The mysteries of type 2 diabetes in developing countries.

Abstract

More research is needed in low- and middle-income countries where the epidemic of type 2 diabetes is on the rise. KM Venkat Narayan talks to Fiona Fleck. [ILLUSTRATION OMITTED] KM Venkat Narayan is one of the world's leading researchers on type 2 diabetes. He directs the Emory Global Diabetes Research Center. Prior to joining Emory University In 2006, he spent 10 years at the United States Centers for Disease Control and Prevention, leading the science efforts in his role as Chief of the Diabetes Epidemiology Section and later the Epidemiology and Statistics Branch. Narayan worked on the first diet-exercise intervention study as part of the Pima Indian Study of diabetes at the National Institute of Diabetes and Digestive and Kidney Diseases from 1992 to 1996, where he helped to develop the Diabetes Prevention Program (DPP). Before that, he worked in India, the United Arab Emirates and the United Kingdom of Great Britain and Northern Ireland as a tenured public health physician. He graduated in medicine in 1980 from St John's Medical College, Bangalore, India and subsequently qualified in geriatric medicine, public health and management. He is a member of several international and national committees on type 2 diabetes and other noncommunicable diseases. In 2015 he won the American Diabetes Association's Kelly West Award for outstanding achievement in epidemiology and is the Danish Diabetes Academy visiting professor at the University of Copenhagen. Q; How did you become interested in type 2 diabetes research? A: When I was a physician and public health person working largely on cardiovascular diseases (CVD) in the early 1990s, a leading cause of death in Scotland at the time, I was invited to join a study of people with type 2 diabetes. This study included a work group to develop standards of care and I got to attend the Cambridge Diabetes Epidemiology Seminar. I met Peter Bennett, who was leading the Pima Indian Study at the National Institutes for Health in the United States of America. He invited me to join his team for two years. It was a difficult decision. My wife and I had to leave tenured jobs and move to Phoenix, Arizona. But those two years have extended to 24 years. Spending time with the Pima Indians and studying the disease and the suffering it was causing was a defining experience for me. I sensed that what was happening in the Pima community could happen to the rest of the world. Q: And it did happen. As a cause of death, diabetes jumped from number 15 in 1990 to number nine in 2010. Which countries now have a high burden of type 2 diabetes and which are tackling this disease in the most effective way? A: Countries in the Middle East have a very high prevalence. The countries with the largest number of people with type 2 diabetes are China, India and the United States of America (USA). A major concern today is the increasing numbers of people with type 2 diabetes--not just in China and India--but also in other middle-income and low-income countries. The greatest success in the last 10 to 15 years has been in reducing deaths and complications in people with diabetes, such as heart attacks, stroke, amputations and kidney failure, particularly in Finland, the USA and other high-income countries. High-income countries now have effective tools for the control of blood glucose, blood pressure, lipids and screening for early complications and have done useful research to find ways to implement good quality of care. Q: So more people are living with type 2 diabetes than two decades ago? A: Yes, more people are surviving longer with the disease, but that means there are more and more people with costly complications. For example, diabetes is the leading contributor to the rise in inflation-adjusted health-care costs in the United States. Q: If it's so expensive to manage the disease and its complications, why isn't more done to prevent it? …