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Understanding Diabetes

Diabetes in people of South Asian origin in the UK

Introduction

Map of the Indian sub-continentThere 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.

Some known facts about Diabetes in South Asians

  • The risk of type 2 diabetes in South Asians is about four to five times as high as that in Europeans
  • Around 20-25% of Indo Asian adults in the UK who are over the age of 50 years suffer from Type 2 diabetes
  • Diabetes tends to develop about 10 years earlier than in Europeans
  • Complications of diabetes such as kidney disease and heart disease develops more commonly
  • South Asians have the highest death rates for coronary heart disease in the UK
  • Increasing levels of obesity have been observed among South Asian children

What is the explanation for the higher prevalence of diabetes in South Asians?

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.

What is insulin resistance?

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.

What social and cultural factors may contribute?

Diet and lifestyle is thought to be one of the major contributors to increasing obesity among South Asians.

  • low levels of physical activity
  • high fat diet
  • urbanisation
  • smoking

What is being done to reduce this risk of diabetes ?

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.

More on the Diabetes Prevention Programme

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
Consultant Diabetologist
West Suffolk Hospitals NHS Trust
Revised: October 2007