There has been a dramatic increase in the prevalence of diabetes in people of South Asian origin, which is observed throughout the world as well as in the United Kingdom.
People of Indian, Sri Lankan, Pakistani and Bangladeshi origin carry a high risk of diabetes and cardiovascular disease. It is a fact that this segment of the population carry the highest risk of death from heart attacks.
In recent years much research has been undertaken to explore the possible reasons for this trend.
The increased prevalence of diabetes and coronary heart disease in people of Indo-Asian origin is thought to be due to several factors. A genetic basis is very likely. The risk of type 2 diabetes increases with obesity and high insulin levels and people of South Asian origin appear to be more insulin resistant than Caucasians.
Obesity particularly abdominal obesity is now considered a greater health problem than smoking. Waist circumference is thought to be a more significant risk marker for heart disease than body weight.
This is a measure of how sensitive the body is to the action of insulin. In people who are ‘insulin resistant’, insulin is less effective in lowering blood sugar.
Higher background levels of insulin are required to maintain normal blood sugar concentrations. This leads to high insulin levels or hyperinsulinaemia.
Insulin resistance is strongly associated with obesity or ‘fatness’. In South Asians, it is thought that insulin resistance occurs at lower levels of fatness than in Caucasians.
The World Health Organization has recommended that a body mass index (BMI) of 23 kg/m2 is classified as overweight and 25 kg/m2 is recognised as obese.
Diet and lifestyle is thought to be one of the major contributors to increasing obesity among South Asians.
Education is key to reversing the trends described above. The Diabetes Prevention Programme offers some hope that Type 2 diabetes may be preventable in some individuals. Interventions which involve large sections of the community, are being researched in Leicester and Birmingham.
The Diabetes Prevention Programme was a large study done in America, of over three thousand patients who had impaired glucose tolerance. Importantly almost half of the participants in this study were from high risk ethnic groups. Lifestyle changes introduced to volunteers for this study, resulted in a significant reduction in the risk of developing type 2 diabetes over five years.
Dr Nishan Wijenaike
West Suffolk Hospitals NHS Trust
Revised: October 2007