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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.

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.

Author Affiliations: Hong Kong Institute of Diabetes and Obesity, Department of Medicine, and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China (Dr Chan); Departments of Nutrition and Epidemiology, Harvard School of Public Health, and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (Drs Malik and Hu); Department of Endocrinology and Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China (Dr Jia); Department of Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (Dr Kadowaki); Diabetes Unit, KEM Hospital Research Center, Pune, India (Dr Yajnik); and Department of Endocrinology and Metabolism, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea (Dr Yoon).

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