Diabetes and Associated Complications in the South Asian Population

Diabetes and Cardiovascular Disease (S Malik, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Diabetes and Cardiovascular Disease

Abstract

The rising prevalence of diabetes in South Asians has significant health and economic implications. South Asians are predisposed to the development of diabetes due to biologic causes which are exacerbated by lifestyle and environmental factors. Furthermore, they experience significant morbidity and mortality from complications of diabetes, most notably coronary artery disease, cerebrovascular disease, and chronic kidney disease. Therefore, understanding the pathophysiology and genetics of diabetes risk factors and its associated complications in South Asians is paramount to curbing the diabetes epidemic. With this understanding, the appropriate screening, preventative and therapeutic strategies can be implemented and further developed. In this review, we discuss in detail the biologic and lifestyle factors that predispose South Asians to diabetes and review the epidemiology and pathophysiology of microvascular and macrovascular complications of diabetes in South Asians. We also review the ongoing and completed diabetes prevention and management studies in South Asians.

Keywords

South Asians Type 2 diabetes Diabetes risk factors Diabetes complications Genetics of diabetes Diabetes prevention 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4–14.PubMedGoogle Scholar
  2. 2.
    Lee JW, Brancati FL, Yeh HC. Trends in the prevalence of type 2 diabetes in Asians versus Whites: Results from the United States National Health Interview Survey, 1997-2008. Diabetes Care. 2011;34(2):353–7.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Misra R, Patel T, Kotha P, et al. Prevalence of diabetes, metabolic syndrome, and cardiovascular risk factors in US Asian Indians: Results from a national study. J Diabetes Complicat. 2010;24(3):145–53.PubMedGoogle Scholar
  4. 4.
    Mohan V. Why are Indians more prone to diabetes? J Assoc Physicians India. 2004;52:468–74.PubMedGoogle Scholar
  5. 5.
    Chan JC, Malik V, Jia W, et al. Diabetes in Asia: Epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129–40.PubMedGoogle Scholar
  6. 6.
    Ramachandran A, Ma RC, Snehalatha C. Diabetes in Asia. Lancet. 2010;375(9712):408–18.PubMedGoogle Scholar
  7. 7.
    Chowdhury TA, Lasker SS. Complications and cardiovascular risk factors in South Asians and Europeans with early-onset type 2 diabetes. QJM. 2002;95(4):241–6.PubMedGoogle Scholar
  8. 8.
    Swerdlow AJ, Laing SP, Dos Santos SI, et al. Mortality of South Asian patients with insulin-treated diabetes mellitus in the United Kingdom: A cohort study. Diabet Med. 2004;21(8):845–51.PubMedGoogle Scholar
  9. 9.
    Mather HM, Chaturvedi N, Fuller JH. Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey, London, UK. Diabet Med. 1998;15(1):53–9.Google Scholar
  10. 10.
    Mohan V, Sharp PS, Cloke HR, Burrin JM, Schumer B, Kohner EM. Serum immunoreactive insulin responses to a glucose load in Asian Indian and European type 2 (non-insulin-dependent) diabetic patients and control subjects. Diabetologia. 1986;29(4):235–7.PubMedGoogle Scholar
  11. 11.
    Hu FB. Globalization of diabetes: The role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249–57.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Bavdekar A, Yajnik CS, Fall CH, et al. Insulin resistance syndrome in 8-year-old Indian children: Small at birth, big at 8 years, or both? Diabetes. 1999;48(12):2422–9.PubMedGoogle Scholar
  13. 13.
    Ramachandran A, Snehalatha C, Yamuna A, Murugesan N, Narayan KM. Insulin resistance and clustering of cardiometabolic risk factors in urban teenagers in southern India. Diabetes Care. 2007;30(7):1828–33.PubMedGoogle Scholar
  14. 14.
    Scholfield DJ, Behall KM, Bhathena SJ, Kelsay J, Reiser S, Revett KR. A study on Asian Indian and American vegetarians: Indications of a racial predisposition to glucose intolerance. Am J Clin Nutr. 1987;46(6):955–61.PubMedGoogle Scholar
  15. 15.
    Chandalia M, Abate N, Garg A, Stray-Gundersen J, Grundy SM. Relationship between generalized and upper body obesity to insulin resistance in Asian Indian men. J Clin Endocrinol Metab. 1999;84(7):2329–35.PubMedGoogle Scholar
  16. 16.
    Petersen KF, Dufour S, Feng J, et al. Increased prevalence of insulin resistance and nonalcoholic fatty liver disease in Asian-Indian men. Proc Natl Acad Sci U S A. 2006;103(48):18273–7.PubMedCentralPubMedGoogle Scholar
  17. 17.
    Kahn SE. The relative contributions of insulin resistance and beta-cell dysfunction to the pathophysiology of type 2 diabetes. Diabetologia. 2003;46(1):3–19.PubMedGoogle Scholar
  18. 18.
    Motala AA, Omar MA. Evidence for impaired pancreatic beta cell function in South African Indians with impaired glucose tolerance. Diabet Med. 1994;11(5):437–44.PubMedGoogle Scholar
  19. 19.
    Staimez LR, Weber MB, Ranjani H, et al. Evidence of reduced beta-cell function in Asian Indians with mild dysglycemia. Diabetes Care. 2013;36(9):2772–8.PubMedGoogle Scholar
  20. 20.
    Deurenberg-Yap M, Schmidt G, van Staveren WA, Deurenberg P. The paradox of low body mass index and high body fat percentage among Chinese, Malays and Indians in Singapore. Int J Obes Relat Metab Disord. 2000;24(8):1011–7.PubMedGoogle Scholar
  21. 21.
