Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites
Year: 2021
Type: article
Abstract: 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/m 2 : 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/m 2 ), 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.
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
Funders: U.S. Department of Health and Human Services, Wellcome Trust, Public Health Foundation of India, National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute, Fogarty International Center, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Child Health and Human Development, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1114307781, G118672084, G149924713, G1522370804, G1669593605, G1788514665, G1795591630, G1823732541, G196810821, G2033595045, G2262505034, G2292195038, G2447245713, G2462410987, G2485801466, G2711263188, G2780798618, G2911417447, G2964737878, G3018383113, G3051506083, G3418899737, G357764881, G3744596180, G3973572274, G4391111602, G4597579782, G4739409156, G4790942633, G508454511, G5352314984, G542872069, G5770678025, Worksite Lifestyle Program for Reducing Diabetes and Cardiovascular Risk in India, Research and Mentoring in the Clinical Epidemiology of Cardiovascular Disease and Type 2 Diabetes, G6060132884, G6739173425, G6837735701, Interdisciplinary research training: NCD epidemiology and prevention in India, G7253084156, G7262240292, G7437505128, G7977449326, G8449739276, G9000061866, G9000238808, Emory Specialized Center of Research Excellence (SCORE) on Sex Differences, Institutional Career Development Core, Georgia Center for Diabetes Translation Research, G916230891, Integrated Tracking, Referral, and Algorithmic Management (I-TREC) System for Hypertension and Diabetes
OpenAlex ID: W3136889592