Diabetes in Asia and the Pacific: Implications for the Global Epidemic
Article Figures & Tables
Figures
- Figure 1
Map shows the Western Pacific and South Asian regions.
Tables
- Table 1
Plausible etiological factors responsible for the increased propensity to develop T2DM
Genetic and acquired factors Genetic factors (familial aggregations) Ethnic susceptibility Adverse gene–environment interaction (i.e., epigenetics, metabolic maladaptations) Lower threshold for diabetogenic risk factors (i.e., age, BMI, central adiposity) Low muscle mass Increased insulin resistance Decreased β-cell compensation disproportionate to insulin insensitivity Presence of metabolic obesity Increased inflammatory response Environmental risk factors Urbanization and modernization Globalization and industrialization Unhealthy behavioral habits (sedentary lifestyle, consumption of energy- dense food, smoking, tobacco chewing, and excessive alcohol consumption) Sleep disturbances Psychological stress Societal factors Cultural and religious taboos Psychosocial factors Lack of universal health coverage - Table 2
Prevalence of diabetes in the WPR, with temporal changes shown wherever available*
Country Year (Ref) Sample size (n) Characteristics Diagnostic criteria Diabetes (%) American Samoa 2004 (14) 2,072 WHO STEPS; stratified cluster sampling; age: 25–64 years Capillary FPG ≥6.1 mmol/L 47.3 Australia 2011–2012 (20)† NR Age: ≥18 years HbA1c ≥6.5% (≥47.5 mmol/mol) 5.4 Brunei Darussalam 2003 (21)† NR Population-based data from integrated health screening system from medical case records; age: NR Capillary FPG ≥6.1 mmol/L or known diabetes 5.4 2010 (21)† NR Age: ≥20 years Capillary FPG ≥6.1 mmol/L or known diabetes 12.5 Cambodia 2004 (16) 2,246 Cross-sectional; two communities: rural and semiurban; age: ≥25 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L Rural: 5.0 Suburban: 11.0 2011 (24)† 5,123 WHO STEPS; multistage cluster method (180 clusters); age: 25–65 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L Total: 2.9 (95% CI 2.3–3.4) Rural: 2.3 (95% CI 1.7–2.9) Urban: 5.6 (95% CI 4.0–7.2) China 2001 (25)† 15,838 Nationally representative stratified sampling; age: 35–74 years FPG ≥7.0 mmol/L or 2-h PG ≥11.1 mmol/L 5.5 2010 (15)† 98,658 Complex, multistage, probability sampling design; age: ≥18 years FPG ≥7.0 mmol/L or 2-h PG ≥11.1 mmol/L 11.6 China, Hong Kong SAR 1990 (22) 1,513 Participants from a public utility company and a regional hospital; age: ≥30 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 4.5 2007–2010 (23) 3,376 Hong Kong professional driver community project; age: 18–70 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 8.1 Cook Islands 1980 (14) 1,102 Population-based study; age: ≥20 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 6.8 2003 (14) 2,036 WHO STEPS; stratified samples; age: NR Capillary FPG ≥6.1 mmol/L or on medication 23.6 Federated States of Micronesia 1994 (14) 2,188 Population-based study in Kosrae population; age: 20–85 years FPG ≥7.0 mmol/L 12.0 2002 (14) 1,638 WHO STEPS; population-based cross-sectional study; age: 25–64 years FPG ≥7.0 mmol/L 32.1 Fiji 2002 (14) 2,277 Population-based multistage sampling in 30 clusters; age: 15–64 years Capillary FPG ≥6.1 mmol/L or on medication; HbA1c ≥6.5% (≥47.5 mmol/mol) or known to have diabetes 16.0 2009 (14) 1,353 WHO STEPS; population-based study; age: ≥40 years 44.8 French Polynesia 2010 (14) 3,469 WHO STEPS; population-based multistage sampling; age: 18–64 years Capillary FPG ≥6.1 mmol/L or on medication 7.3 Indonesia 1997 (18) 941 Population-based study of government and retired individuals; age: NR FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 5.4 2009 (19) 24,417 Samples from 13 urban provinces; age: ≥15 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 5.7 Japan 1997 (17) National Age: ≥20 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L M:F 9.9:7.1 2007 (17) National Age: ≥20 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L M:F 15.3:7.3 Kiribati 1983 (14) 2,938 Population-based survey; age: ≥20 years; South Tarawa and the four outer islands; age: 15–64 years FPG ≥7.0 mmol/L or 2-h PG ≥11.1 mmol/L Urban: M:F 9.6:8.7 Rural: M:F 3.0:3.3 2004–2006 (14) 1,146 WHO STEPS; population- based multistage sampling; age: 18–64 years FPG ≥7.0 mmol/L 28.1 Malaysia 2006 (26) 34,539 Malaysian National Health Morbidity