    Lear SA, Humphries KH, Kohli S, Chockalingam A, Frohlich JJ, Birmingham CL. Visceral adipose tissue accumulation differs according to ethnic background: Results of the Multicultural Community Health Assessment Trial (M-CHAT). Am J Clin Nutr. 2007;86(2):353–9.PubMedGoogle Scholar
  22. 22.
    Sharp PS, Mohan V, Levy JC, Mather HM, Kohner EM. Insulin resistance in patients of Asian Indian and European origin with non-insulin dependent diabetes. Horm Metab Res. 1987;19(2):84–5.PubMedGoogle Scholar
  23. 23.
    Yajnik CS, Fall CH, Coyaji KJ, et al. Neonatal anthropometry: The thin-fat Indian baby. The Pune Maternal Nutrition Study. Int J Obes Relat Metab Disord. 2003;27(2):173–80.Google Scholar
  24. 24.
    Krishnaveni GV, Hill JC, Veena SR, et al. Truncal adiposity is present at birth and in early childhood in South Iindian children. Indian Pediatr. 2005;42(6):527–38.Google Scholar
  25. 25.
    Bhargava SK, Sachdev HS, Fall CH, et al. Relation of serial changes in childhood body-mass index to impaired glucose tolerance in young adulthood. N Engl J Med. 2004;350(9):865–75.PubMedCentralPubMedGoogle Scholar
  26. 26.
    McKeigue PM, Pierpoint T, Ferrie JE, Marmot MG. Relationship of glucose intolerance and hyperinsulinaemia to body fat pattern in South Asians and Europeans. Diabetologia. 1992;35(8):785–91.PubMedGoogle Scholar
  27. 27.
    Banerji MA, Faridi N, Atluri R, Chaiken RL, Lebovitz HE. Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab. 1999;84(1):137–44.PubMedGoogle Scholar
  28. 28.
    Raji A, Seely EW, Arky RA, Simonson DC. Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians. J Clin Endocrinol Metab. 2001;86(11):5366–71.PubMedGoogle Scholar
  29. 29.
    Sandeep S, Gokulakrishnan K, Velmurugan K, Deepa M, Mohan V. Visceral & subcutaneous abdominal fat in relation to insulin resistance & metabolic syndrome in non-diabetic South Indians. Indian J Med Res. 2010;131:629–35.PubMedGoogle Scholar
  30. 30.
    Indulekha K, Anjana RM, Surendar J, Mohan V. Association of visceral and subcutaneous fat with glucose intolerance, insulin resistance, adipocytokines and inflammatory markers in Asian Indians (CURES-113). Clin Biochem. 2011;44(4):281–7.PubMedGoogle Scholar
  31. 31.
    Chandalia M, Lin P, Seenivasan T, et al. Insulin resistance and body fat distribution in South Asian men compared to Caucasian men. PLoS One. 2007;2(8):e812.Google Scholar
  32. 32.
    Chandran M, Phillips SA, Ciaraldi T, Henry RR. Adiponectin: More than just another fat cell hormone? Diabetes Care. 2003;26(8):2442–50.PubMedGoogle Scholar
  33. 33.
    Abate N, Chandalia M, Snell PG, Grundy SM. Adipose tissue metabolites and insulin resistance in nondiabetic Asian Indian men. J Clin Endocrinol Metab. 2004;89(6):2750–5.PubMedGoogle Scholar
  34. 34.
    Wasim H, Al-Daghri NM, Chetty R, McTernan PG, Barnett AH, Kumar S. Relationship of serum adiponectin and resistin to glucose intolerance and fat topography in South-Asians. Cardiovasc Diabetol. 2006;5:10.Google Scholar
  35. 35.
    Rabe K, Lehrke M, Parhofer KG, Broedl UC. Adipokines and insulin resistance. Mol Med. 2008;14(11–12):741–51.PubMedCentralPubMedGoogle Scholar
  36. 36.
    Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA. 2001;286(3):327–34.PubMedGoogle Scholar
  37. 37.
    Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336(14):973–9.PubMedGoogle Scholar
  38. 38.
    Forouhi NG, Sattar N, McKeigue PM. Relation of C-reactive protein to body fat distribution and features of the metabolic syndrome in Europeans and South Asians. Int J Obes Relat Metab Disord. 2001;25(9):1327–31.PubMedGoogle Scholar
  39. 39.
    Chambers JC, Eda S, Bassett P, et al. C-reactive protein, insulin resistance, central obesity, and coronary heart disease risk in Indian Asians from the United Kingdom compared with European whites. Circulation. 2001;104(2):145–50.PubMedGoogle Scholar
  40. 40.
    Chandalia M, Cabo-Chan Jr AV, Devaraj S, Jialal I, Grundy SM, Abate N. Elevated plasma high-sensitivity C-reactive protein concentrations in Asian Indians living in the United States. J Clin Endocrinol Metab. 2003;88(8):3773–6.PubMedGoogle Scholar
  41. 41.
    Mohan V, Deepa R, Velmurugan K, Premalatha G. Association of C-reactive protein with body fat, diabetes and coronary artery disease in Asian Indians: The Chennai Urban Rural Epidemiology Study (CURES-6). Diabet Med. 2005;22(7):863–70.PubMedGoogle Scholar
  42. 42.
    Gujral UP, Pradeepa R, Weber MB, Narayan KM, Mohan V. Type 2 diabetes in South Asians: Similarities and differences with white Caucasian and other populations. Ann N Y Acad Sci. 2013;1281:51–63.PubMedCentralPubMedGoogle Scholar
  43. 43.
