**5. Strategies for preventing diabetes in South Asia**

As we suggested in the previous sections, the implementation of preventive strategies for diabetes is necessary as soon as possible. Preventive treatment should be performed as early as possible in subjects at risk of developing diabetes, as complete recovery is extremely difficult once diabetes develops. Second, the recovery of the glucose consumption capacity and insulin sensitivity are the most important targets for treatment because most diabetic patients in South Asia have T2DM, which is mainly caused by disorders in these activities. Furthermore, inexpensive treatments are necessary, as diabetic patients in South Asians tend not to be very wealthy. Given these aspects, we propose three strategies herein for reducing the prevalence rate of diabetes. The first strategy involves the induction of uncoupling protein 1 (UCP1) by changing the diet and lifestyle. UCP1, which is expressed only in brown adipocytes, plays a role in nonshivering heat generation using the proton potential of the inner membrane of mitochondria. Through the effects of UCP1, fatty acid is effectively metabolized to compensate for the loss of energy. Recently, the effects of UCP1 on glucose and insulin resistance were examined using fatty mouse and UCP1 transgenic mouse models [77–79]. The results of those studies suggest that increasing the concentration of UCP1 is the most effective way to rescue subjects with preliminary T2DM. The induction of UCP1 is relatively easy because muscle cells and white adipocytes can be differentiated to brown adipocyte by the stimulation of cool temperatures and exercise [80, 81] or by consuming herbal and/or complementary medicines [66]. We therefore think that the induction of brown adipocytes is the most inexpensive and effective way of preventing the development of diabetes at the early stage in South Asia.

The second strategy involves qualitative improvements in the diet by proactively consuming functional compounds or food products containing antidiabetic bioactives. Many effective compounds for protecting against obesity have been identified. For example, consuming fish instead of meat is good for protecting against obesity because DHA contained in fish can reduce fat and cholesterol. Proactively consuming food containing polyphenols, such as green tea, soybean products and berries, and carnitine, such as fish [82–84], is also effective for similar reasons. Superfoods that contain high levels of these effective compounds and functional foods with artificially enhanced levels have been enthusiastically studied, and many inexpensive functional foods and supplements are now available in developed countries [85, 86]. The proactive consumption of superfoods and functional foods through the daily diet without expensive drugs is extremely effective for protecting against obesity and diabetes.

The final and most important strategy involves changing the consensus. If most South Asians with obese constitutions continue their bad habits, such as chronic heavy smoking and drinking and consuming high-calorie and oily foods, the rapid increase in the prevalence rate of diabetes cannot be effectively curbed. In Japan, the consensus regarding obesity and metabolic syndrome has recently been enhanced by a trend toward anti-obesity and education via TV and books; in this way, the rising tide of obesity is being stemmed little by little. This is a strategy which could be easily implemented in South Asia as well. Therefore, revising the consensus can be effective, even in South Asians. In a case report from Ballabgarh, India, a five-step model (identify the problem, understand the problem, evaluate feasible and costeffective intervention) is addressed to the issue [87], but statistics clearly display that such efforts are not sufficient, and further education toward diabetes and national strategies and interventions to protect against obesity and diabetes should be implemented immediately.