Survey (NHMS) III; age: ≥18 years FPG ≥7.1 mmol/L or known to have diabetes 11.6 2013 (26) 4,341 Two-stage stratified sampling design; age: ≥18 years HbA1c ≥6.5%, FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 22.9 Marshall Islands 2002 (14) 994 WHO STEPS; population-based; age: 15–64 years FPG ≥7.0 mmol/L 19.6 Mongolia 2005 (27) 3,411 WHO STEPS; population-based; age: 15–64 years Capillary FBG ≥6.1 mmol/L or on medication 8.2 2009 (27) 5,368 WHO STEPS; population-based; age: 15–64 years Capillary FBG ≥6.1 mmol/L or on medication 6.5 Nauru 1987 (1) 1,201 Population-based data; age: ≥20 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 24.0 2004 (14) 883 Systematic random sample design; age: 15–64 years FPG ≥7.0 mmol/L or on medication 16.2 (age 15–24 years) 22.7 (age 25–64 years) New Zealand 2002–2003 (28) 12,929 Stratified cluster sampling; age: ≥15 years FPG ≥7.0 mmol/L or 2-h PG ≥11.1 mmol/L 8.1 2008–2009 (28) 4,721 Age: ≥15 years FPG ≥7.0 mmol/L or 2-h PG ≥11.1 mmol/L 7.0 Niue 1980 (1) 1,128 Population-based survey; age: ≥20 years FPG ≥7.8 mmol/L 7.2 2012 (14) 863 WHO STEPS; population-based; age: ≥15 years Capillary FBG ≥6.1 mmol/L or on medication 38.4 Papua New Guinea 1991 (14) 497 Population-based cluster; age: ≥25 years Random blood glucose ≥8 mmol/L or known diabetes Urban: 30.3 Rural: Wanigela: 11.7 Kalo: 1.6 2008 (14) 2,944 WHO STEPS; population-based survey; age: 15–64 years Capillary FBG ≥6.1 mmol/L or on medication 14.4 Republic of Korea 2005 (29) 4,628 KNHANES; age: ≥30 years FPG ≥7.0 mmol/L or/and history of diabetes 9.1 2007–2009 (29) 13,512 Age: ≥30 years FPG ≥7.0 mmol/L 9.9 2011–2012 (30)† 14,330 National Health Survey; age: ≥30 years FPG ≥7.0 mmol/L 10.1 Samoa 1991 (14)† 1,776 Population-based cluster sampling; age: 25–74 years FPG ≥7.8 mmol/L or/and 2-h PG ≥11.1 mmol/L Apia: M:F 9.5:13.4 Poutasi: M:F 5.3: 5.6 Tuasivi: M:F 7.0:7.5 2002 (14) 2,817 WHO STEPS; random sample population-based study; age: 15–64 years Capillary FBG ≥6.1 mmol/L or venous FPG ≥7.0 mmol/L or on medication 22.1 Singapore 2004 (31)† NR National survey; age: 18–69 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 8.2 2010 (31)† NR National survey; age: 18–69 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 11.3 Solomon Islands 1986 (14) 243 Population-based study; age ≥18 years WHO STEPS; population-based; age: 25–64 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L 2.09 2006 (14) 950 Capillary FBG ≥6.1 mmol/L or on medication 13.5 Thailand 1991 (32)† National Age: ≥30 years FPG ≥7.0 mmol/L 2.3 2004 (32)† National Age: ≥15 years FPG ≥7.0 mmol/L 6.8 2009 (33)† National Age: ≥20 years FPG ≥7.0 mmol/L 7.5 Tokelau 1976 (14) 346 Population-based study; age: 35–74 years OGTT (100 g): 1-h PG ≥13.9 mmol/L M:F 7.0:14.3 2005 (14) 573 WHO STEPS; population-based national survey; age: 15–64 years Capillary FBG ≥6.1 mmol/L or on medication 33.6 Tonga 1991 (14)† 1,024 National sample; age: ≥15 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L 15.1 2004 (14)† 453 WHO STEPS; population-based national survey; age: 15–64 years Capillary FBG ≥6.1 mmol/L or on medication 16.4 Vanuatu 1991 (14) 1,378 An occupation-based (civil servants) urban sample and area-based semirural and rural samples; age: NR FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L Vila: M:F 2.1:12.1 Nguna: M:F 2.1:1.1 Tanna: M:F 1.0:0.9 2011 (14)† 4,422 WHO STEPS; population-based national survey; survey included all six provinces; age: 25–64 years Capillary FBG ≥6.1 mmol/L or on medication 21.2 Vietnam 2001 (34) 2,932 Cross-sectional; age ≥15 years FPG ≥7.8 mmol/L or/and 2-h PG ≥11.1 mmol/L 3.8 FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 2011 (12) 2,710 Cross-sectional; age: 40–64 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L 3.7 Wallis and Futuna 1980 (14)† 549 Population-based study; age: ≥20 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 2.7 2010 (14)† 487 WHO STEPS; population-based national survey; age: 15–64 years FPG ≥7.0 mmol/L or on medication 17.5 F, female; FBG, fasting blood glucose; HbA1c, glycated hemoglobin A1c; M, male; NR, not reported; PG, plasma glucose; SAR, Special Administrative Region.
↵*It needs to be recognized that only broad comparisons can be made from these data owing to significant differences in age-groups, survey methodologies, diagnostic criteria, etc.
↵†National studies.