    Kooner JS, Saleheen D, Sim X, et al. Genome-wide association study in individuals of South Asian ancestry identifies six new type 2 diabetes susceptibility loci. Nat Genet. 2011;43(10):984–9.PubMedCentralPubMedGoogle Scholar
  44. 44.
    Chambers JC, Elliott P, Zabaneh D, et al. Common genetic variation near MC4R is associated with waist circumference and insulin resistance. Nat Genet. 2008;40(6):716–8.PubMedGoogle Scholar
  45. 45.
    Abate N, Carulli L, Cabo-Chan Jr A, Chandalia M, Snell PG, Grundy SM. Genetic polymorphism PC-1 K121Q and ethnic susceptibility to insulin resistance. J Clin Endocrinol Metab. 2003;88(12):5927–34.PubMedGoogle Scholar
  46. 46.
    Vaidya A, Williams JS. Vitamin D and insulin sensitivity: Can gene association and pharmacogenetic studies of the vitamin D receptor provide clarity? Metabolism. 2012;61(6):759–61.PubMedGoogle Scholar
  47. 47.
    Sanghera DK, Ortega L, Han S, et al. Impact of nine common type 2 diabetes risk polymorphisms in Asian Indian Sikhs: PPARG2 (Pro12Ala), IGF2BP2, TCF7L2 and FTO variants confer a significant risk. BMC Med Genet. 2008;9:59-2350-9-59.Google Scholar
  48. 48.
    Chauhan G, Spurgeon CJ, Tabassum R, et al. Impact of common variants of PPARG, KCNJ11, TCF7L2, SLC30A8, HHEX, CDKN2A, IGF2BP2, and CDKAL1 on the risk of type 2 diabetes in 5,164 Indians. Diabetes. 2010;59(8):2068–74.PubMedCentralPubMedGoogle Scholar
  49. 49.
    Rees SD, Hydrie MZ, Shera AS, et al. Replication of 13 genome-wide association (GWA)-validated risk variants for type 2 diabetes in Pakistani populations. Diabetologia. 2011;54(6):1368–74.PubMedGoogle Scholar
  50. 50.
    Sanghera DK, Demirci FY, Been L, et al. PPARG and ADIPOQ gene polymorphisms increase type 2 diabetes mellitus risk in Asian Indian Sikhs: Pro12Ala still remains as the strongest predictor. Metabolism. 2010;59(4):492–501.PubMedCentralPubMedGoogle Scholar
  51. 51.
    Humphries SE, Gable D, Cooper JA, et al. Common variants in the TCF7L2 gene and predisposition to type 2 diabetes in UK European whites, Indian Asians and Afro-Caribbean men and women. J Mol Med (Berl). 2006;84(12):1005–14.Google Scholar
  52. 52.
    Tan JT, Nurbaya S, Gardner D, Ye S, Tai ES, Ng DP. Genetic variation in KCNQ1 associates with fasting glucose and beta-cell function: A study of 3,734 subjects comprising three ethnicities living in Singapore. Diabetes. 2009;58(6):1445–9.PubMedCentralPubMedGoogle Scholar
  53. 53.
    Been LF, Ralhan S, Wander GS, et al. Variants in KCNQ1 increase type II diabetes susceptibility in South Asians: A study of 3,310 subjects from India and the US. BMC Med Genet. 2011;12:18-2350-12-18.Google Scholar
  54. 54.
    Sanghera DK, Been L, Ortega L, et al. Testing the association of novel meta-analysis-derived diabetes risk genes with type II diabetes and related metabolic traits in Asian Indian Sikhs. J Hum Genet. 2009;54(3):162–8.PubMedGoogle Scholar
  55. 55.
    Chauhan G, Tabassum R, Mahajan A, et al. Common variants of FTO and the risk of obesity and type 2 diabetes in Indians. J Hum Genet. 2011;56(10):720–6.PubMedGoogle Scholar
  56. 56.
    Ramya K, Radha V, Ghosh S, Majumder PP, Mohan V. Genetic variations in the FTO gene are associated with type 2 diabetes and obesity in South Indians (CURES-79). Diabetes Technol Ther. 2011;13(1):33–42.Google Scholar
  57. 57.
    Yajnik CS, Janipalli CS, Bhaskar S, et al. FTO gene variants are strongly associated with type 2 diabetes in South Asian Indians. Diabetologia. 2009;52(2):247–52.Google Scholar
  58. 58.
    Vasan SK, Fall T, Neville MJ, et al. Associations of variants in FTO and near MC4R with obesity traits in South Asian Indians. Obesity (Silver Spring). 2012;20(11):2268–77.Google Scholar
  59. 59.
    Rees SD, Islam M, Hydrie MZ, et al. An FTO variant is associated with type 2 diabetes in South Asian populations after accounting for body mass index and waist circumference. Diabet Med. 2011;28(6):673–80.PubMedCentralPubMedGoogle Scholar
  60. 60.
    Radha V, Vimaleswaran KS, Ayyappa KA, Mohan V. Association of lipoprotein lipase gene polymorphisms with obesity and type 2 diabetes in an Asian Indian population. Int J Obes (Lond). 2007;31(6):913–8.Google Scholar
  61. 61.
    Cassell PG, Saker PJ, Huxtable SJ, et al. Evidence that single nucleotide polymorphism in the uncoupling protein 3 (UCP3) gene influences fat distribution in women of European and Asian origin. Diabetologia. 2000;43(12):1558–64.PubMedGoogle Scholar
  62. 62.
