of major importance

  1. • International Diabetes Federation. IDF Diabetes Atlas eighth edition 2017, Brussels, Belgium, 2017. Available at http://www.diabetesatlas.org/resources/2017-atlas.html/ [Accessed on 30th January 2018] Publication providing the most up-to-date information on diabetes burden faced by countries and regions.

  2. Rai R, Reeves P, editors. The south Asian diaspora: transnational networks and changing identities. Routledge: Oxford; 2009.

    Google Scholar 

  3. Unnikrishnan R, Anjana RM, Mohan V. Diabetes in south Asians: is the phenotype different? Diabetes. 2014;63:53–5.

    Article  PubMed  CAS  Google Scholar 

  4. Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. The Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study: methodological details. J Diabetes Sci Technol. 2011;5:906–14.

    Article  PubMed  PubMed Central  Google Scholar 

  5. •• Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. ICMR–INDIAB Collaborative Study Group. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5:585–96. Article based on the largest epidemiological study on diabetes in India, providing clear evidence about the changing nature of the diabetes epidemic.

    Article  PubMed  Google Scholar 

  6. Anjana RM, Shanthi Rani CS, Deepa M, Pradeepa R, Sudha V, Divya Nair H, et al. Incidence of diabetes and prediabetes and predictors of progression among Asian Indians: 10-year follow-up of the Chennai Urban Rural Epidemiology Study (CURES). Diabetes Care. 2015;38(8):1441–8.

    Article  PubMed  Google Scholar 

  7. Mohan V, Sharp PS, Cloke HR, Burrin JM, Schumer B, Kohner EM. Serum immunoreactive insulin responses to a glucose load in Asian Indian and European type 2 (non-insulin-dependent) diabetic patients and control subjects. Diabetologia. 1986;29:235–7.

    Article  PubMed  CAS  Google Scholar 

  8. McKeigue PM, Shah B, Marmot MG. Relation of central obesity and insulin resistance with high diabetes prevalence and cardiovascular risk in south Asians. Lancet. 1991;337:382–6.

    Article  PubMed  CAS  Google Scholar 

  9. Yajnik CS, Fall CH, Coyaji KJ, Hirve SS, Rao S, Barker DJ, et al. Neonatal anthropometry: the thin-fat Indian baby. The Pune Maternal Nutrition Study. Int J Obes Relat Metab Disord. 2003;27:173–80.

    Article  PubMed  CAS  Google Scholar 

  10. Yajnik CS, Lubree HG, Rege SS, Naik SS, Deshpande JA, Deshpande SS, et al. Adiposity and hyperinsulinemia in Indians are present at birth. J Clin Endocrinol Metab. 2002;87:5575–80.

    Article  PubMed  CAS  Google Scholar 

  11. •• Narayan KM. Type 2 diabetes: why we are winning the battle but losing the war? 2015 Kelly West Award Lecture. Diabetes Care. 2016;39:653–63. In-depth review about the mechanistic aspects of type 2 diabetes in south Asians.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Staimez LR, Weber MB, Ranjani H, Ali MK, Echouffo-Tcheugui JB, Phillips LS, et al. Evidence of reduced β-cell function in Asian Indians with mild dysglycemia. Diabetes Care. 2013;36:2772–8.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mohan V, Amutha A, Ranjani H, Unnikrishnan R, Datta M, Anjana RM, et al. Associations of β-cell function and insulin resistance with youth-onset type 2 diabetes and prediabetes among Asian Indians. Diabetes Technol Ther. 2013;15:315–22.

    Article  PubMed  CAS  Google Scholar 

  14. Gujral UP, Narayan KM, Kahn SE, Kanaya AM. The relative associations of β-cell function and insulin sensitivity with glycemic status and incident glycemic progression in migrant Asian Indians in the United States: the MASALA study. J Diabetes Complicat. 2014;28:45–50.

    Article  PubMed  Google Scholar 

  15. Ikehara S, Tabák AG, Akbaraly TN, Hulmán A, Kivimäki M, Forouhi NG, et al. Age trajectories of glycaemic traits in non-diabetic south Asian and white individuals: the Whitehall II cohort study. Diabetologia. 2015;58:534–42.

