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The challenge of diabetes in Asia

European Journal of Clinical Nutrition volume 71, pages 803–804 (2017)Cite this article

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This special issue, with its focus on China and India, presents a challenge for clinicians and scientists in Asia because there seems to be little doubt that the prevalence of diabetes has escalated, but we need to recognise, as highlighted by Ma et al1 in this issue, that we are easily muddled about the magnitude of the increase if we keep changing the criteria for the diagnosis of diabetes. Furthermore, the new emphasis on the pre-diabetes stage means that we need to accept a standard classification of hyperglycaemia however tempting it is for another academic group to present a supposedly better system of classification. We already have multiple options presented by WHO2 presumably geared to their need to help clinics operating in very poor circumstances. Furthermore, the International Diabetes Federation has accepted this portfolio of tests to allow consistency,3 so it is important that we now recognise the confusion that can arise when we compare prevalences but use different diagnostic criteria.

It does now seem clear that Asian populations are two to four times more susceptible to type 2 diabetes than Caucasians living in Australasia, with equivalent levels of BMI.4 This, however, may partly reflect the difference in ratios of the body’s lean mass and body fat, with what seems clear evidence in India, that Indians born and raised in their own country seem to have greater body fat levels than Caucasians. Indeed, Yajnik,5 several years ago, highlighted the relatively greater fat levels in Indian babies despite being so much smaller than their English counterparts.6 The Indian babies had substantially less lean tissue and altered organ masses, and probably different metabolic capacities compared with English babies. Hence, Indian babies, at birth, already had a propensity to insulin resistance and this together with the excess relative body fat persisted into adulthood. These data are now amplified in this symposium.7

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  1. Department of Population Health, Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK

    W P T James

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James, W. The challenge of diabetes in Asia. Eur J Clin Nutr 71, 803–804 (2017). https://doi.org/10.1038/ejcn.2017.77

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