    Bhagat N, Agrawal M, Luthra K, Vikram NK, Misra A, Gupta R. Evaluation of single nucleotide polymorphisms of Pro12Ala in peroxisome proliferator-activated receptor-gamma and Gly308Ala in tumor necrosis factor-alpha genes in obese Asian Indians: A population-based study. Diabetes Metab Syndr Obes. 2010;3:349–56.PubMedCentralPubMedGoogle Scholar
  63. 63.
    Qi L, Tai ES, Tan CE, et al. Intragenic linkage disequilibrium structure of the human perilipin gene (PLIN) and haplotype association with increased obesity risk in a multiethnic Asian population. J Mol Med (Berl). 2005;83(6):448–56.Google Scholar
  64. 64.
    Shen H, Qi L, Tai ES, Chew SK, Tan CE, Ordovas JM. Uncoupling protein 2 promoter polymorphism -866G/A, central adiposity, and metabolic syndrome in Asians. Obesity (Silver Spring). 2006;14(4):656–61.Google Scholar
  65. 65.
    Guettier JM, Georgopoulos A, Tsai MY, et al. Polymorphisms in the fatty acid-binding protein 2 and apolipoprotein C-III genes are associated with the metabolic syndrome and dyslipidemia in a South Indian population. J Clin Endocrinol Metab. 2005;90(3):1705–11.Google Scholar
  66. 66.
    Vimaleswaran KS, Radha V, Mohan V. Thr54 allele carriers of the Ala54Thr variant of FABP2 gene have associations with metabolic syndrome and hypertriglyceridemia in urban South Indians. Metabolism. 2006;55(9):1222–6.PubMedGoogle Scholar
  67. 67.
    Dodani S, Henkhaus R, Dong L, Butler MG. Apolipoprotein A1 gene polymorphisms predict cardio-metabolic risk in South Asian immigrants. Dis Markers. 2012;32(1):9–19.PubMedCentralPubMedGoogle Scholar
  68. 68.
    Ranjith N, Pegoraro RJ, Rom L. Lipid profiles and associated gene polymorphisms in young Asian Indian patients with acute myocardial infarction and the metabolic syndrome. Metab Syndr Relat Disord. 2009;7(6):571–8.PubMedGoogle Scholar
  69. 69.
    Vimaleswaran KS, Radha V, Ghosh S, et al. Peroxisome proliferator-activated receptor-gamma co-activator-1alpha (PGC-1alpha) gene polymorphisms and their relationship to type 2 diabetes in Asian Indians. Diabet Med. 2005;22(11):1516–21.PubMedGoogle Scholar
  70. 70.•
    Anand SS, Meyre D, Pare G, et al. Genetic information and the prediction of incident type 2 diabetes in a high-risk multiethnic population: The EpiDREAM genetic study. Diabetes Care. 2013;36(9):2836–42. This study investigated the role of a gene score (using 16 polymorphisms known to be associated with diabetes) in predicting incident diabetes. They looked at several ethnic groups, including South Asians. PubMedGoogle Scholar
  71. 71.
    Ramachandran A, Mary S, Yamuna A, Murugesan N, Snehalatha C. High prevalence of diabetes and cardiovascular risk factors associated with urbanization in India. Diabetes Care. 2008;31(5):893–8.PubMedGoogle Scholar
  72. 72.
    Singh RB, Ghosh S, Niaz AM, et al. Epidemiologic study of diet and coronary risk factors in relation to central obesity and insulin levels in rural and urban populations of North India. Int J Cardiol. 1995;47(3):245–55.PubMedGoogle Scholar
  73. 73.
    Ramachandran A, Snehalatha C, Latha E, Manoharan M, Vijay V. Impacts of urbanisation on the lifestyle and on the prevalence of diabetes in native Asian Indian population. Diabetes Res Clin Pract. 1999;44(3):207–13.PubMedGoogle Scholar
  74. 74.
    Abate N, Chandalia M. Ethnicity, type 2 diabetes & migrant Asian Indians. Indian J Med Res. 2007;125(3):251–8.PubMedGoogle Scholar
  75. 75.
    Mohanty SA, Woolhandler S, Himmelstein DU, Bor DH. Diabetes and cardiovascular disease among Asian Indians in the United States. J Gen Intern Med. 2005;20(5):474–8.PubMedCentralPubMedGoogle Scholar
  76. 76.
    Patel JV, Vyas A, Cruickshank JK, et al. Impact of migration on coronary heart disease risk factors: Comparison of Gujaratis in Britain and their contemporaries in villages of origin in India. Atherosclerosis. 2006;185(2):297–306.Google Scholar
  77. 77.
    Misra A, Khurana L, Isharwal S, Bhardwaj S. South Asian diets and insulin resistance. Br J Nutr. 2009;101(4):465–73.PubMedGoogle Scholar
  78. 78.
    Raj S, Ganganna P, Bowering J. Dietary habits of Asian Indians in relation to length of residence in the United States. J Am Diet Assoc. 1999;99(9):1106–8.PubMedGoogle Scholar
  79. 79.
    Wandel M, Raberg M, Kumar B, Holmboe-Ottesen G. Changes in food habits after migration among South Asians settled in Oslo: The effect of demographic, socio-economic and integration factors. Appetite. 2008;50(2–3):376–85.PubMedGoogle Scholar
  80. 80.
    Garduno-Diaz SD, Khokhar S. Prevalence, risk factors and complications associated with type 2 diabetes in migrant South Asians. Diabetes Metab Res Rev. 2012;28(1):6–24.PubMedGoogle Scholar
  81. 81.
