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Endocrine, Metabolic & Immune Disorders - Drug Targets


ISSN (Print): 1871-5303
ISSN (Online): 2212-3873

Systematic Review Article

Impact of Type 2 Diabetes Mellitus with a Focus on Asian Indians Living in India and Abroad: A Systematic Review

Author(s): Faiz Noor Khan Yusufi*, Aquil Ahmed, Jamal Ahmad, Athanasios Alexiou*, Ghulam Md Ashraf and Ahad Noor Khan Yusufi

Volume 23, Issue 5, 2023

Published on: 18 November, 2022

Page: [609 - 616] Pages: 8

DOI: 10.2174/1871530322666220827161236

Price: $65


Background: Diabetes is a highly prevalent disease in the world. Type 2 diabetes mellitus (T2DM) is growing at an alarming rate due to rapid urbanization, migration, aging population, and lifestyle changes.

Introduction: We have summarized the global T2DM distribution in specific International Diabetes Federation (IDF)-defined regions and various countries and highlighted the high risk of T2DM prevalence in Asian Indians living in India and worldwide.

Methods: A systematic review was conducted using combinations of the following key concepts ‘T2DM’; ‘global distribution’; ‘Asian Indians’; ‘high risk’ and ‘prevalence’ by searching PubMed and EMBASE databases for articles describing the global distribution of T2DM. From 430 searched articles, 54 full-text articles were reviewed to study the distribution, risk, and prevalence of diabetes in various countries.

Results: As per IDF Atlas, 463 million people in 2019 have diabetes worldwide, and it is expected to rise to 700 million by 2045. The global distribution of T2DM differs from various countries to various regions. Asia is the epicenter of diabetes, where 60% of people with diabetes live, mainly in China (139.9 million) and India (65 million). South Asians are more susceptible to developing T2DM as compared to ethnic Europeans. Asian Indians living worldwide are at a high risk of developing T2DM. Those who have migrated to various countries (USA, UK, Australia, Singapore, Mauritius, New Zealand, Fiji, etc.) have a higher prevalence of T2DM than the native population and even more significant than those Indians living in India due to being more insulin resistant. Indians develop T2DM at a younger age and at a lower BMI due to genetic makeup and behavioral and environmental determinants, including diet and sedentary lifestyle and westernization.

Conclusion: In conclusion, insulin levels were found to be higher not only in adults but also in adolescents and young adults. In addition, rapid urbanization, migration, industrial modernization, and lifestyle changes are other factors responsible for the development of T2DM.

Keywords: Diabetes, type 2 diabetes mellitus, global distribution, asian indians, high risk, insulin resistance.

