**6. Conclusion**

way of reducing the rate of diabetes. The World Diabetes Foundation has already implemented prevention programs at the national level to educate students in urban and semi-urban areas in

**Figure 2** shows a schematic illustration of the characteristics of diabetes in South Asia described in this chapter. The causes underlying the high prevalence of diabetes in South Asians can be distilled down to four main factors. First, South Asians have the thrifty gene derived from Asian Indian populations that induces insulin resistance and disorder of glucose consumption; they therefore develop a T2DM constitution. Second, obese populations are increasing due to dietary changes and a decrease in physical activity in the wake of remarkable economic progress, which causes T2DM. Third, traditional bad habits such as chronic heavy smoking and drinking, which cause T1DM and T2DM, are increasingly being adopted due to increased income caused by economic progress. Fourth, the recognition to diabetes is

South Asian countries about the risk of diabetes, in view of these shortcomings [76].

poor because of a lack of relevant policies and the education system.

12 Diabetes and Its Complications

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

**Figure 2.** Causes of diabetes in South Asia and suggestions for their prevention.

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

We focused on the issue of the recent increase in the diabetes prevalence in South Asia and described the results consequently obtained in associated studies. First, we investigated the prevalence of diabetes and its complications in South Asia. Existing studies and statistics suggest that the prevalence was much higher in this region than in other developed and developing countries and that this prevalence is rapidly increasing despite already being a serious problem in the subcontinent. This high prevalence rate will induce increased diabetes-related expenditures and incur a heavy financial and social burden in the near future for people in South Asia.

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Second, we examined why South Asians show a higher prevalence rate of diabetes than other populations and explored the reasons for its rapid increase in prevalence. One potential internal cause is a constitution based on obesity, which is induced by the thrifty gene characteristic of Asians. Another potential internal cause is the adoption of traditional bad habits, such as chronic heavy smoking and drinking. These factors may cause T2DM even in nonobese subjects and T1DM even in older individuals. A potential environmental cause is urbanization. Rapid development gives rise to an undesirable diet and lifestyle, which can cause obesity in South Asians, especially those living in rural areas.

Finally, we proposed effective prevention strategies based on the above analyses. Primary prevention through the promotion of a healthy diet and lifestyle should be a priority, and the prevalence rate may be able to be drastically decreased by making changes to one's diet and lifestyle. However, if South Asians fail to recognize the impending diabetes crisis, this condition will unfortunately become much more serious in the near future. The implementation of public health strategies aimed at mitigating the obesogenic environment is critical.
