Global estimates of diabetes prevalence for 2013 and projections for 2035.

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.

Diabetes in Asia: epidemiology, risk factors, and pathophysiology.

Diabetes is a major lifestyle disorder, the prevalence of which is increasing globally. Asian countries contribute to more than 60% of the world's diabetic population as the prevalence of diabetes is increasing in these countries. Socio-economic growth and industrialization are rapidly occurring in many of these countries. The urban-rural divide in prevalence is narrowing as urbanization is spreading widely, adversely affecting the lifestyle of populations. Asians have a strong ethnic and genetic predisposition for diabetes and have lower thresholds for the environmental risk factors. As a result, they develop diabetes at a younger age and at a lower body mass index and waist circumference when compared with the Western population. The adverse effect of physical inactivity and fatty food are manifested as the increasing rate of overweightness and obesity, even among children. The health care budgets for the disease management are meager and the health care outcome is far from the optimum. As a result, complications of diabetes are common and the economic burden is very high, especially among the poor strata of the society. National endeavors are urgently needed for early diagnosis, effective management and for primary prevention of diabetes. This editorial aims to highlight the rising trend in prevalence of diabetes in Asia, its causative factors and the urgent need to implement national strategies for primary prevention of type 2 diabetes.

Trends in prevalence of diabetes in Asian countries

Tissue specimens from 283 principally spontaneously (naturally) desiccated human mummies from coastal and low valley sites in northern Chile and southern Peru were tested with a DNA probe directed at a kinetoplast DNA segment of Trypanosoma cruzi. The time interval spanned by the eleven major cultural groups represented in the sample ranged from ≈9,000 years B.P. (7050 B.C.) to approximately the time of the Spanish conquest, ≈450 B.P. (≈1500 A.D.). Forty-one percent of the tissue extracts, amplified by the PCR reacted positively (i.e., hybridized) with the probe. Prevalence patterns demonstrated no statistically significant differences among the individual cultural groups, nor among subgroups compared on the basis of age, sex, or weight of specimen tested. These results suggest that the sylvatic (animal-infected) cycle of Chagas' disease was probably well established at the time that the earliest humans (members of the Chinchorro culture) first peopled this segment of the Andean coast and inadvertently joined the many other mammal species acting as hosts for this parasite.

https://www.pnas.org/content/pnas/101/7/2034.full.pdf

A 9,000-year record of Chagas' disease

Background: Diabetes mellitus has reached epidemic proportions worldwide. South Asians are known to have an increased predisposition for diabetes which has become an important health concern in the region. We discuss the prevalence of pre-diabetes and diabetes in South Asia and explore the differential risk factors reported. Methods: Prevalence data were obtained by searching the Medline W database with; ‘prediabetes’ and ‘diabetes mellitus’ (MeSH major topic) and ‘Epidemology/EP’ (MeSH subheading). Search limits were articles in English, between 01/01/1980–31/12/2011, on human adults (≥19 years). The conjunction of the above results was narrowed down with country names. Results: The most recent reported prevalence of pre-diabetes:diabetes in regional countries were; Bangladesh–4.7%:8.5% (2004–2005;Rural), India–4.6%:12.5% (2007;Rural); Maldives–3.0%:3.7% (2004;National), Nepal–19.5%:9.5% (2007;Urban), Pakistan–3.0%:7.2% (2002;Rural), Sri Lanka–11.5%:10.3% (2005–2006;National). Urban populations demonstrated a higher prevalence of diabetes. An increasing trend in prevalence of diabetes was observed in urban/rural India and rural Sri Lanka. The diabetes epidemicity index decreased with the increasing prevalence of diabetes in respective countries. A high epidemicity index was seen in Sri Lanka (2005/2006–52.8%), while for other countries, the epidemicity index was comparatively low (rural India 2007–26.9%; urban India 2002/2005–31.3%, and urban Bangladesh–33.1%). Family history, urban residency, age, higher BMI, sedentary lifestyle, hypertension and waist-hip ratio were associated with an increased risks of diabetes. Conclusion: A significant epidemic of diabetes is present in the South Asian region with a rapid increase in prevalence over the last two decades. Hence there is a need for urgent preventive and curative strategies .

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Prevalence and trends of the diabetes epidemic in South Asia: a systematic review and meta-analysis

The increase in life expectancy in developing countries and as a result of increasing obesity and other life style changes, the global incidence of type 2 diabetes mellitus (T2DM) is increasing. The purpose of this study was to investigate the prevalence of T2DM and impaired fasting glucose (IFG) in semi-urban population of Nepal and to compare the prevalence between men and women and among different age groups. A total 740 adults (286 men and 454 women) aged 21 to 94 years (men +/- SD; 45.6 +/- 15.6 years) were included. The prevalence of T2DM and IFG was 9.5% and 19.2% in the whole population. Prevalence of T2DM was higher in men (11.8%) then in women (7.9%), similarly IFG was noted higher in men (25%) then in women (15.4%0). The prevalence of T2DM and IFG was seen to be increased with age in the whole population. Among women, the prevalence of T2DM and IFG was 2.9% and 12.8% in 21 to 40 years age group, 9.7% and 13.8% in 41 to 60 years age group and 15.4% and 27.7% in > 60 years age group. Among men, it was 4.7% and 22.6% in 21 to 40 years age group, 13.3% and 30.5% in 41 to 60 years age group and 23% and 17.3% in > 60 years age group. To conclude, the overall prevalence of T2DM and IFG increases with age. Prevalence of IFG is highest among middle age men where as the prevalence of T2DM is highest among older men.