    Article  PubMed  CAS  Google Scholar 

  16. Kanaya AM, Herrington D, Vittinghoff E, Ewing SK, Liu K, Blaha MJ, et al. Understanding the high prevalence of diabetes in U.S. south Asians compared with four racial/ethnic groups: the MASALA and MESA studies. Diabetes Care. 2014;37:1621–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Bavdekar A, Yajnik CS, Fall CH, Bapat S, Pandit AN, Deshpande V, et al. Insulin resistance syndrome in 8-year-old Indian children: small at birth, big at 8 years, or both? Diabetes. 1999;48:2422–9.

    Article  PubMed  CAS  Google Scholar 

  18. Pilgaard K, Færch K, Carstensen B, Poulsen P, Pisinger C, Pedersen O, et al. Low birthweight and premature birth are both associated with type 2 diabetes in a random sample of middle-aged Danes. Diabetologia. 2010;53:2526–30.

    Article  PubMed  CAS  Google Scholar 

  19. Gujral UP, Pradeepa R, Weber MB, Narayan KM, Mohan V. Type 2 diabetes in south Asians: similarities and differences with white Caucasian and other populations. Ann N Y Acad Sci. 2013;1281:51–63.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kanga U, Vaidyanathan B, Jaini R, Menon PS, Mehra NK. HLA haplotypes associated with type 1 diabetes mellitus in north Indian children. Hum Immunol. 2004;65:47–53.

    Article  PubMed  CAS  Google Scholar 

  21. Balasubramanian K, Dabadghao P, Bhatia V, Colman PG, Gellert SA, Bharadwaj U, et al. High frequency of type 1B (idiopathic) diabetes in north Indian children with recent-onset diabetes. Diabetes Care. 2003;26:2697.

    Article  PubMed  Google Scholar 

  22. Unnikrishnan R, Mohan V. Fibrocalculous pancreatic diabetes (FCPD). Acta Diabetol. 2015;52:1–9.

    Article  PubMed  CAS  Google Scholar 

  23. Misra S, Shields B, Colclough K, Johnston DG, Oliver NS, Ellard S, et al. South Asian individuals with diabetes who are referred for MODY testing in the UK have a lower mutation pick-up rate than white European people. Diabetologia. 2016;59:2262–5.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Radha V, Ek J, Anuradha S, Hansen T, Pedersen O, Mohan V. Identification of novel variants in the hepatocyte nuclear factor-1 alpha gene in south Indian patients with maturity onset diabetes of young. J Clin Endocrinol Metab. 2009;94:1959–65.

    Article  PubMed  CAS  Google Scholar 

  25. Anuradha S, Radha V, Mohan V. Association of novel variants in the hepatocyte nuclear factor 4A gene with maturity onset diabetes of the young and early onset type 2 diabetes. Clin Genet. 2011;80:541–9.

    Article  PubMed  CAS  Google Scholar 

  26. Chapla A, Mruthyunjaya MD, Asha HS, Varghese D, Varshney M, Vasan SK, et al. Maturity onset diabetes of the young in India—a distinctive mutation pattern identified through targeted next-generation sequencing. Clin Endocrinol. 2015;82:533–42.

    Article  CAS  Google Scholar 

  27. Bhavadharini B, Mahalakshmi MM, Anjana RM, Maheswari K, Uma R, Deepa M, et al. Prevalence of gestational diabetes mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clin Diabetes Endocrinol. 2016;2:8.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Jayathilaka KGH, Dahanayake S, Abewardhana R, Ranaweera AKP, Rishard MRM, Wijeyaratne CN. Diabetes in pregnancy among Sri Lankan women: gestational or pre-gestational? Sri Lanka J Diabetes Endocrinol Metabolism. 2012;1:8–13.

    Article  Google Scholar 

  29. Vangen S, Stoltenberg C, Holan S, Moe N, Magnus P, Harris JR, et al. Outcome of pregnancy among immigrant women with diabetes. Diabetes Care. 2003;26:327–32.

    Article  PubMed  Google Scholar 

  30. Qiao Q, Hu G, Tuomilehto J, Nakagami T, Balkau B, Borch-Johnsen K, et al. DECODA Study Group. Age- and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts. Diabetes Care. 2003;26:1770–80.

    Article  PubMed  Google Scholar 

  31. Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, 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;54:3022–7.

    Article  PubMed  CAS  Google Scholar 

  32. Misra A, Vikram NK, Arya S, Pandey RM, Dhingra V, Chatterjee A, et al. High prevalence of insulin resistance in postpubertal Asian Indian children is associated with adverse truncal body fat patterning, abdominal adiposity and excess body fat. Int J Obes Relat Metab Disord. 2004 Oct;28(10):1217–26.