    Helmrich SP, Ragland DR, Leung RW, Paffenbarger Jr RS. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med. 1991;325(3):147–52.PubMedGoogle Scholar
  82. 82.
    Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.PubMedGoogle Scholar
  83. 83.
    Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537–44.PubMedGoogle Scholar
  84. 84.
    Fischbacher CM, Hunt S, Alexander L. How physically active are South Asians in the United Kingdom? A literature review. J Public Health (Oxf). 2004;26(3):250–8.Google Scholar
  85. 85.
    Mohan V, Gokulakrishnan K, Deepa R, Shanthirani CS, Datta M. Association of physical inactivity with components of metabolic syndrome and coronary artery disease–the Chennai Urban Population Study (CUPS no. 15). Diabet Med. 2005;22(9):1206–11.PubMedGoogle Scholar
  86. 86.
    Hayes L, White M, Unwin N, et al. Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population. J Public Health Med. 2002;24(3):170–8.PubMedGoogle Scholar
  87. 87.
    Kanaya AM, Wassel CL, Mathur D, et al. Prevalence and correlates of diabetes in South Asian Indians in the United States: Findings from the Metabolic Syndrome and Atherosclerosis in South Asians Living in America Study and the Multi-Ethnic Study of Atherosclerosis. Metab Syndr Relat Disord. 2010;8(2):157–64.Google Scholar
  88. 88.
    Tillin T, Hughes AD, Mayet J, et al. The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent revisited) – a prospective population-based study. J Am Coll Cardiol. 2013;61(17):1777–86.PubMedCentralPubMedGoogle Scholar
  89. 89.
    Ethnicity and cardiovascular disease. The incidence of myocardial infarction in white, South Asian, and Afro-Caribbean patients with type 2 diabetes (U.K. Prospective Diabetes Study 32). Diabetes Care. 1998;21(8):1271-1277.Google Scholar
  90. 90.•
    Kanaya AM, Adler N, Moffet HH, et al. Heterogeneity of diabetes outcomes among Asians and Pacific Islanders in the US: The Diabetes Study of Northern California (DISTANCE). Diabetes Care. 2011;34(4):930–7. This paper discusses ethnic differences in complications of diabetes in a large northern California population, focusing specifically on the large differences among different Asian American populations. PubMedCentralPubMedGoogle Scholar
  91. 91.
    Forouhi NG, Sattar N, Tillin T, McKeigue PM, Chaturvedi N. Do known risk factors explain the higher coronary heart disease mortality in South Asian compared with European men? Prospective follow-up of the Southall and Brent studies, UK. Diabetologia. 2006;49(11):2580–8.PubMedGoogle Scholar
  92. 92.
    Wilkinson P, Sayer J, Laji K, et al. Comparison of case fatality in South Asian and white patients after acute myocardial infarction: Observational study. BMJ. 1996;312(7042):1330–3.PubMedCentralPubMedGoogle Scholar
  93. 93.
    Nijjar AP, Wang H, Dasgupta K, Rabi DM, Quan H, Khan NA. Outcomes in a diabetic population of South Asians and whites following hospitalization for acute myocardial infarction: A retrospective cohort study. Cardiovasc Diabetol. 2010;9:4-2840-9-4.Google Scholar
  94. 94.
    Game FL, Jones AF. Ethnicity and risk factors for coronary heart disease in diabetes mellitus. Diabetes Obes Metab. 2000;2(2):91–7.PubMedGoogle Scholar
  95. 95.
    Barnett AH, Dixon AN, Bellary S, et al. Type 2 diabetes and cardiovascular risk in the UK South Asian community. Diabetologia. 2006;49(10):2234–46.PubMedGoogle Scholar
  96. 96.
    Deepa R, Mohan V, Premanand C, et al. Accelerated platelet activation in Asian Indians with diabetes and coronary artery disease–the Chennai Urban Population Study (CUPS-13). J Assoc Physicians India. 2006;54:704–8.PubMedGoogle Scholar
  97. 97.
    Bhaskar S, Ganesan M, Chandak GR, et al. Association of PON1 and APOA5 gene polymorphisms in a cohort of Indian patients having coronary artery disease with and without type 2 diabetes. Genet Test Mol Biomarkers. 2011;15(7–8):507–12.PubMedGoogle Scholar
  98. 98.
    Siezenga MA, Shaw PK, Daha MR, Rabelink TJ, Berger SP. Low mannose-binding lectin (MBL) genotype is associated with future cardiovascular events in type 2 diabetic South Asians. A prospective cohort study. Cardiovasc Diabetol. 2011;10:60-2840-10-60.Google Scholar
  99. 99.
    Narne P, Ponnaluri KC, Singh S, Siraj M, Ishaq M. Relationship between NADPH oxidase p22phox C242T, PARP-1 Val762Ala polymorphisms, angiographically verified coronary artery disease and myocardial infarction in South Indian patients with type 2 diabetes mellitus. Thromb Res. 2012;130(5):e259–65.Google Scholar
  100. 100.
    Gunarathne A, Patel JV, Gammon B, Gill PS, Hughes EA, Lip GY. Ischemic stroke in South Asians: A review of the epidemiology, pathophysiology, and ethnicity-related clinical features. Stroke. 2009;40(6):e415–23.PubMedGoogle Scholar
  101. 101.
    Moussouttas M, Aguilar L, Fuentes K, et al. Cerebrovascular disease among patients from the Indian subcontinent. Neurology. 2006;67(5):894–6.PubMedGoogle Scholar
  102. 102.