- Table 3
Prevalence of diabetes in South Asia, with temporal changes shown wherever available
Country Year (Ref) Sample size (n) Characteristics Diagnostic criteria Diabetes (%) Afghanistan 2013 (42) 1,169 Age: >40 years Capillary FBG ≥6.1 mmol/L or on medication 13.3 Bangladesh 2005 (5) 6,312 Cross-sectional; age: ≥20 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L Urban: 8.3 Rural: 2.3 2011 (43)* 8,835 Population-based national survey; age: ≥35 years FPG ≥7.0 mmol/L or 2-h PG ≥11.1 mmol/L 9.7 Bhutan 2008 (44) 2,474 Stratified two-stage sampling; age: 25–74 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L 8.2 India 2000 (45) 11,216 Random sampling, six metropolitan cities; age: ≥20 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L 12.1 2008–10 (46) 13,055 Stratified multistage sampling (188 urban, 175 rural) in three states and one union territory; age not reported Fasting CBG ≥7 mmol/L or/and 2-h CBG ≥12.2 mmol/L or on medication Tamil Nadu: 10.4 Maharashtra: 8.4 Jharkhand: 5.3 Chandigarh: 13.6 Maldives 2004 (47)* 1,556 Cross-sectional; national; age: 25–64 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L 4.5 Mauritius 1987 (48) 5,083 Independent population-based survey; age: 20–74 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 13.0 2009 (48) 6,371 Age: 20–74 years FPG ≥7.8 mmol/L or 2-h PG ≥11.1 mmol/L 21.3 Nepal 2011 (49) 14,425 Population from Eastern Nepal; age: >20–100 years FPG ≥7.0 mmol/L or 2-h PG ≥11.1 mmol/L 6.3 Pakistan 2000 (50) 1,042 Age: 30–64 years FPG ≥7.0 mmol/L or 2-h PG ≥11.1 mmol/L 6.5 2006 (50) 5,433 Age: 30–64 years FPG ≥7.0 mmol/L or/and 2-h PG ≥11.1 mmol/L Urban: 10.6 Rural: 7.7 Sri Lanka 2001 (5) 6,047 Cross-sectional; stratified random samples from four provinces; age: ≥30 years FPG ≥7.0 mmol/L or on medication 13.8 2006 (51)* 4,532 Cross-sectional; national representative; age: ≥20 years FPG ≥7.0 mmol/L or 2-h PG ≥11.1 mmol/L 10.3 CBG, capillary blood glucose; FBG, fasting blood glucose; PG, plasma glucose.
↵*National study.
- Table 4
Randomized controlled prevention studies in T2DM in Asian populations using lifestyle intervention
Study population characteristics Mean duration Participants by treatment group Cumulative incidence of diabetes Relative risk reduction Study (year) (Ref) (years) (n) (%) (%) Da Qing IGT and Diabetes Study (1997) (102) Chinese: Total n = 577 Control: 67.7 Diet: 31.0 BMI: 26.0 6 Control: 133 Diet: 43.8 Exercise: 46.0 Age: 45.0 Diet: 130 Exercise: 41.1 Diet + exercise: 42.0 Cluster randomized by clinic Exercise: 141 Diet + exercise: 46.0 Diet + exercise: 126 Da Qing Diabetes Prevention Study (2008) (103) Control Control: 138 Control: 93.0 43.0 BMI: 24.4 20 Intervention: 439 Intervention: 80.0 Intervention BMI: 24.5 Da Qing Diabetes Prevention Study (2014) (103) Control Total n = 568 (by interview from medical records) Control: 89.9 45.0 BMI: 25.7 23 Control: 138 Intervention: 72.6 Intervention Intervention: 430 CVD mortality 41.0 BMI: 26.2 Control: 19.6 Intervention: 11.9 All-cause mortality 29.0 Control: 38.4 Intervention: 28.0 IDPP-1 (2006) (104) BMI: 25.8 2.6 (median) Total n = 531 Control: 55.0 LSM: 28.5 Age: 45.9 Control: 136 LSM: 39.3 Metformin: 26.4 Persistent IGT, individual randomization LSM: 133 Metformin: 40.5 LSM + metformin: 28.2 Metformin: 133 LSM + metformin: 39.5 LSM + metformin: 129 Indian SMS study (2013) (108) BMI: 25.8 2 Control: 266 Control: 27.4 Age: 45.9 Intervention: 271 Intervention: 18.5 36.0 Persistent IGT, men Japanese prevention study (2005) (105) Japanese men: 4 Control: 102 Control: 9.3 67.4 BMI: 23.5 Intervention: 356 Intervention: 3.0 Age: 51.5 IGT, individual randomization Zensharen Study for Prevention of Lifestyle Diseases (2011) (106) Japanese men: 3 Control: 330 Control: 16.6 44.0 BMI: 27.0 Intervention: 311 Intervention: 12.2 Age: 49.0 IGT, individual randomization Age given as mean (years) and BMI given as mean (kg/m2). CVD, cardiovascular disease.
In this Issue
March 2016, 39(3)
Diabetes in Asia and the Pacific: Implications for the Global Epidemic
