Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites
Introduction We compared diabetes incidence in South Asians aged ≥45 years in urban India (Chennai and Delhi) and Pakistan (Karachi), two low-income and middle-income countries undergoing rapid transition, with blacks and whites in the US, a high-income country.Research design and methods We compute...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e001927.full |
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| author | Lisa R Staimez Ranjit Mohan Anjana Viswanathan Mohan Dorairaj Prabhakaran Roopa Shivashankar Dimple Kondal Nikhil Tandon K M Venkat Narayan Elizabeth Selvin Mohammed K Ali Unjali P Gujral Natalie Daya Deepa Mohan Shivani A Patel Howard H Chang Masood Kadir |
| author_facet | Lisa R Staimez Ranjit Mohan Anjana Viswanathan Mohan Dorairaj Prabhakaran Roopa Shivashankar Dimple Kondal Nikhil Tandon K M Venkat Narayan Elizabeth Selvin Mohammed K Ali Unjali P Gujral Natalie Daya Deepa Mohan Shivani A Patel Howard H Chang Masood Kadir |
| author_sort | Lisa R Staimez |
| collection | DOAJ |
| description | Introduction We compared diabetes incidence in South Asians aged ≥45 years in urban India (Chennai and Delhi) and Pakistan (Karachi), two low-income and middle-income countries undergoing rapid transition, with blacks and whites in the US, a high-income country.Research design and methods We computed age-specific, sex-specific and body mass index (BMI)-specific diabetes incidence from the prospective Center for Cardiometabolic Risk Reduction in South Asia Study (n=3136) and the Atherosclerosis Risk in Communities Study (blacks, n=3059; whites, n=9924). We assessed factors associated with incident diabetes using Cox proportional hazards regression.Results South Asians have lower BMI and waist circumference than blacks and whites (median BMI, kg/m2: 24.9 vs 28.2 vs 26.0; median waist circumference, cm 87.5 vs 96.0 vs 95.0). South Asians were less insulin resistant than blacks and whites (age-BMI-adjusted homeostatic model assessment of insulin resistance, µIU/mL/mmol/L: 2.30 vs 3.45 vs 2.59), and more insulin deficient than blacks but not whites (age-BMI-adjusted homeostasis model assessment of β-cell dysfunction, µIU/mL/mmol/L: 103.7 vs 140.6 vs 103.9). Age-standardized diabetes incidence (cases/1000 person-years (95% CI)) in South Asian men was similar to black men and 1.6 times higher (1.37 to 1.92) than white men (26.0 (22.2 to 29.8) vs 26.2 (22.7 to 29.7) vs 16.1 (14.8 to 17.4)). In South Asian women, incidence was slightly higher than black women and 3 times (2.61 to 3.66) the rate in white women (31.9 (27.5 to 36.2) vs 28.6 (25.7 to 31.6) vs 11.3 (10.2 to 12.3)). In normal weight (BMI <25 kg/m2), diabetes incidence adjusted for age was 2.9 times higher (2.09 to 4.28) in South Asian men, and 5.3 times (3.64 to 7.54) in South Asian women than in white women.Conclusions South Asian adults have lower BMI and are less insulin resistant than US blacks and whites, but have higher diabetes incidence than US whites, especially in subgroups without obesity. Factors other than insulin resistance (ie, insulin secretion) may play an important role in the natural history of diabetes in South Asians. |
| format | Article |
| id | doaj-art-763f3fd7cb984491905688e5248e9ff1 |
| institution | DOAJ |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-763f3fd7cb984491905688e5248e9ff12025-08-20T02:50:26ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2020-001927Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whitesLisa R Staimez0Ranjit Mohan Anjana1Viswanathan Mohan2Dorairaj Prabhakaran3Roopa Shivashankar4Dimple Kondal5Nikhil Tandon6K M Venkat Narayan7Elizabeth Selvin8Mohammed K Ali9Unjali P Gujral10Natalie Daya11Deepa Mohan12Shivani A Patel13Howard H Chang14Masood Kadir15Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USASchool of Public Health, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, IndiaDepartment of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, IndiaPublic