    Article  PubMed  CAS  Google Scholar 

  33. Deepa M, Anjana RM, Manjula D, Narayan KM, Mohan V. Convergence of prevalence rates of diabetes and cardiometabolic risk factors in middle and low income groups in urban India: 10-year follow-up of the Chennai Urban Population Study. J Diabetes Sci Technol. 2011;5:918–27.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gujral UP, Narayan KM, Pradeepa RG, Deepa M, Ali MK, Anjana RM, et al. Comparing type 2 diabetes, prediabetes, and their associated risk factors in Asian Indians in India and in the U.S.: the CARRS and MASALA studies. Diabetes Care. 2015;38:1312–8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Rema M, Premkumar S, Anitha B, Deepa R, Pradeepa R, Mohan V. Prevalence of diabetic retinopathy in urban India: the Chennai Urban Rural Epidemiology Study (CURES) eye study, I. Invest Ophthalmol Vis Sci. 2005;46:2328–33.

    Article  PubMed  Google Scholar 

  36. Unnikrishnan RI, Rema M, Pradeepa R, Deepa M, Shanthirani CS, Deepa R, et al. Prevalence and risk factors of diabetic nephropathy in an urban south Indian population: the Chennai Urban Rural Epidemiology Study (CURES 45). Diabetes Care. 2007;30:2019–24.

    Article  PubMed  CAS  Google Scholar 

  37. Abbott CA, Chaturvedi N, Malik RA, Salgami E, Yates AP, Pemberton PW, et al. Explanations for the lower rates of diabetic neuropathy in Indian Asians versus Europeans. Diabetes Care. 2010;33:1325–30.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34:2220–4.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Enas EA, Singh V, Munjal YP, Bhandari S, Yadave RD, Manchanda SC. Reducing the burden of coronary artery disease in India: challenges and opportunities. Indian Heart J. 2008;60:161–75.

    PubMed  Google Scholar 

  40. Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in south Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia. 2006;49:2580–8.

    Article  PubMed  CAS  Google Scholar 

  41. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes Care 2018;41(Suppl 1):S13-S27.

  42. Mohan V, Anbalagan VP. Expanding role of the Madras Diabetes Research Foundation—Indian Diabetes Risk Score in clinical practice. Indian J Endocrinol Metab. 2013;17:31–6.

    Article  PubMed  PubMed Central  Google Scholar 

  43. The Diabetes Prevention Program Research Group. The Diabetes Prevention Program: baseline characteristics of the randomized cohort. Diabetes Care. 2000;11:1619–29.

    Google Scholar 

  44. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20:537–44.

    Article  PubMed  CAS  Google Scholar 

  45. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343–50.

    Article  PubMed  CAS  Google Scholar 

  46. Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V, et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006;49:289–97.

    Article  PubMed  CAS  Google Scholar 

  47. Weber MB, Ranjani H, Staimez LR, Anjana RM, Ali MK, Narayan KM, et al. The stepwise approach to diabetes prevention: results from the D-CLIP randomized controlled trial. Diabetes Care. 2016 Oct;39(10):1760–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. Mohan V, Yang W, Son HY, Xu L, Noble L, Langdon RB, et al. Efficacy and safety of sitagliptin in the treatment of patients with type 2 diabetes in China, India, and Korea. Diabetes Res Clin Pract. 2009;83:106–16.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Diabetology, Dr. Mohan’s Diabetes Specialities Centre & Madras Diabetes Research Foundation, ICMR Centre for Advanced Research on Diabetes, WHO Collaborating Centre, Non-Communicable Disease Prevention & Control & IDF Centre of Excellence in Diabetes Care, No 4, Conran Smith Road, Gopalapuram, Chennai, 600 086, India

    Ranjit Unnikrishnan, Prasanna Kumar Gupta & Viswanathan Mohan

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  1. Ranjit Unnikrishnan
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Ranjit Unnikrishnan, Prasanna Kumar Gupta, and Viswanathan Mohan declare that they have no conflict of interest.

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This article is part of the Topical Collection on Other Forms of Diabetes and Its Complications

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Unnikrishnan, R., Gupta, P.K. & Mohan, V. Diabetes in South Asians: Phenotype, Clinical Presentation, and Natural History. Curr Diab Rep 18, 30 (2018). https://doi.org/10.1007/s11892-018-1002-8

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