    Jafar TH. Blood pressure, diabetes, and increased dietary salt associated with stroke–results from a community-based study in Pakistan. J Hum Hypertens. 2006;20(1):83–5.PubMedGoogle Scholar
  103. 103.
    Deleu D, Hamad AA, Kamram S, El Siddig A, Al Hail H, Hamdy SM. Ethnic variations in risk factor profile, pattern and recurrence of non-cardioembolic ischemic stroke. Arch Med Res. 2006;37(5):655–62.PubMedGoogle Scholar
  104. 104.
    Gholap N, Davies M, Patel K, Sattar N, Khunti K. Type 2 diabetes and cardiovascular disease in South Asians. Prim Care Diabetes. 2011;5(1):45–56.PubMedGoogle Scholar
  105. 105.
    Gunarathne A, Patel JV, Potluri R, et al. Increased 5-year mortality in the migrant South Asian stroke patients with diabetes mellitus in the United Kingdom: The West Birmingham Stroke Project. Int J Clin Pract. 2008;62(2):197–201.PubMedGoogle Scholar
  106. 106.
    Gerstein HC, Anand S, Yi QL, et al. The relationship between dysglycemia and atherosclerosis in South Asian, Chinese, and European individuals in Canada: A randomly sampled cross-sectional study. Diabetes Care. 2003;26(1):144–9.PubMedGoogle Scholar
  107. 107.
    Venkataraman V, Amutha A, Anbalagan VP, et al. Association of glycated hemoglobin with carotid intimal medial thickness in Asian Indians with normal glucose tolerance. J Diabetes Complicat. 2012;26(6):526–30.PubMedGoogle Scholar
  108. 108.
    Chow CK, McQuillan B, Raju PK, et al. Greater adverse effects of cholesterol and diabetes on carotid intima-media thickness in South Asian Indians: Comparison of risk factor-IMT associations in two population-based surveys. Atherosclerosis. 2008;199(1):116–22.Google Scholar
  109. 109.
    Kelemen LE, Anand SS, Hegele RA, et al. Associations of plasma homocysteine and the methylenetetrahydrofolate reductase C677T polymorphism with carotid intima media thickness among South Asian, Chinese and European Canadians. Atherosclerosis. 2004;176(2):361–70.PubMedGoogle Scholar
  110. 110.
    Gunarathne A, Patel JV, Kausar S, Gammon B, Hughes EA, Lip GY. Glycemic status underlies increased arterial stiffness and impaired endothelial function in migrant South Asian stroke survivors compared to European Caucasians: Pathophysiological insights from The West Birmingham Stroke Project. Stroke. 2009;40(7):2298–306.PubMedGoogle Scholar
  111. 111.
    Kain K, Catto AJ, Grant PJ. Clustering of thrombotic factors with insulin resistance in South Asian patients with ischaemic stroke. Thromb Haemost. 2002;88(6):950–3.Google Scholar
  112. 112.
    Kain K, Brockway M, Ishfaq T, et al. Ankle pressures in UK South Asians with diabetes mellitus: A case control study. Heart. 2013;99(9):614–9.PubMedGoogle Scholar
  113. 113.
    Premalatha G, Shanthirani S, Deepa R, Markovitz J, Mohan V. Prevalence and risk factors of peripheral vascular disease in a selected South Indian population: The Chennai Urban Population Study. Diabetes Care. 2000;23(9):1295–300.PubMedGoogle Scholar
  114. 114.
    Bennett PC, Silverman S, Gill PS, Lip GY. Ethnicity and peripheral artery disease. QJM. 2009;102(1):3–16.PubMedGoogle Scholar
  115. 115.
    Chaturvedi N, Coady E, Mayet J, et al. Indian Asian men have less peripheral arterial disease than European men for equivalent levels of coronary disease. Atherosclerosis. 2007;193(1):204–12.PubMedGoogle Scholar
  116. 116.
    Chaturvedi N, Abbott CA, Whalley A, Widdows P, Leggetter SY, Boulton AJ. Risk of diabetes-related amputation in South Asians vs. Europeans in the UK. Diabet Med. 2002;19(2):99–104.PubMedGoogle Scholar
  117. 117.
    Abbott CA, Garrow AP, Carrington AL, et al. Foot ulcer risk is lower in South-Asian and African-Caribbean compared with European diabetic patients in the U.K.: The Northwest Diabetes Foot Care Study. Diabetes Care. 2005;28(8):1869–75.PubMedGoogle Scholar
  118. 118.
    Stolk RP, van Schooneveld MJ, Cruickshank JK, et al. Retinal vascular lesions in patients of Caucasian and Asian origin with type 2 diabetes: Baseline results from the ADVANCE retinal measurements (AdRem) study. Diabetes Care. 2008;31(4):708–13.PubMedGoogle Scholar
  119. 119.
    Sivaprasad S, Gupta B, Gulliford MC, et al. Ethnic variations in the prevalence of diabetic retinopathy in people with diabetes attending screening in the United Kingdom (DRIVE UK). PLoS One. 2012;7(3):e32182.PubMedCentralPubMedGoogle Scholar
  120. 120.
    Pardhan S, Gilchrist J, Mahomed I. Impact of age and duration on sight-threatening retinopathy in South Asians and Caucasians attending a diabetic clinic. Eye (Lond). 2004;18(3):233–40.Google Scholar
  121. 121.
    Raymond NT, Varadhan L, Reynold DR, et al. Higher prevalence of retinopathy in diabetic patients of South Asian ethnicity compared with white Europeans in the community: A cross-sectional study. Diabetes Care. 2009;32(3):410–5.PubMedCentralPubMedGoogle Scholar
  122. 122.