Health Foundation of India, New Delhi, Delhi, IndiaCentre for Chronic Disease Control, Gurgaon, Haryana, IndiaCentre for Chronic Disease Control, New Delhi, Delhi, IndiaAll India Institute of Medical Sciences, New Delhi, IndiaRollins School of Public Health, Atlanta, Georgia, USA10 Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USAFamily and Preventive Medicine, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USAHubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USAJohns Hopkins Bloomberg School of Public Health Center for Teaching and Learning, Baltimore, Maryland, USAMadras Diabetes Research Foundation, Chennai, Tamil Nadu, IndiaDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA1 Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USAAga Khan University, Karachi, PakistanIntroduction We compared diabetes incidence in South Asians aged ≥45 years in urban India (Chennai and Delhi) and Pakistan (Karachi), two low-income and middle-income countries undergoing rapid transition, with blacks and whites in the US, a high-income country.Research design and methods We computed age-specific, sex-specific and body mass index (BMI)-specific diabetes incidence from the prospective Center for Cardiometabolic Risk Reduction in South Asia Study (n=3136) and the Atherosclerosis Risk in Communities Study (blacks, n=3059; whites, n=9924). We assessed factors associated with incident diabetes using Cox proportional hazards regression.Results South Asians have lower BMI and waist circumference than blacks and whites (median BMI, kg/m2: 24.9 vs 28.2 vs 26.0; median waist circumference, cm 87.5 vs 96.0 vs 95.0). South Asians were less insulin resistant than blacks and whites (age-BMI-adjusted homeostatic model assessment of insulin resistance, µIU/mL/mmol/L: 2.30 vs 3.45 vs 2.59), and more insulin deficient than blacks but not whites (age-BMI-adjusted homeostasis model assessment of β-cell dysfunction, µIU/mL/mmol/L: 103.7 vs 140.6 vs 103.9). Age-standardized diabetes incidence (cases/1000 person-years (95% CI)) in South Asian men was similar to black men and 1.6 times higher (1.37 to 1.92) than white men (26.0 (22.2 to 29.8) vs 26.2 (22.7 to 29.7) vs 16.1 (14.8 to 17.4)). In South Asian women, incidence was slightly higher than black women and 3 times (2.61 to 3.66) the rate in white women (31.9 (27.5 to 36.2) vs 28.6 (25.7 to 31.6) vs 11.3 (10.2 to 12.3)). In normal weight (BMI <25 kg/m2), diabetes incidence adjusted for age was 2.9 times higher (2.09 to 4.28) in South Asian men, and 5.3 times (3.64 to 7.54) in South Asian women than in white women.Conclusions South Asian adults have lower BMI and are less insulin resistant than US blacks and whites, but have higher diabetes incidence than US whites, especially in subgroups without obesity. Factors other than insulin resistance (ie, insulin secretion) may play an important role in the natural history of diabetes in South Asians.https://drc.bmj.com/content/9/1/e001927.full |
| spellingShingle | Lisa R Staimez Ranjit Mohan Anjana Viswanathan Mohan Dorairaj Prabhakaran Roopa Shivashankar Dimple Kondal Nikhil Tandon K M Venkat Narayan Elizabeth Selvin Mohammed K Ali Unjali P Gujral Natalie Daya Deepa Mohan Shivani A Patel Howard H Chang Masood Kadir Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites BMJ Open Diabetes Research & Care |
| title | Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites |
| title_full | Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites |
| title_fullStr | Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites |
| title_full_unstemmed | Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites |
| title_short | Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites |
| title_sort | incidence and pathophysiology of diabetes in south asian adults living in india and pakistan compared with us blacks and whites |
| url | https://drc.bmj.com/content/9/1/e001927.full |
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