**Diabetes Mellitus in South Asia**

**Diabetes Mellitus in South Asia**

Viduranga Y. Waisundara and Naofumi Shiomi Additional information is available at the end of the chapter

Viduranga Y. Waisundara and Naofumi Shiomi

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.76391

#### **Abstract**

The prevalence rates of diabetes mellitus and its complications in South Asia are much higher than in other developed and developing countries; therefore, diabetes mellitus has become a serious problem in this region. While the prevalence of diabetes mellitus in South Asia is remarkable, its characteristics and causes have not been well-elucidated. More than 85% of the diabetic population in South Asia suffer from type 2 diabetes, and the causes can be divided into two categories: internal/traditional causes and causes induced by rapid development. Factors such as age, gender, diet and lifestyle changes, including a lack of physical activity caused by modernization and urbanization, are major contributory factors. The majority of the healthcare costs associated with diabetes are due to its later complications and are not preventable. Therefore, inexpensive treatment at an early stage of diabetes is important. In this review, the following are recommended as preventive measures of the incidence of the disease: (1) induction of UCP1 through the diet, (2) increasing the intake of antidiabetic bioactive components and/or food and (3) evolution of the consensus through educational programs and government policy. National strategies and interventions should be implemented immediately for both the primary and secondary prevention of diabetes mellitus and its complications in order to advocate healthy living among the South Asian populations.

DOI: 10.5772/intechopen.76391

**Keywords:** diabetes mellitus, diabetic complications, India, South Asia, Sri Lanka

### **1. Introduction**

Diabetes mellitus (hereafter referred to as "diabetes") develops under unusual conditions where the glucose level in the blood cannot be controlled. The disease is characterized by several symptoms such as thirst, polyuria and blurred vision [1]. Ketoacidosis or a nonketotichyperosmolar state caused by a chronic higher blood glucose level leads to stupor and coma in advanced cases and can even cause death in severe cases. There are four clinically defined

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categories of diabetes: type 1 diabetes (T1DM), type 2 diabetes (T2DM), gestational diabetes (GDM) and other specific types of the disease [2, 3]. In T1DM, also known as insulin-dependent diabetes (IDDM), the body is unable to produce insulin because of the autoimmune destruction of pancreatic islet beta cells (β cells), and as a result, the glucose levels in the blood cannot be maintained at normal concentrations. It ranks as the most common chronic childhood disease. T2DM or noninsulin-dependent diabetes (NIDDM) is characterized by both impaired insulin secretion and impaired insulin action. This type is associated with aging, obesity, a family history of diabetes, physical inactivity and certain ethnicities, although the causes of some of these factors are not well-explored. In GDM, the most widely accepted definition is diabetes that develops by varying insulin sensitivity during pregnancy or diabetes first recognized during pregnancy; in the former case, treatment with insulin can often be finished after pregnancy, as this type of diabetes is acute. Among these categories, T2DM accounts for about 85–95% of diabetes cases worldwide.

A huge number of people (3.8 million) annually lose their lives due to diabetic complications, a value almost equivalent to the loss of life associated with AIDS [7]. **Table 1** shows the diabetic populations and its prevalence rates in South Asian countries based on the data of the International Diabetes Federation, which was estimated by a statistical investigation of the relevant populations primarily 20–79 years of age [10]. The results suggest that the diabetic populations and the prevalence rates of diabetes in most South Asian countries are thus expected to dramatically increase at a high rate until 2035. In India in particular, which has a large population and is rapidly advancing economically, 109 million people are predicted to develop diabetes by 2035 (**Table 1**). This will place India at the epicenter of this global epidemic [11]. In addition to this upward trend in the prevalence rate, the number of deaths and the economic burden due to diabetes in South Asians have been rapidly increasing. As shown in **Table 1**, around 43–870 USD per person is paid to cure diabetes and its complications. With the rising rate of incidence, people in South Asia will have to compensate for much higher diabetes-related expenditures in the near future, which will constitute a heavy burden upon

Diabetes Mellitus in South Asia

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http://dx.doi.org/10.5772/intechopen.76391

**3. High prevalence rates of complications related to diabetes in South** 

of total adult population in 2035; F, diabetes prevalence per total adult population in 2035.

**Table 1.** Prevalence of diabetes in South Asia in 2014 and its estimated prevalence in 2035.

A, total adult population (20–79 years) in 2014; B, diabetes prevalence per total adult population in 2014; C, deaths number by the disease related to diabetes in 2014; D, mean diabetes-related expenditure per person in 2014; E, estimation

**Countries A (in 1000s) B (%) C D (USD) E (in 1000s) F (%)** Afghanistan 13086.9 6.15 18,514 102 27768.7 6.63 Bangladesh 94378.5 6.34 111,371 43 133493.5 8.18 Bhutan 474.0 4.94 124 150 656.9 6.90 India 774920.8 8.63 1,039,980 95 1042007.9 10.46 Maldives 214.0 7.97 109 870 332.9 5.94 Nepal 15307.4 4.58 14,778 60 23032.1 5.44 Pakistan 102124.6 6.80 87,548 56 158355.1 8.08 Sri Lanka 14155.4 8.32 16,384 123 16398.4 9.47

Diabetes is known to be strongly associated with many other disease and complications, and those ultimately lead to organ and tissue damage. The prevalence rates of macrovascular complications and atherosclerosis are especially high in diabetic patients, inducing adverse effects of ischemic heart disease [14], peripheral vascular disease and cerebrovascular disease. Diabetes is suspected to induce macrovascular complications and atherosclerosis. High blood

**3.1. Prevalence rate of macrovascular complication**

the respective countries [12, 13].

**Asians**

Diabetes research has mainly focused on people living in developed countries as a disease caused by obesity. However, the prevalence rate of diabetes has been increasing in many developing and newly-industrialized nations as well. In this review, we focused on South Asia as one such region. The prevalence rate of diabetes and its complications in South Asia is higher than in other areas, such as Europe [4], and diabetes has recently become a serious health issue leading to death [5]. Therefore, comprehensive knowledge about the prevalence rate and causes of diabetes in South Asian countries is desired. As part of this review, we investigated the present state, characteristics and causes of diabetes in South Asia and proposed strategies for its prevention. We hope that this appraisal will encourage recognition of the serious state of diabetes among South Asians and become an effective index for eventually solving this issue.