    Sivaprasad S, Gupta B, Gulliford MC, et al. Ethnic variation in the prevalence of visual impairment in people attending diabetic retinopathy screening in the United Kingdom (DRIVE UK). PLoS One. 2012;7(6):e39608.PubMedCentralPubMedGoogle Scholar
  123. 123.
    Pradeepa R, Anitha B, Mohan V, Ganesan A, Rema M. Risk factors for diabetic retinopathy in a South Indian type 2 diabetic population–the Chennai Urban Rural Epidemiology Study (CURES) Eye Study 4. Diabet Med. 2008;25(5):536–42.PubMedGoogle Scholar
  124. 124.
    Uthra S, Raman R, Mukesh BN, et al. Diabetic retinopathy and IGF-1 gene polymorphic cytosine-adenine repeats in a Southern Indian cohort. Ophthalmic Res. 2007;39(5):294–9.PubMedGoogle Scholar
  125. 125.
    Uthra S, Raman R, Mukesh BN, et al. Intron 4 VNTR of endothelial nitric oxide synthase (eNOS) gene and diabetic retinopathy in type 2 patients in Southern India. Ophthalmic Genet. 2007;28(2):77–81.PubMedGoogle Scholar
  126. 126.
    Uthra S, Raman R, Mukesh BN, et al. Association of VEGF gene polymorphisms with diabetic retinopathy in a South Indian cohort. Ophthalmic Genet. 2008;29(1):11–5.PubMedGoogle Scholar
  127. 127.
    Uthra S, Raman R, Mukesh BN, et al. Diabetic retinopathy: Validation study of ALR2, RAGE, iNOS and TNFB gene variants in a South Indian cohort. Ophthalmic Genet. 2010;31(4):244–51.PubMedGoogle Scholar
  128. 128.
    Prasad P, Tiwari AK, Kumar KM, et al. Chronic renal insufficiency among Asian Indians with type 2 diabetes: I. Role of RAAS gene polymorphisms. BMC Med Genet. 2006;7:42.PubMedCentralPubMedGoogle Scholar
  129. 129.
    Dixon AN, Raymond NT, Mughal S, et al. Prevalence of microalbuminuria and hypertension in South Asians and white Europeans with type 2 diabetes: A report from the United Kingdom Asian Diabetes Study (UKADS). Diab Vasc Dis Res. 2006;3(1):22–5.Google Scholar
  130. 130.
    Burden AC, McNally PG, Feehally J, Walls J. Increased incidence of end-stage renal failure secondary to diabetes mellitus in Asian ethnic groups in the United Kingdom. Diabet Med. 1992;9(7):641–5.PubMedGoogle Scholar
  131. 131.
    Karter AJ, Ferrara A, Liu JY, Moffet HH, Ackerson LM, Selby JV. Ethnic disparities in diabetic complications in an insured population. JAMA. 2002;287(19):2519–27.PubMedGoogle Scholar
  132. 132.
    Roderick PJ, Raleigh VS, Hallam L, Mallick NP. The need and demand for renal replacement therapy in ethnic minorities in England. J Epidemiol Community Health. 1996;50(3):334–9.PubMedCentralPubMedGoogle Scholar
  133. 133.
    Mather HM, Chaturvedi N, Kehely AM. Comparison of prevalence and risk factors for microalbuminuria in South Asians and Europeans with type 2 diabetes mellitus. Diabet Med. 1998;15(8):672–7.PubMedGoogle Scholar
  134. 134.
    Dreyer G, Hull S, Aitken Z, Chesser A, Yaqoob MM. The effect of ethnicity on the prevalence of diabetes and associated chronic kidney disease. QJM. 2009;102(4):261–9.PubMedGoogle Scholar
  135. 135.
    Chandie Shaw PK, Baboe F, van Es LA, et al. South-Asian type 2 diabetic patients have higher incidence and faster progression of renal disease compared with Dutch-European diabetic patients. Diabetes Care. 2006;29(6):1383–5.PubMedGoogle Scholar
  136. 136.
    Chandie Shaw PK, Vandenbroucke JP, Tjandra YI, et al. Increased end-stage diabetic nephropathy in Indo-Asian immigrants living in the Netherlands. Diabetologia. 2002;45(3):337–41.PubMedGoogle Scholar
  137. 137.
    Shah VN, Cheema BS, Sharma R, et al. ACAC-β gene (rs2268388) and AGTR1 gene (rs5186) polymorphism and the risk of nephropathy in Asian Indian patients with type 2 diabetes. Mol Cell Biochem. 2013;372(1–2):191–8.PubMedGoogle Scholar
  138. 138.
    Prasad P, Tiwari AK, Kumar KM, et al. Association of TGF-β-1, TNF-α, CCR2 and CCR5 gene polymorphisms in type-2 diabetes and renal insufficiency among Asian Indians. BMC Med Genet. 2007;8:20.PubMedCentralPubMedGoogle Scholar
  139. 139.
    Ahluwalia TS, Khullar M, Ahuja M, et al. Common variants of inflammatory cytokine genes are associated with risk of nephropathy in type 2 diabetes among Asian Indians. PLoS One. 2009;4(4):e5168.PubMedCentralPubMedGoogle Scholar
  140. 140.
    Prasad P, Kumar KM, Ammini AC, Gupta A, Gupta R, Thelma BK. Association of dopaminergic pathway gene polymorphisms with chronic renal insufficiency among Asian Indians with type-2 diabetes. BMC Genet. 2008;9:26-2156-9-26.Google Scholar
  141. 141.
