Diabetes – The Growing Threat to South Asians Living in the United States

Renu Deshpande, M.D.

Diabetes mellitus is a public health problem of epidemic proportions and its incidence in Asian Indians and other South Asians is on the rise. More than 21 million adults in the United States and 150 million worldwide have diabetes. By 2025 the World Health Organization projects more than 300 million cases worldwide and by 2030, an estimated 79 million Indians will have type 2 diabetes mellitus (also referred to as “diabetes”), 80% of whom will die from heart disease. The risk of developing heart disease is fourfold in individuals with diabetes and is, therefore, a significant health concern in this at-risk population.

Diabetes mellitus is caused by the inability to produce and/or utilize insulin (a hormone made by the pancreas) and is the most common endocrine disorder in men and women. Type 2 diabetes mellitus is caused by an inability of the body to use the insulin that it is producing as well as an inability of the pancreas to operate at a level that would maintain appropriate insulin levels in the body. Historically, diabetes has generally affected people over age 40 but is now seen in individuals as young as three years of age. South Asians (people of the Indian subcontinent, Nepal, Sri Lanka), Mauritius and Fijian Indians have a genetic predisposition as well as behavioral and environmental risk factors for developing diabetes. Among these risk factors are a diet high in carbohydrates, abdominal obesity or “thick in the middle” (which is measured by one’s waist circumference) and a sedentary lifestyle.

There is a close association of diabetes with heart disease and because of the big impact heart health has on one’s life, any discussion of diabetes must include a discussion of heart disease. Asian Indians have a higher risk of developing heart disease (about 10 years earlier) than other populations. More than half of Asian Indians are lifelong vegetarians, however heart disease rates are similar among both vegetarians and non-vegetarians. This is in sharp contrast to Western vegetarians who tend to have very low rates of heart disease. Consumption of fried, processed and fast foods high in saturated fats and transfats is on the rise in immigrant South Asians. This has a direct effect on worsening insulin resistance and subsequent development of diabetes and heart disease. Tobacco use, abdominal obesity, high blood pressure, low consumption of fruits and vegetables and sedentary lifestyle habits are all well studied determinants of heart disease and diabetes. Additionally, diabetes impacts kidney and nerve function and can lead to blindness if not treated correctly. It also makes your body more susceptible to infections by affecting the way your immune system works.

The prevalence of diabetes and heart disease among South Asian populations is cause for individual due diligence. It is important to assess your risk and to seek advice and appropriate treatment from your physician.

Are You at Risk?

If you think you, or a family member, is at risk of developing diabetes, discuss your concerns with your physician. Important questions to consider are:

1. Are you overweight?
2. Does your mother, father, sister(s) or brother(s) have diabetes?
3. Have you ever developed diabetes during pregnancy?
4. Are you South Asian?
5. Have you ever been told by a doctor that you had high blood pressure?

If you think you are at risk, here are some things that you can do:

1. Obtain a baseline annual physical exam with your doctor, sharing your concern for diabetes and/or heart disease.
2. Exercise 30-45 minutes, seven days a week. Consider brisk walking, cycling, swimming, jogging, step aerobics, etc., and resistance training at least two days per week.
3. Adopt a healthy diet. Eliminate liquid calories, i.e. soda and juices, even diet soda, which has been linked to increased triglyceride levels. Limit fried foods, the use of ghee and butter and tropical oils like palm and coconut. Eliminate transfat (deep fried items) altogether. Increase monounsaturated fat (e.g. olive, flax seed, canola, or safflower oil). Include legumes and whole grain foods, fruits and vegetables in your daily diet. Limit salt intake to about one teaspoon per day.
4. Avoid drinking alcohol.

Be patient with yourself and start with small steps and achievable goals. Gradually, increase your commitment to diet and exercise and celebrate your successes. Soon, you will find that you have adopted a lifetime of healthier habits.

Renu Deshpande, M.D., is a family medicine physician practicing in Bay Valley Medical Group’s Danville office.