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The Prevalence of Type 2 Diabetes among South Asians

What is Type 2 diabetes?


Type 2 diabetes is a chronic, lifelong disease and it is the most common form of diabetes. It is caused when your body cells become resistant to the insulin produced by your pancreas when your blood glucose levels rise. This results in large amounts of sugar in your blood, also known as hyperglycemia, which is deadly as it can damage blood vessels in your body. Insulin works by causing glucose to move into your cells, thereby reducing the amount of sugar in your blood.


What makes you South Asian and what is the link between this and diabetes?


South Asians are people who fall into the categories of having ethnicities from the countries Afghanistan, Bangladesh, Bhutan, India, Myanmar, Nepal, Pakistan, and Sri Lanka. Individuals who originate from these countries are 6 times more likely to have type 2 diabetes.They are also 3 times more likely to have cardiovascular disease and this statistic only increases when they have type 2 diabetes. Between 2010 and 2030, diabetes prevalence among South Asians is expected to rise by 72% (7.6% to 9.1%). In a study conducted on Asian Indians and Europeans, both non-diabetic and diabetic Asian Indians basal insulin levels, which is insulin that keeps blood glucose levels consistent during periods of fasting, were higher than their European counterparts, and the amount of insulin is needed to maintain euglycemia, which is a state where blood glucose levels are within a normal range, was also higher. All of this helps contribute to the racial and ethnic disparity in medicine. But why does it seem that South Asians are disproportionately affected by this?


Biomarkers


One reason for this is biomarkers. A biomarker is a biological molecule found in the blood or in bodily fluids that can indicate a sign of either a normal or abnormal process, as well as a sign that a person is suffering from a disease or condition. Adipokines are molecules released by adipose tissues (body fat). Body fat is not necessarily a bad thing: it is a reservoir for energy, it insulates the body, it protects vital organs, and also secretes biomarkers, and hormones. Some examples of adipokines released by adipose tissues are adiponectin, and leptin. In South Asians there tends to be a lower level of adiponectin, which plays a crucial role in fighting against insulin resistance, reduces inflammation, and the formation of fatty deposits in arteries. These lower levels correspond to insulin resistance increasing the chances of developing type 2 diabetes. South Asians also tend to have higher levels of leptin, which is known to suppress hunger and make insulin more sensitive. However, these high levels can make individuals leptin resistant, subsequently causing individuals to become less sensitive and resistant to insulin.


Lifestyle


Another reason is their lifestyle. There tend to be dietary imbalances, for example, a low intake of fibrous food but a high intake of carbohydrates and saturated fats, which plays a key role in the insulin resistance found among South Asian individuals. Fibre is known to help decrease your appetite, which can prevent you from overeating and consuming too much food which could raise your blood glucose levels. Carbohydrates are broken down into sugars in the body when digested, increasing the blood sugar level of an individual.


South Asians are more likely to store fat around their abdomen, which covers the pancreas and liver where it may then affect the function of these organs. The development of insulin resistance is strongly related to your waist to hip ratio and the larger the ratio the more likely you are to be insulin resistant. South Asians tend to have a larger waist to hip ratio. The increase in fat causes there to be higher levels of free fatty acids in the blood, and these higher levels of free fatty acids are known to inhibit a cell's uptake of glucose ,which is stimulated by insulin which thereby causes insulin resistance. South Asian individuals tend to also be more physically inactive in comparison to other ethnicities. When the amount of exercise decreases, generally among all ethnicities, your risk of type 2 diabetes increases. Exercise is very beneficial in preventing type 2 diabetes as it causes your muscle cells to use insulin and sugar more efficiently subsequently lowering the amount of sugar in your blood and reducing insulin resistance.


Why is learning about ethnic and race disparity within medicine important?


An increase in the understanding of how race and ethnicity can affect the health of a person can ensure healthcare providers can implement strategies to properly treat people from different backgrounds, in a way that effectively helps them. This can help us be one step closer to race equality.



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