Diabetes in Asia

Just how concerned should South Asians be about diabetes?

The latest issue of The Lancet has a focus on diabetes mellitus, with particular reference to Asia.

Much of the content in this issue is premium, so I don't have access to it.

There is also an editorial about the relevance of this issue to Asia, and the rising proportions of both type 2 diabetes and obesity in Asian populations. There is one free article in the issue, with references to India ("Epidemic obesity and type 2 diabetes in Asia").

Interestingly, the journal also discusses advances in treatment, involving degradation-resistant GLP-1 receptor agonists (incretin mimetics), and inhibitors of dipeptidyl peptidase-4 (DPP-4) activity (incretin enhancers).

The question that confronts many of us (the lay person all the more) is the applicability of findings for non South Asian populations relating to, say lifestyle modification and diet, to the Indian population.

A forthcoming report (Nov 13) in the Proceedings of the National Academy of Sciences says, "the findings suggest that Asian Indian men are at increased risk to develop type 2 diabetes due to hepatic insulin resistance associated with fatty liver
disease (steatosis), even at lower body mass indices."

(I am not reproducing more from this report at this time because of embargo restrictions. CONTACT: Gerald Shulman, Howard Hughes Medical Institute,
Yale University School of Medicine, New Haven, CT; Tel (day):
(203) 785-5447; Tel (eve): (203) 468-0313; email:
<gerald.shulman@yale.edu>)

Back to the question of the Asian situation, many of us are very concerned that there is a skewed approach to the issue:

Policy approaches of the Government appear not to be oriented towards improving lifestyles and are in fact operating negatively.

Automobile dependence is rising, walking spaces are shrinking, lack of labour law enforcement is leading to excessive working hours and pressure on employees to produce profit (adding to stresses and discordant relationships).

junk food and empty calories are compounding this burden.

I contrast this with some published findings that say, merely encouraging people to take public transportation provides, at least in the US context, the daily walking requirement recommended by the Surgeon-General (Besser et al, 2005).

Are we doing enough to influence and change policy that places obstacles to health-seeking behaviours?

ga