Graphical Abstract
International Diabetes Federation 2019. Available from: (Accessed on 15 Feb, 2021)
Wild, S.; Roglic, G.; Green, A.; Sicree, R.; King, H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care, 2004, 27(5), 1047-1053.
[] [PMID: 15111519]
Hu, F.B. Globalization of diabetes: The role of diet, lifestyle, and genes. Diabetes Care, 2011, 34(6), 1249-1257.
[] [PMID: 21617109]
Chen, L.; Magliano, D.J.; Zimmet, P.Z. The worldwide epidemiology of type 2 diabetes mellitus-present and future perspectives. Nat. Rev. Endocrinol., 2011, 8(4), 228-236.
[] [PMID: 22064493]
Thomas, A.; Ashcraft, A. Type 2 diabetes risk among Asian Indians in the US: A pilot study. Nurs. Res. Pract., 2013, 2013, 492893.
[] [PMID: 23970965]
Abate, N.; Chandalia, M. Ethnicity, type 2 diabetes & migrant Asian Indians. Indian J. Med. Res., 2007, 125(3), 251-258.
[PMID: 17496354]
Chan, J.C.; Malik, V.; Jia, W.; Kadowaki, T.; Yajnik, C.S.; Yoon, K.H.; Hu, F.B. Diabetes in Asia: Epidemiology, risk factors, and pathophysiology. JAMA, 2009, 301(20), 2129-2140.
[] [PMID: 19470990]
Bakker, L.E.; Sleddering, M.A.; Schoones, J.W.; Meinders, A.E.; Jazet, I.M. Pathogenesis of type 2 diabetes in South Asians. Eur. J. Endocrinol., 2013, 169(5), R99-R114.
[] [PMID: 23939919]
Gujral, U.P.; Pradeepa, R.; Weber, M.B.; Narayan, K.M.; Mohan, V. Type 2 diabetes in South Asians: Similarities and differences with white Caucasian and other populations. Ann. N. Y. Acad. Sci., 2013, 1281(1), 51-63.
[] [PMID: 23317344]
Ballotari, P.; Caroli, S.; Ferrari, F.; Romani, G.; Marina, G.; Chiarenza, A.; Manicardi, V.; Giorgi Rossi, P. Differences in diabetes prevalence and inequalities in disease management and glycaemic control by immigrant status: A population-based study (Italy). BMC Public Health, 2015, 15(1), 87.
[] [PMID: 25884923]
Burke, J.P.; Williams, K.; Haffner, S.M.; Villalpando, C.G.; Stern, M.P. Elevated incidence of type 2 diabetes in San Antonio, Texas, compared with that of Mexico City, Mexico. Diabetes Care, 2001, 24(9), 1573-1578.
[] [PMID: 11522701]
Mohanty, S.A.; Woolhandler, S.; Himmelstein, D.U.; Bor, D.H. Diabetes and cardiovascular disease among Asian Indians in the United States. J. Gen. Intern. Med., 2005, 20(5), 474-478.
[] [PMID: 15963176]
Mokdad, A.H.; Ford, E.S.; Bowman, B.A.; Nelson, D.E.; Engelgau, M.M.; Vinicor, F.; Marks, J.S. Diabetes trends in the U.S.: 1990-1998. Diabetes Care, 2000, 23(9), 1278-1283.
[] [PMID: 10977060]
Oza-Frank, R.; Ali, M.K.; Vaccarino, V.; Narayan, K.M. Asian Americans: Diabetes prevalence across U.S. and World Health Organization weight classifications. Diabetes Care, 2009, 32(9), 1644-1646.
[] [PMID: 19509010]
Creatore, M.I.; Moineddin, R.; Booth, G.; Manuel, D.H.; DesMeules, M.; McDermott, S.; Glazier, R.H. Age- and sex-related prevalence of diabetes mellitus among immigrants to Ontario, Canada. CMAJ, 2010, 182(8), 781-789.
[] [PMID: 20403889]
Gujral, U.P.; Narayan, K.M.; Pradeepa, R.G.; Deepa, M.; Ali, M.K.; Anjana, R.M.; Kandula, N.R.; Mohan, V.; Kanaya, A.M. Comparing type 2 diabetes, prediabetes, and their associated risk factors in Asian Indians in India and in the US: The CARRS and MASALA studies. Diabetes Care, 2015, 38(7), 1312-1318.
[] [PMID: 25877810]
World Health Organization. World health organization global report on diabetes. Geneva: World Health Organization. 2016. Available from: (Accessed on 15 Feb, 2021)
