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Diabetes in Asia:  Epidemiology, Risk Factors, and Pathophysiology

Juliana C. N. Chan, MBChB, MD; Vasanti Malik, MSc; Weiping Jia, MD, PhD; Takashi Kadowaki, MD, PhD; Chittaranjan S. Yajnik, MD, PhD; Kun-Ho Yoon, MD; Frank B. Hu, MD, PhD
JAMA. 2009;301(20):2129-2140. doi:10.1001/jama.2009.726.
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Context With increasing globalization and East-West exchanges, the increasing epidemic of type 2 diabetes in Asia has far-reaching public health and socioeconomic implications.

Objective To review recent data in epidemiologic trends, risk factors, and complications of type 2 diabetes in Asia.

Evidence Acquisition Search of MEDLINE using the term diabetes and other relevant keywords to identify meta-analyses, systematic reviews, large surveys, and cohort studies. Separate searches were performed for specific Asian countries. The review was limited to English-language articles published between January 1980 and March 2009; publications on type 1 diabetes were excluded.

Evidence Synthesis The prevalence of diabetes in Asian populations has increased rapidly in recent decades. In 2007, more than 110 million individuals in Asia were living with diabetes, with a disproportionate burden among the young and middle aged. Similarly, rates of overweight and obesity are increasing sharply, driven by economic development, nutrition transition, and increasingly sedentary lifestyles. The “metabolically obese” phenotype (ie, normal body weight with increased abdominal adiposity) is common in Asian populations. The increased risk of gestational diabetes, combined with exposure to poor nutrition in utero and overnutrition in later life in some populations, may contribute to the increasing diabetes epidemic through “diabetes begetting diabetes” in Asia. While young age of onset and long disease duration place Asian patients with diabetes at high risk for cardiorenal complications, cancer is emerging as an important cause of morbidity and mortality.

Conclusions Type 2 diabetes is an increasing epidemic in Asia, characterized by rapid rates of increase over short periods and onset at a relatively young age and low body mass index. Prevention and control of diabetes should be a top public health priority in Asian populations.

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Figure. Number of Persons With Diabetes in Different Age Groups and Number of Deaths Attributable to Diabetes in Different Regions of the World in 2007
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Source: International Diabetes Federation.2 EMME indicates Eastern Mediterranean/Middle East; SACA, South America/Central America; SEA, Southeast Asia (comprises Bangladesh, Bhutan, India, Maldives, Mauritius, Nepal, and Sri Lanka [total population, 770 350 000; estimated prevalence of diabetes in the region, 6%]). Western Pacific comprises Australia, Brunei Darussalam, Cambodia, China, Hong Kong, Macau, Cook Islands, Fiji, French Polynesia, Guam, Indonesia, Japan, Kiribati, Korea (Democratic People's Republic of), Korea (Republic of), Lao People's Democratic Republic, Malaysia, Marshall Islands, Micronesia (Federal States of), Mongolia, Myanmar, Nauru, New Caledonia, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Samoa, Singapore, Solomon Islands, Taiwan, Thailand, Timor-Leste, Tokelau, Tonga, Tuvalu, Vanuatu, and Vietnam (total population, 1 468 598,000; estimated prevalence of diabetes in the region, 7.6%).

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