Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The double puzzle of diabetes

Nature volume 423, pages 599–602 (2003)Cite this article

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.

Type 2 diabetes mellitus exacts a huge toll in money and human suffering. For instance, it accounts for more than 100 billion dollars of healthcare costs annually in the United States, or 15% of costs due to all diseases combined. The number of cases worldwide is estimated at 150 million. But this is a minimum number because, for each diagnosed case, there is thought to be one undiagnosed case in First World countries and eight in the Third World1. Despite its other name of adult-onset diabetes, the disease is becoming more common in young people2,3. At its present rate of increase, within a few decades it will be one of the world's commonest diseases and biggest public-health problems2,4, with an estimated minimum of half-a-billion cases5. This explosion in prevalence is occurring especially in the Third World, at about 50% per decade; and because the epidemic is just beginning in the world's two most populous countries, India and China, by the year 2010 more than half of the world's diabetics will be Asians2,3,5.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

Buy

All prices are NET prices.

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

References

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

    CAS  Article  PubMed  Google Scholar 

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

    ADS  CAS  Article  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).

    CAS  Article  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

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

    CAS  Article  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).

    CAS  Article  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).

    CAS  Article  PubMed  Google Scholar 

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

    CAS  Article  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).

    ADS  CAS  Article  PubMed  Google Scholar 

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

    CAS  Article  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).

    CAS  Article  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).

    CAS  Article  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.

Author information

Authors and Affiliations

  1. the Departments of Geography and Environmental Health Sciences, University of California, 1255 Bunche Hall, Box 951524, Los Angeles, 90095-1524, California, USA

    Jared Diamond

Authors
  1. Jared Diamond
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jared Diamond.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1038/423599a

Further reading

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing