>> So in your perspective, why do we see such an alarming increase in
the number of cases of type 2 diabetes particularly?
>> That's a very good question, there are some factors that we understand and
there are others that we don't.
I mean, clearly among the factors that we understand, some are the very obvious one.
There has been a huge increase in overweight and obesity worldwide.
And that's probably driven by major changes in lifestyle factors.
For example, people are consuming larger amounts of refined carbohydrates,
not consuming enough fruits and vegetables,
and dietary patterns are changing very rapidly in most parts of the world.
And also, thanks to mechanized transportation and mechanized labor,
people are doing less physical activity as part of their work and
as part of their daily routines.
And because of the advent of television culture, computer use,
etc, people are increasingly more sedentary.
These are some of the established risk factors that changes, increases in
obesity, changes in dietary factors, changes in loss of physical activity etc.
That said, there are many factors that we don't seem to understand.
Especially in low and middle income countries where data are extremely scarce,
we are beginning to notice diabetes, type 2 diabetes, occurring even in thin people.
And not in small numbers but very large numbers.
The question is, why is that so?
It can't just be explained by obesity.
There might be other factors involved.
Obesity might be a contributory factor.
For example, there is the theory that children who are born
in impoverished circumstances due to generations of maternal and
child malnutrition, may be born with a disadvantage which,
on the one hand, makes them store body fat for survival.
But on the other hand,
they may also be insulin deficient because of the body is trying to save glucose for
the brain so that the children are born insulin deficient.
So then when you suddenly impose the modern life style in terms of changes in
diet and physical activity, these children, as young adults, don't have
the capacity to compensate and very quickly progress to developing diabetes.
But fundamentally, 90% of the burden of diabetes occurs in low and
middle income countries, but 95% of the research
that we know from about diabetes comes from high income countries.
This is a huge mismatch, so we really need to invest more in terms of research
in low and middle income countries to understand the epidemic better and to
understand some of these unique phenotypes such as diabetes in thin people occurring
in countries like India, Sub-Saharan Africa, other parts of Asia, etc.
>> So help me understand.
If we have a person with early stages of type 2 diabetes living in low,
middle, and high income areas, how is it the disease manifesting differently or
the prospects for the ill person?
How is that different?
>> For one thing, we need to notice that type 2 diabetes is
occurring a lot more frequently at younger ages in low and middle income countries.
And like I just said, we're also noticing that type 2 diabetes is also occurring
in thin people more often in low and middle income countries.
More worryingly, 50 to 80% of diabetes remains undiagnosed in low and
middle income countries which means by the time the disease comes to attention,
considerable organ damage has happened and often complications have set in.
So all of these pose very important questions,
both for new research and for prevention.