Mayo Clinic Available from: (Accessed on 15 Feb, 2021)
Kaul, P.; Savu, A.; Nerenberg, K.A.; Donovan, L.E.; Chik, C.L.; Ryan, E.A.; Johnson, J.A. Impact of gestational diabetes mellitus and high maternal weight on the development of diabetes, hypertension and cardiovascular disease: A population-level analysis. Diabet. Med., 2015, 32(2), 164-173.
[] [PMID: 25407209]
Gupta, M.; Singh, R.; Lehl, S.S. Diabetes in India: A long way to go. Int. J. Sci. Res., 2015, 1(1), 1-2.
Radha, V.; Mohan, V. Genetic predisposition to type 2 diabetes among Asian Indians. Indian J. Med. Res., 2007, 125(3), 259-274.
[PMID: 17496355]
Hirst, J.E.; Raynes-Greenow, C.H.; Jeffery, H.E. A systematic review of trends of gestational diabetes mellitus in Asia. J. Diabetol., 2012, 3(3), 5.
Gallagher, J. Diabetes cases soar by 60% in past decade. Health editor, BBC News website. 2015. Available from: (Accessed on 15 Feb, 2021)
Shamshirgaran, S.M.; Jorm, L.; Bambrick, H.; Hennessy, A. Independent roles of country of birth and socioeconomic status in the occurrence of type 2 diabetes. BMC Public Health, 2013, 13(1), 1223.
[] [PMID: 24359144]
Jowitt, L.M.; Lu, L.W.; Rush, E.C. Migrant Asian Indians in New Zealand; prediction of metabolic syndrome using body weights and measures. Asia Pac. J. Clin. Nutr., 2014, 23(3), 385-393.
[PMID: 25164448]
Lin, S.; Tukana, I.; Linhart, C.; Morrell, S.; Taylor, R.; Vatucawaqa, P.; Magliano, D.J.; Zimmet, P. Diabetes and obesity trends in Fiji over 30 years. J. Diabetes, 2016, 8(4), 533-543.
[] [PMID: 26201444]
Quah, J.H.; Liu, Y.P.; Luo, N.; How, C.H.; Tay, E.G. Younger adult type 2 diabetic patients have poorer glycaemic control: A cross-sectional study in a primary care setting in Singapore. BMC Endocr. Disord., 2013, 13(1), 18.
[] [PMID: 23725198]
Phan, T.P.; Alkema, L.; Tai, E.S.; Tan, K.H.; Yang, Q.; Lim, W.Y.; Teo, Y.Y.; Cheng, C.Y.; Wang, X.; Wong, T.Y.; Chia, K.S.; Cook, A.R. Forecasting the burden of type 2 diabetes in Singapore using a demographic epidemiological model of Singapore. BMJ Open Diabetes Res. Care, 2014, 2(1), e012.
[] [PMID: 25452860]
Söderberg, S.; Zimmet, P.; Tuomilehto, J.; de Courten, M.; Dowse, G.K.; Chitson, P.; Gareeboo, H.; Alberti, K.G.; Shaw, J.E. Increasing prevalence of type 2 diabetes mellitus in all ethnic groups in Mauritius. Diabet. Med., 2005, 22(1), 61-68.
[] [PMID: 15606693]
Khan, N.A.; Wang, H.; Anand, S.; Jin, Y.; Campbell, N.R.; Pilote, L.; Quan, H. Ethnicity and sex affect diabetes incidence and outcomes. Diabetes Care, 2011, 34(1), 96-101.
[] [PMID: 20978094]
Chandie Shaw, P.K.; Baboe, F.; van Es, L.A.; van der Vijver, J.C.; van de Ree, M.A.; de Jonge, N.; Rabelink, T.J. South-Asian type 2 diabetic patients have higher incidence and faster progression of renal disease compared with Dutch-European diabetic patients. Diabetes Care, 2006, 29(6), 1383-1385.
[] [PMID: 16732026]
Carlsson, A.C.; Wändell, P.E.; Hedlund, E.; Walldius, G.; Nordqvist, T.; Jungner, I.; Hammar, N. Country of birth-specific and gender differences in prevalence of diabetes in Sweden. Diabetes Res. Clin. Pract., 2013, 100(3), 404-408.
[] [PMID: 23618551]
Chowdhury, T.A.; Hitman, G.A. Type 2 diabetes in people of South Asian origin: Potential strategies for prevention. Br. J. Diabetes Vasc. Dis., 2007, 7(6), 279-282.
National Diabetes Statistics Report. 2014. Available from: (Accessed on 15 Feb, 2021)
