Global diabetes landscape—type 2 diabetes mellitus in South Asia: Epidemiology, risk factors, and control

Abstract

Background: Type 2 diabetes mellitus (DM) is a new epidemic in South Asia and is the result of societal influences and changing lifestyles. Epidemiologic studies suggest that the prevalence of DM has increased exponentially in urban and rural populations.

Objective: This study was conducted to determine trends in the prevalence of DM in various countries in South Asia.

Methods: We performed an extensive, systematic MEDLINE search for primary articles that reported on the epidemiology of DM in South Asia. Additional articles were obtained from personal collections and references cited in the primary articles. No formal meta-analysis was performed because of differing methodologies and diagnostic criteria.

Results: Epidemiologic studies conducted in India during the 1960s and 1970s, using random and postload blood glucose estimations, reported DM in 1% to 4% of urban populations and 1% to 2% of rural populations. More standardized epidemiologic studies in adults since the late 1980s reported DM in 5% to 15% of urban populations, 4% to 6% of semiurban populations, and 2% to 5% of rural populations. A significantly increasing trend has been observed in urban populations (exponential trend R² = 0.74), whereas the increase is slower (R² = 0.29) in rural populations. The diabetes scenario is similar in other South Asian countries. Current prevalence rates are 5% to 16% in urban areas and 2% to 8% in rural areas. Risk factors for DM in this region are increasing sedentariness, dietary excess, obesity (especially high waist-to-hip ratio), low birth weight, and genetic influences.

Conclusions: DM is a major public health problem in South Asia. The prevalence is higher in urban areas than in rural areas and is increasing. Population-based measures to control the epidemic of DM include avoidance of adiposity through enhanced physical activity and regulated calorie intake. A comprehensive national chronic care program is needed.