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Incidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites.

TitleIncidence and pathophysiology of diabetes in South Asian adults living in India and Pakistan compared with US blacks and whites.
Publication TypeJournal Article
Year of Publication2021
AuthorsNarayan KMVenkat, Kondal D, Daya N, Gujral UP, Mohan D, Patel SA, Shivashankar R, Anjana RMohan, Staimez LR, Ali MK, Chang HH, Kadir M, Prabhakaran D, Selvin E, Mohan V, Tandon N
JournalBMJ Open Diabetes Res Care
Volume9
Issue1
Date Published2021 Mar
ISSN2052-4897
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: 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

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.

DOI10.1136/bmjdrc-2020-001927
Alternate JournalBMJ Open Diabetes Res Care
PubMed ID33771764
PubMed Central IDPMC8006839
Grant ListKL2 TR002381 / TR / NCATS NIH HHS / United States
UL1 TR002378 / TR / NCATS NIH HHS / United States