Diabetes mellitus is a public health problem of epidemic proportions and its incidence in Asian Indians and other South Asians is on the rise. More than 21 million adults in the United States and 150 million worldwide have diabetes. By 2025, the World Health Organization projects more than 300 million cases worldwide and by 2030, an estimated 79 million Indians will have type 2 diabetes, 80 percent of whom will die from heart disease.
The risk of developing heart disease is fourfold in individuals with diabetes and is, therefore, a significant health concern in this at-risk population. This article highlights the association of diabetes in the South Asian population and identifies the risk factors for developing diabetes and heart disease.
Type 1 diabetes is caused by the inability to produce and/or utilize insulin (a hormone made by the pancreas) and is the most common endocrine disorder. Type 2 diabetes is caused by an inability of the body to use the insulin that it is producing as well as an inability of the pancreas to operate at a level that would maintain appropriate insulin levels in the body. Historically, Type 2 has generally affected people over age 40 but is now seen in individuals as young as 3.
South Asians (people of the Indian subcontinent, Nepal, Sri Lanka), Mauritius and Fijian Indians have a genetic predisposition as well as behavioral and environmental risk factors for developing diabetes. Among these risk factors are a diet high in carbohydrates, abdominal obesity or “thick in the middle” (which is measured by one’s waist circumference), and a sedentary lifestyle.
Research has noted that Indians develop diabetes at a younger age and at a lower waist circumference than Caucasians. This difference in people who share a common genetic pool suggests a tremendous impact of environmental and lifestyle factors. The prevalence of diabetes among immigrant South Asians is more than 20 percent and is generally three to six times higher than whites in America.
There is a close association of diabetes with heart disease and because of the big impact heart health has on one’s life, any discussion of diabetes must include a discussion of heart disease. Indians have a higher risk of developing heart disease than other populations. More than half of Indians are lifelong vegetarians and heart disease rates are similar among both vegetarians and non-vegetarians. This is in sharp contrast to Western vegetarians who tend to have very low rates of heart disease. Consumption of fried, processed, and fast foods high in saturated fats and transfats is on the rise in immigrant South Asians. This has a direct effect on worsening insulin resistance and subsequent development of diabetes and heart disease. Tobacco use, abdominal obesity, high blood pressure, low consumption of fruits and vegetables and sedentary lifestyle habits are all well studied determinants of heart disease and diabetes. Additionally, diabetes impacts kidney and nerve function and can lead to blindness if not treated correctly. It also makes your body more susceptible to infections by affecting the way your immune system works.
The prevalence of diabetes and heart disease among South Asian populations is cause for individual due diligence. It is important to assess your risk and to seek advice and appropriate treatment from your physician.
Are you at risk?
If you think you are at risk of developing diabetes, discuss your concerns with your physician. Important questions to consider are:
1. Are you overweight?
2. Does your mother, father, or sibling(s) have diabetes?
3. Have you ever developed diabetes during pregnancy?
4. Are you South Asian?
5. Have you ever been told by a doctor that you had high blood pressure?
If you think you are at risk, here are some things that you can do:
1. Obtain a baseline annual physical exam with your doctor, sharing your concern for diabetes and/or heart disease.
2. Exercise 30-45 minutes, seven days a week. Consider brisk walking, cycling, swimming, jogging, step aerobics, etc., and resistance training at least two days per week.
3. Adopt a healthy diet. Eliminate liquid calories, i.e., juices and sodas, even diet soda, which has been linked to increased triglyceride levels. Limit fried foods, ghee, butter and tropical oils like palm and coconut. Eliminate transfat. Increase monounsaturated fat (e.g. olive, flax seed, canola, or safflower oil). Include legumes and whole grain foods, fruits and vegetables in your diet. Limit salt intake to a teaspoon per day.
4. Avoid drinking alcohol.
Be patient and start with small steps and achievable goals. Gradually, increase your commitment to diet and exercise and celebrate your successes. Soon, you will find that you have adopted a lifetime of healthier habits.
Renu Deshpande is a family physician with Bay Valley Medical Group, practicing in Danville. For more information about Deshpande and the other South Asian physicians who practice at Bay Valley Medical Group, please visit: www.bayvalleymedicalgroup.com.