The prevalence of type 2 diabetes mellitus and impaired fasting glucose in semi-urban population of Nepal.

We report the prevalence of intestinal helminthiasis and its impact on health of Nepalese in two different rural Village Development Committees (VDC) in Nepal. A total of 261 school children from Okharpauwa VDC in Nuwakot district (Central Region) and 242 inhabitants of Boya VDC in Bhojpur district (Eastern Region) in Nepal were included in this study. The overall prevalence in these two different districts were 57.5% and 55.4%, respectively. Altogether four types of helminths were detected. In both districts, Ascaris lumbricoides was the commonest helminth. Mixed helminth infection in both study areas accounted for less than 5.0%. All helminth infected subjects were treated with a single dose of albendazole. Heavy Trichuris trichiura infection needed a second dose. Blood hemoglobin and serum total protein level in school children in Okharpauwa VDC increased significantly after chemotherapy (P < 0.05). Eosinophil count (10.1%; SD 5.0325) returned to normal (4.8%; SD 4.6997). Helminth infection in Boya VDC was more common in children than in adults. Serum total protein, albumin, total cholesterol and triglycerides levels were not influenced by the presence or absence of helminths among the inhabitants of Boya VDC. In both districts, more than 80.0% of the household had no latrine. In Boya VDC, 94.0% of inhabitants interviewed were not aware of other intestinal parasite other than A. lumbricoides.

Effect of intestinal helminth infection on some nutritional parameters among rural villagers in nepal

A total of 200 soil samples taken from different sites and 1,504 stool samples collected from school children (n = 188) and patients (n = 1,316) visiting the health care centres in Kathmandu Valley were included in this study. Soil samples were investigated for the presence of parasitic eggs using sucrose flotation technique. Stool samples were examined by formal-ether concentration and direct smear techniques. The contamination rate of soil with parasitic eggs and larvae was found to be 28.5% (57/ 200). The overall parasitic infection rates in school children and patients were 42.5% and 2.8%, respectively. Four types of parasites were detected from soil samples, of which Ascaris was the most common. Trichuris was most common among school children whereas Ascaris in patients. Females in both study groups had higher prevalence compared with male counterparts with significantly low rate in health care centre visiting patients (p < 0.05).

Soil transmitted helminthiasis in Kathmandu, Nepal.

Dyslipidemia is one of the major risk factors of coronary artery disease. Present study was aimed to find out the lipid profile of non-diabetic adult Nepalese population (n = 454; M: 180 and F: 274; Mean age: 42.8+/-15.5 years). The mean +/- SD (mg/dl) level of total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) was 184+/-50.7, 147.4+/-79.9, 111.9+/-42.0 and 45.0+/-11.7, respectively. All lipid levels except LDL were higher among 41 to 60 years age group while LDL was higher among participants aged >60 years. Desirable TC level ( or =240 mg/dl) and very high TG (> or =500 mg/dl) and LDL (> or =190 mg/dl) were found in 8.8%, 2.6% and 5.8% of participants, respectively. Higher HDL level (40 mg/dl) was seen in 60.0% of the total population. Higher percentage of women than men (65.3% vs 52.2%) had >40 mg/dl HDL level. Nornal lipid profile (TC 40 mg/dl) was seen in 26.7% of participants, and was higher in females (32.1%) than in males (18.3%). The overall mean cholesterol level was within normal limit. Mean LDL level showed increasing trend with age and about one fourth of participants had normal lipid profile.

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Lipid profile of adult Nepalese population.

Status of drinking water contamination was studied in three mountainous districts in Nepal. A total of 43 water samples (Sankhuwasabha: 11, Rasuwa: 12 and Dolpa: 20) were tested for the presence of total coliform (TC) and Escherichia coli as fecal coliform bacilli using commercially available test system called Colilert (Japan). Of the total, 85.7% (36/43) were positive for TC whereas 67.4% (29/43) were positive for Esch. coli. The fecal contamination rates (as indicated by the growth of Esch. coli) in Sankhuwasabha, Rasuwa and Dolpa Districts were 81.8% (9/11), 75.0% (9/12) and 65.0% (13/20), respectively. Most of the water samples collected in district headquarter towns namely Khandbari, Dhunche and Dunai, respectively) showed Esch. coli compared with those collected in remote villages areas.

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Rai Ck

Papers

The prevalence of type 2 diabetes mellitus and impaired fasting glucose in semi-urban population of Nepal.

Effect of intestinal helminth infection on some nutritional parameters among rural villagers in nepal

Soil transmitted helminthiasis in Kathmandu, Nepal.

Lipid profile of adult Nepalese population.

Status of drinking water contamination in Mountain Region, Nepal.