With the spread of fast-food outlets and more sedentary lifestyles, the prevalence of diabetes in India is rising alarmingly. But the subpopulations at risk and the symptoms of the disease differ from those in the West.
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Diamond, J. Diabetes in India. Nature 469, 478–479 (2011). https://doi.org/10.1038/469478a
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DOI: https://doi.org/10.1038/469478a
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Tobacco use, an important risk factor for diabetes in India
In addition to the points raised by Jared Diamond, tobacco use should not be ignored when assessing the risk factors for diabetes in India and other Asian countries.
It is estimated that 131.6 million males smoked and 97.8 million men were oral (chewing) tobacco users in India in 2008, next to China's 311.2 million male tobacco users (American Cancer Society and World Lung Foundation. The Tobacco Atlas. www.tobaccoatlas.org). Numerous studies have shown that smoking and secondhand smoking are associated with significantly increased risks of diabetes. Moreover, the tobacco farmers who harvest and cure tobacco often report poor health, and pesticides used in tobacco farming can also cause diseases (Majra, J. P. & Gur, A. J Health Popul Nutr 27, 316-318 2009).
Eleven Asian countries are among the top 20 nations worldwide having more male tobacco users. Also, the percentage of male adults who are regular smokers is high in many Asian countries (American Cancer Society and World Lung Foundation. The Tobacco Atlas. www.tobaccoatlas.org). Therefore, effective tobacco control should be a public health priority for the prevention of diabetes epidemic in this continent. Unfortunately, this is already a reality in India and China. India has more than 50 million (age-adjusted prevalence, 8%) while China has 92.4 million people (9.7%) with diabetes today (Yang, W. et al. N Engl J Med 362, 1090-1101; 2010).