Type II Diabetes and India

Bloomberg has released an excellent report India’s Diabetes Epidemic Strikes Millions Who Escape Poverty which describes a new health problem for that country, which appears to be due to previously unknown factors. The scale of the problem today is described:

The International Diabetes Federation in October 2009 ranked India as the country with the most diabetics worldwide. The umbrella group of more than 200 national associations estimates that the disease will kill about 1 million Indians this year, more than in any other country.

With 7.1 percent of adults afflicted, India is on a par with developed countries such as Australia, where 7.2 percent of adults suffer. India now fares worse than the U.K., where 4.9 percent are diabetic. In the U.S., where more than two-thirds of adults are overweight or obese, 12.3 percent have diabetes.

The cause of this rapid spread of diabetes in India seems to be different than the factors driving the disease in the US and other Western countries. A British researcher identified pre-natal factors as the cause; underfed mothers produce small, undernourished babies with metabolisms equipped for deprivation and unable to cope with calorie-rich diets available to people who have escaped poverty due to India’s economic progress.

“Barker, the British physician studying lifestyle diseases, reported findings two decades ago that are helping scientists understand India’s diabetes surge. At the University of Southampton, Barker discovered that areas of Britain in which coronary heart disease was most common had had the highest infant mortality 60 years earlier.

Studying the medical records of about 15,000 people born from 1911 to 1940, he found those who were small as infants were more likely to get heart disease, diabetes and stroke as adults. The link sparked Barker’s hypothesis that diabetics could trace their disease to how they adapted to malnutrition in the womb.”

One explanation for diabetes in Western countries is over-eating and lack of exercise. Barker believes that this doesn’t apply in India:

“The conventional explanation up until that time was that poorer people have worse lifestyles and so they are kind of bringing it all on themselves,” Barker, 72, says. “That would be the prevailing view in the U.S. today. There isn’t evidence for that.”

As Barker sees it, malnutrition during a baby’s development affects how a person’s body behaves for a lifetime. An undernourished fetus prioritizes sugar for its growing brain. To make more glucose available in the blood, the fetus stores less of the energy in its muscles by making the muscles resistant to the effects of insulin.

What starts as a clever survival trick in the womb becomes a liability in later life. When food is freely available but the muscles can’t store excess glucose, the blood floods with sugar and diabetes develops. Too much sugar in the blood damages the heart, small blood vessels and nerves, compounding the risk of heart attack, stroke and kidney failure.”

A problem for health care workers promoting improved pre-natal care as a solution may be that governments aren’t inclined to promote maternal nutrition as a key diabetes prevention strategy without more scientific proof, and that may take decades according to an Australian researcher who contributed to identification of the surprising increase in diabetes rates in India.

There are about 50 million Indians with Type II diabetes and the disease strikes at an average age of 42.5 years — about a decade earlier than it strikes people of European origin. One might say that India is experiencing an accelerated health transition, defined by the World Health Organization as follows:

In the developing regions, where four-fifths of the planet’s people live, noncommunicable diseases such as depression and heart disease, as well as road traffic deaths, are fast replacing the traditional enemies such as infectious diseases and malnutrition, as the leading causes of disability and premature death. By the year 2020, noncommunicable diseases are expected to account for seven out of every ten deaths in the developing regions, compared with less than half today.

With drug resistant microbes increasing in developed countries, and noncommunicable health problems increasing in rapidly developing countries it seems that the world may be in a period of health convergence.