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The double puzzle of diabetes

Why is the prevalence of type 2 diabetes mellitus now exploding in most populations, but not in Europeans? The genetic and evolutionary consequences of geographical differences in food history may provide the answer.

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Figure 1: Age-standardized prevalence of type 2 diabetes mellitus.

References

  1. Levitt, N. et al. Diabetes Care 16, 601–607 (1993).

    Article  CAS  PubMed  Google Scholar 

  2. Zimmet, P., Alberti, K. & Shaw, J. Nature 414, 782–787 (2001).

    Article  ADS  CAS  PubMed  Google Scholar 

  3. Zimmet, P. in The Medical Challenge: Complex Traits (eds Fischer, E. & Moller, G.) 55–110 (Piper, Munich, 1997).

    Google Scholar 

  4. Zimmet, P. J. Intern. Med. 247, 301–310 (2000).

    Article  CAS  PubMed  Google Scholar 

  5. King, H., Aubert, R. & Herman, W. Diabetes Care 21, 1414–1431 (1998).

    Article  CAS  PubMed  Google Scholar 

  6. Dowse, G., Zimmet, P., Finch, C. & Collins, V. Am. J. Epidemiol. 133, 1093–1104 (1991).

    Article  CAS  PubMed  Google Scholar 

  7. Rubinstein, H. & Zimmet, P. Phosphate, Wealth, and Health in Nauru: A Study of Lifestyle Change (Brolga, Gundaroo, 1993).

    Google Scholar 

  8. Knowler, W., Pettitt, D., Saad, N. & Bennett, P. Diabetes Metab. Rev. 6, 1–27 (1990).

    Article  CAS  PubMed  Google Scholar 

  9. Dowse, G. et al. Med. J. Aust. 160, 767–774 (1994).

    CAS  PubMed  Google Scholar 

  10. Gardner, L. et al. Diabetes 33, 86–92 (1984).

    Article  PubMed  Google Scholar 

  11. Elbein, S., Chiu, K. & Permutt, M. in The Genetic Basis of Common Diseases 2nd edn (eds King, R., Rotter, J. & Motulsky, A.) 457–480 (Oxford Univ. Press, 2002).

    Google Scholar 

  12. Raffel, L. & Rotter, J. in Principles and Practice of Medical Genetics Vol. 2, 4th edn (eds Rimoin, D., Connor, J. & Pyeritz, R.) 2231–2276 (Churchill Livingston, London, 2001).

    Google Scholar 

  13. Hales, C. & Barker, D. Diabetologia 35, 595–601 (1992).

    Article  CAS  PubMed  Google Scholar 

  14. Zimmet, P. Diabetes Care 15, 232–252 (1992).

    Article  CAS  PubMed  Google Scholar 

  15. Campbell, G. S. Afr. Med. J. 37, 1195–1207 (1963).

    CAS  PubMed  Google Scholar 

  16. Coleman, D. Science 203, 663–665 (1979).

    Article  ADS  CAS  PubMed  Google Scholar 

  17. Dowse, G. K. et al. Diabetes 39, 390–396 (1990).

    Article  CAS  PubMed  Google Scholar 

  18. Diamond, J. Nature 410, 521 (2001).

  19. Neel, J. Am. J. Hum. Genet. 14, 353–362 (1962).

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Neel, J. in The Genetics of Diabetes Mellitus (eds Kobberling, J. & Tattersall, J.) 283–293 (Academic, New York, 1982).

    Google Scholar 

  21. Haines, H., Hackel, D. & Schmidt-Nielsen, K. Am. J. Physiol. 208, 297–300 (1965).

    Article  CAS  PubMed  Google Scholar 

  22. Russell, F. The Pima Indians (Univ. Arizona Press, Tucson, 1975).

    Google Scholar 

  23. Appleby, A. Famine in Tudor and Stuart England (Stanford Univ. Press, 1978).

    Google Scholar 

  24. Jordan, W. The Great Famine: Northern Europe in the Early Fourteenth Century (Princeton Univ. Press, 1996).

    Google Scholar 

  25. Monahan, W. Year of Sorrows: The Great Famine of 1709 in Lyon (Ohio State Univ. Press, Columbus, 1993).

    Google Scholar 

  26. Post, J. Food Shortage, Climatic Variability and Epidemic Disease in Preindustrial Europe (Cornell Univ. Press, Ithaca, 1985).

    Google Scholar 

  27. Rotberg, R. & Rabd, T. (eds) Hunger and History: The Impact of Changing Food Production and Consumption Patterns on Society (Cambridge Univ. Press, 1983).

    Google Scholar 

  28. McMichael, A. Human Frontiers, Environments and Disease: Past Patterns on Certain Futures (Cambridge Univ. Press, 2001).

    Book  Google Scholar 

  29. Kranemann, D. Bach Jahrbuch 53–64 (1990).

  30. King, H. & Rewers, M. Diabetes Care 16, 157–177 (1993).

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

It is a pleasure to acknowledge my debt for fruitful discussions about diabetes with Paul Zimmet and Jerome Rotter, and about European food history with Jack Goldstone and William Jordan.

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Correspondence to Jared Diamond.

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Diamond, J. The double puzzle of diabetes. Nature 423, 599–602 (2003). https://doi.org/10.1038/423599a

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