The Diabetes Epidemic

With bulging stomachs, expanding waistlines and an increasing propensity to eat fast-food Mirpuris in unison with other South Asian heritage communities are fast becoming health victims of their own lifestyle excesses. The fast food culture that now permeates communities the length and breadth of Britain has spurned an entire generation that bucks the trend in improved longevity thanks to medical advancements of the previous century. Britons of all backgrounds are now eating themselves to death but for those of South Asian descent this trend is even more worrying given the prevalence of Type 2 diabetes in numerous households. We have collated the following articles to shed more light on the subject from different perspectives with a view of tackling the poor diets of many Mirpuris who seem oblivious to the dangers posed by Type 2 diabetes and the factors that lead up to it.


The Diabetes Epidemic

The South Asian Report

South Asian people of Indian, Pakistani and Bangladeshi descent who live in the UK are up to six times more likely to have Type 2 diabetes than the white European population. With diabetes prevalence in the UK generally predicted to rise from 2.5 million today to more than four million by 2025, the condition will continue to have a disproportionately large impact on South Asian communities across the UK. Meanwhile, recent estimates put UK prevalence figures for children with Type 2 diabetes at 1,400 and rising. As children of South Asian origin are estimated to be more than 13 times more likely to have Type 2 diabetes than white European children, this can only increase the burden and cost of the condition to the South Asian community. Despite these clear and alarming statistics, our knowledge of the link between diabetes and people of South Asian descent is still very limited. In an effort, therefore, to review existing knowledge in this field of research, identify gaps in our understanding and make recommendations on the priorities for future diabetes research in this population, Diabetes UK and the South Asian Health Foundation teamed up with leading researchers to produce a report entitled Diabetes UK and South Asian Health Foundation recommendations on diabetes research priorities for British South Asians. The report comprises 16 chapters, including ‘Self-management and education for people with Type 2 diabetes’, ‘Childhood and adolescent Type 2 diabetes’, ‘Cultural aspects’, ‘Genetics’, ‘Screening for diabetes and non-diabetic hyperglycaemia’, ‘Prevention of Type 2 diabetes’, ‘Gestational diabetes’, ‘Psychological consequences of diabetes’, ‘Dyslipidaemia’ and ‘Bariatric surgery’. Two central issues emerge from the report:  first, an understanding that South Asian people have varied origins, with different cultures, languages, religions and rates of diabetes, and cannot therefore always be grouped together; and, second, the lack of involvement of South

Asian people in health research. Each chapter in the report ends with recommended priorities for future research, so this second point is worth some immediate attention. As probably seems self-evident, the success and value of future research in all areas, in terms of shaping the best-quality diabetes care for all, is entirely dependent in the first place on the participation of the many ethnic groups that make up the South Asian population. Unfortunately, however, as spelt out in the report’s first chapter, ‘Participation in research’, the involvement of South Asians and other minority ethnic groups in research is generally low for various reasons, including, on the part of patients, lack of time and motivation, previous unsuccessful experiences and language barriers. Healthcare professionals, meanwhile, cite a lack of support and resources dedicated to involving South Asian people in research. All these problems may also be linked with literacy issues in some communities, making it more difficult to obtain people’s consent, especially when many primary care databases lack the necessary ethnicity and language codes.

The UK Asian Diabetes Study, however, recently found that while the collection of self-management and psychosocial data was challenging, recruiting participants and collecting clinical data were straightforward, possibly because of innovative ways of obtaining consent. Nevertheless, the reasons behind non-participation in research among the South Asian community are far from clear and must be identified in order to increase and improve involvement in future research, which needs to concentrate on the effectiveness and cost effectiveness of different recruitment strategies, as well as the development and validation of study outcome measures for use among South Asians.

Lifestyle factors

The study of lifestyle factors cuts across several chapters in the report, including ‘Epidemiology’, ‘Treatment and care of people with diabetes’ and ‘Cultural aspects’. Compelling evidence exists for the role of lifestyle intervention, including both diet and physical activity, in the primary prevention of Type 2 diabetes. Despite this, we still don’t know specifically whether South Asian diets adversely influence Type 2 diabetes risk or to what extent physical activity patterns and the effects of physical activity differ between different ethnic groups.

Diabetes-related complications

While there is a paucity of long-term studies to assess confidently the epidemiology of diabetes-related complications in the South Asian population, there is mounting evidence to suggest that the risk of cardiovascular disease, peripheral vascular disease, stroke, diabetic nephropathy and, potentially, diabetic retinopathy may all be elevated in South Asians compared with white Europeans. Not all studies, however, have confirmed these risk associations. The UK Prospective Diabetes Study (UKPDS), for example, looked at newly diagnosed subjects rather than those with a longer duration of diabetes. Either way, the South Asian population has not been adequately represented in several of the large studies that have been used to inform evidence-based guidelines. This throws into question the practice of merely extrapolating data from a largely white European population to the South Asian one.

Cardiovascular disease and diabetes

Coronary heart disease and stroke are both more prevalent, occur at an earlier age and have an increased associated mortality rate in the South Asian population when compared with white Europeans. A higher prevalence of cardiovascular risk factors, including diabetes, a high waist-to-hip ratio and a high apolipoprotein B-to-apolipoprotein A1 ratio, has been shown to be associated with heart attacks in the South Asian population at an earlier age, although there is a lack of data on the risk factors for stroke. It is also unclear whether the aggressive management of conventional risk factors would lower coronary heart disease risk in South Asians. Research is therefore needed in this area, and also to assess the effect of pharmacological treatments aimed at achieving lower than current targets for lipids, blood pressure and other risk factors.


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