    Tiwari AK, Prasad P, B KT, et al. Oxidative stress pathway genes and chronic renal insufficiency in Asian Indians with type 2 diabetes. J Diabetes Complicat. 2009;23(2):102–11.PubMedGoogle Scholar
  142. 142.
    Prasad P, Tiwari AK, Kumar KM, et al. Association analysis of ADPRT1, AKR1B1, RAGE, GFPT2 and PAI-1 gene polymorphisms with chronic renal insufficiency among Asian Indians with type-2 diabetes. BMC Med Genet. 2010;11:52-2350-11-52.Google Scholar
  143. 143.
    Mooyaart AL, van Valkengoed IG, Shaw PK, et al. Lower frequency of the 5/5 homozygous CNDP1 genotype in South Asian Surinamese. Diabetes Res Clin Pract. 2009;85(3):272–8.PubMedGoogle Scholar
  144. 144.
    Ashok S, Ramu M, Deepa R, Mohan V. Prevalence of neuropathy in type 2 diabetic patients attending a diabetes centre in South India. J Assoc Physicians India. 2002;50:546–50.Google Scholar
  145. 145.
    Pradeepa R, Rema M, Vignesh J, Deepa M, Deepa R, Mohan V. Prevalence and risk factors for diabetic neuropathy in an urban South Indian population: The Chennai Urban Rural Epidemiology Study (CURES-55). Diabet Med. 2008;25(4):407–12.PubMedGoogle Scholar
  146. 146.
    UK Prospective Diabetes Study. XII: Differences between Asian, Afro-Caribbean and white Caucasian type 2 diabetic patients at diagnosis of diabetes. UK Prospective Diabetes Study group. Diabet Med. 1994;11(7):670-677.Google Scholar
  147. 147.
    Abbott CA, Chaturvedi N, Malik RA, et al. Explanations for the lower rates of diabetic neuropathy in Indian Asians versus Europeans. Diabetes Care. 2010;33(6):1325–30.PubMedCentralPubMedGoogle Scholar
  148. 148.
    Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34(10):2220–4.PubMedCentralPubMedGoogle Scholar
  149. 149.
    Gujral JS, McNally PG, O'Malley BP, Burden AC. Ethnic differences in the incidence of lower extremity amputation secondary to diabetes mellitus. Diabet Med. 1993;10(3):271–4.PubMedGoogle Scholar
  150. 150.
  151. 151.
    Lindstrom J, Tuomilehto J. The diabetes risk score: A practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725–31.PubMedGoogle Scholar
  152. 152.••
    Mohan V, Anbalagan VP. Expanding role of the Madras Diabetes Research Foundation - Indian Diabetes Risk Score in clinical practice. Indian J Endocrinol Metab. 2013;17(1):31–6. This paper discusses the role of a diabetes risk score that was developed and validated in a South Asian population and reviews it myriad applications. PubMedCentralPubMedGoogle Scholar
  153. 153.
    Joshi SR. Indian diabetes risk score. J Assoc Physicians India. 2005;53:755–7.PubMedGoogle Scholar
  154. 154.
    Ramachandran A, Snehalatha C, Mary S, et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006;49(2):289–97.PubMedGoogle Scholar
  155. 155.
    Snehalatha C, Mary S, Selvam S, et al. Changes in insulin secretion and insulin sensitivity in relation to the glycemic outcomes in subjects with impaired glucose tolerance in the Indian Diabetes Prevention Programme-1 (IDPP-1). Diabetes Care. 2009;32(10):1796–801.PubMedCentralPubMedGoogle Scholar
  156. 156.
    Ramachandran A, Snehalatha C, Mary S, et al. Pioglitazone does not enhance the effectiveness of lifestyle modification in preventing conversion of impaired glucose tolerance to diabetes in asian indians: Results of the Indian Diabetes Prevention Programme-2 (IDPP-2). Diabetologia. 2009;52(6):1019–26.Google Scholar
  157. 157.
    DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators, Gerstein HC, Yusuf S, et al. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet. 2006;368(9541):1096–105.PubMedGoogle Scholar
  158. 158.
    Bellary S, O'Hare JP, Raymond NT, et al. Enhanced diabetes care to patients of South Asian ethnic origin (The United Kingdom Asian Diabetes Study): A cluster randomised controlled trial. Lancet. 2008;371(9626):1769–76.Google Scholar
  159. 159.
    Narayan V. National Institutes of Health. A randomized trial of diabetes prevention through lifestyles changes in India (D-CLIP). http://clinicaltrials.gov/ct2/show/NCT01283308. Updated 30 March 2012.
  160. 160.
    Douglas A, Bhopal RS, Bhopal R, et al. Design and baseline characteristics of the PODOSA (Prevention of Diabetes & Obesity in South Asians) trial: A cluster, randomised lifestyle intervention in Indian and Pakistani adults with impaired glycaemia at high risk of developing type 2 diabetes. BMJ Open. 2013;3(2):e002226. doi:10.1136/bmjopen-2012-002226.PubMedCentralPubMedGoogle Scholar
  161. 161.
    Narayan V. National Institutes of Health. A Culturally tailored lifestyle intervention to prevent diabetes in South Asians (SHAPE). http://clinicaltrials.gov/ct2/show/NCT01084928. Updated 30 March 2012.

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Medicine, Division of EndocrinologyUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of Medicine, Division of General Internal MedicineUniversity of CaliforniaSan FranciscoUSA

Personalised recommendations