Thursday, January 27, 2011

Jared Diamond on type-2 diabetes in India

The latest issue of Nature has a piece by Jared Diamond about the diabetes epidemic in India, and how some aspects of its pathology are unique among Indians as compared to other groups.
Medicine: Diabetes in India
Jared Diamond
Nature Volume: 469, Pages:478–479 : 27 January 2011

Some of the more interesting points:
In 2010, the average age-adjusted prevalence of diabetes in India was 8%, higher than that in most European countries
In India, as in the West, diabetes is ultimately due to chronically high levels of blood glucose, and some of the clinical consequences are similar. But whereas Westerners think of type 2 diabetes as an adult-onset disease appearing especially after the age of 50, Indians (and Chinese, Japanese and Aboriginal Australians) with diabetes exhibit symptoms at an age one or two decades younger than that. The age of onset in India has been shifting towards ever-younger people even within the past decade9 — among Indians in their late teens, 'adult-onset' diabetes already manifests itself more often than does 'juvenile-onset' diabetes. In Britain, the prevalence of type 2 diabetes is 14 times higher in Asian than European children. And although obesity is a risk factor for diabetes both in India and in the West, the disease appears at a lower threshold of obesity in India, as is also the case in China, Japan and other Asian countries.

Symptoms also differ between Indians and Westerners: Indians with diabetes are less likely to develop blindness and kidney disease, but much more likely to suffer coronary artery disease at a relatively young age
He stresses the difference in prevalence between rich and poor Indians, and discusses how these differences are the opposite of what we observe in the US and Europe, for example, where socio-economic status is positively correlated with health.
Given Jared Diamond's past speculation on the evolutionary and/or genetic causes of these types of epidemics, I thought he might have expounded on that, as others have, but alas, he didn't.


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