Omar, M.A.; Seedat, M.A.; Dyer, R.B.; Motala, A.A.; Knight, L.T.; Becker, P.J. South African Indians show a high prevalence of NIDDM and bimodality in plasma glucose distribution patterns. Diabetes Care, 1994, 17(1), 70-73.
[] [PMID: 8112193]
Ramachandran, A.; Snehalatha, C. Type 2 diabetes mellitus-the epidemic of the 21st century: The Indian scenario. Int. J. Diabetes Dev. Ctries., 1999, 19, 158-164.
Bindraban, N.R.; van Valkengoed, I.G.; Mairuhu, G.; Holleman, F.; Hoekstra, J.B.; Michels, B.P.; Koopmans, R.P.; Stronks, K. Prevalence of diabetes mellitus and the performance of a risk score among Hindustani Surinamese, African Surinamese and ethnic Dutch: A cross-sectional population-based study. BMC Public Health, 2008, 8(1), 271.
[] [PMID: 18673544]
Nazroo, J.Y. The Health of Britain’s Ethnic Minorities: Findings from a National Survey; Policy Studies Institute, 1997.
Agency for Healthcare research and Quality (AHRQ): Diabetes disparities among racial and ethnic minorities. US Department of Health and Human Services, Public health Services. 2001. Available from: (Accessed on 15 Feb, 2021)
Creatore, M.I.; Booth, G.L.; Manuel, D.G.; Moineddin, R.; Glazier, R.H. Diabetes screening among immigrants: A population-based urban cohort study. Diabetes Care, 2012, 35(4), 754-761.
[] [PMID: 22357181]
Australian Institute of Health and Welfare (AIHW)), Australian Government, Diabetes. 2015. Available from: (Accessed on 15 Feb, 2021)
National Diabetes Services Scheme (NDSS). Available from: (Accessed on 15 Feb, 2021)
Ramachandran, A.; Snehalatha, C.; Kapur, A.; Vijay, V.; Mohan, V.; Das, A.K.; Rao, P.V.; Yajnik, C.S.; Prasanna Kumar, K.M.; Nair, J.D. High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey. Diabetologia, 2001, 44(9), 1094-1101.
[] [PMID: 11596662]
Ramachandran, A.; Ma, R.C.; Snehalatha, C. Diabetes in Asia. Lancet, 2010, 375(9712), 408-418.
[] [PMID: 19875164]
Gupta, R.; Misra, A. Type 2 diabetes in India: Regional disparities. Br. J. Diabetes Vasc. Dis., 2007, 7(1), 12-16.
Misra, A.; Shrivastava, U. Obesity and dyslipidemia in South Asians. Nutrients, 2013, 5(7), 2708-2733.
[] [PMID: 23863826]
Gupta, R. Diabetes in India: Current Status. Express Healthcare. 2008. Available from: (Accessed on 15 Feb, 2021)
Mohan, V.; Sandeep, S.; Deepa, R.; Shah, B.; Varghese, C. Epidemiology of type 2 diabetes: Indian scenario. Indian J. Med. Res., 2007, 125(3), 217-230.
[PMID: 17496352]
Mohan, V.; Pradeepa, R. Epidemiology of diabetes in different Regions of India. Health Administrator, 2009, 22(1-2), 1-8.
Anjana, R.M.; Pradeepa, R.; Deepa, M.; Datta, M.; Sudha, V.; Unnikrishnan, R.; Bhansali, A.; Joshi, S.R.; Joshi, P.P.; Yajnik, C.S.; Dhandhania, V.K.; Nath, L.M.; Das, A.K.; Rao, P.V.; Madhu, S.V.; Shukla, D.K.; Kaur, T.; Priya, M.; Nirmal, E.; Parvathi, S.J.; Subhashini, S.; Subashini, R.; Ali, M.K.; Mohan, V. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia, 2011, 54(12), 3022-3027.
[] [PMID: 21959957]
Anjana, R.M.; Deepa, M.; Pradeepa, R.; Mahanta, J.; Narain, K.; Das, H.K.; Adhikari, P.; Rao, P.V.; Saboo, B.; Kumar, A.; Bhansali, A.; John, M.; Luaia, R.; Reang, T.; Ningombam, S.; Jampa, L.; Budnah, R.O.; Elangovan, N.; Subashini, R.; Venkatesan, U.; Unnikrishnan, R.; Das, A.K.; Madhu, S.V.; Ali, M.K.; Pandey, A.; Dhaliwal, R.S.; Kaur, T.; Swaminathan, S.; Mohan, V. Prevalence of diabetes and prediabetes in 15 states of India: Results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol., 2017, 5(8), 585-596.
[] [PMID: 28601585]
Zargar, A.H.; Khan, A.K.; Masoodi, S.R.; Laway, B.A.; Wani, A.I.; Bashir, M.I.; Dar, F.A. Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent. Diabetes Res. Clin. Pract., 2000, 47(2), 135-146.
[] [PMID: 10670914]
Mohan, V.; Mathur, P.; Deepa, R.; Deepa, M.; Shukla, D.K.; Menon, G.R.; Anand, K.; Desai, N.G.; Joshi, P.P.; Mahanta, J.; Thankappan, K.R.; Shah, B. Urban rural differences in prevalence of self-reported diabetes in India--the WHO-ICMR Indian NCD risk factor surveillance. Diabetes Res. Clin. Pract., 2008, 80(1), 159-168.
[] [PMID: 18237817]
Kaveeshwar, S.A.; Cornwall, J. The current state of diabetes mellitus in India. Australas. Med. J., 2014, 7(1), 45-48.
[] [PMID: 24567766]
Anjana, R.M.; Shanthi Rani, C.S.; Deepa, M.; Pradeepa, R.; Sudha, V.; Divya Nair, H.; Lakshmipriya, N.; Subhashini, S.; Binu, V.S.; Unnikrishnan, R.; Mohan, V. Incidence of diabetes and prediabetes and predictors of progression among Asian Indians: 10-year follow-up of the Chennai Urban Rural Epidemiology Study (CURES). Diabetes Care, 2015, 38(8), 1441-1448.
[] [PMID: 25906786]
Skar, M.; Villumsen, A.B.; Christensen, D.L.; Petersen, J.H.; Deepa, M.; Anjana, R.M.; Pradeepa, R.; Mohan, V. Increased risk of type 2 diabetes with ascending social class in urban South Indians is explained by obesity: The Chennai urban rural epidemiology study (CURES-116). Indian J. Endocrinol. Metab., 2013, 17(6), 1084-1089.
[] [PMID: 24381889]
Vijayakumar, G.; Arun, R.; Kutty, V.R. High prevalence of type 2 diabetes mellitus and other metabolic disorders in rural Central Kerala. J. Assoc. Physicians India, 2009, 57(2), 563-567.
[PMID: 20209716]
Daivadanam, M.; Absetz, P.; Sathish, T.; Thankappan, K.R.; Fisher, E.B.; Philip, N.E.; Mathews, E.; Oldenburg, B. Lifestyle change in Kerala, India: Needs assessment and planning for a community-based diabetes prevention trial. BMC Public Health, 2013, 13(1), 95.
[] [PMID: 23375152]
International Diabetes Federation Diabetes Atlas. International Diabetes Federation, 6th ed; Brussels, 2013.
Mohan, V.; Deepa, R.; Deepa, M.; Somannavar, S.; Datta, M. A simplified Indian Diabetes Risk Score for screening for undiagnosed diabetic subjects. J. Assoc. Physicians India, 2005, 53, 759-763.
[PMID: 16334618]
Ramachandran, A.; Snehalatha, C.; Vijay, V.; Wareham, N.J.; Colagiuri, S. Derivation and validation of diabetes risk score for urban Asian Indians. Diabetes Res. Clin. Pract., 2005, 70(1), 63-70.
[] [PMID: 16126124]
Kulothungan, V.; Ramakrishnan, R.; Subbiah, M.; Raman, R. Risk score estimation of diabetic retinopathy: Statistical alternatives using multiple logistic regression. J. Biom. Biostat., 2014, 5(5), 211.
Yusufi, F.N.K.; Ahmed, A.; Ahmad, J. Modelling and developing diabetic retinopathy risk scores on Indian type 2 diabetes patients. Int. J. Diabetes Dev. Ctries., 2019, 39(1), 29-38.
Yusufi, F.N.K.; Doddigarla, Z.; Ahmed, A.; Ahmad, J. Validation of Swedish and Chinese 5-year heart disease prediction models on Indian type 2 diabetes mellitus patients. Int. J. Agricult. Stat. Sci. Vol., 2021, 17(2), 461-470.
Yusufi, F.N.K.; Ahmed, A.; Ahmad, J. System and method for dual model-based early prediction of heart disease for Indian type-2 diabetes mellitus patients. AU Patent 2021105334, Int. J. Agricult. Stab. Sci., 2021, 17(2), 461-470.

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