The prevalence of diabetes is much higher in South Asians than the general population. South Asians are at least 3-5 times increased risk of developing diabetes as compared to Caucasians. The prevalence of diabetes in South Asians in the UK, USA, and Canada is as high as 12-15% as compared to 3-5 % in Europeans. There is also an increased risk of diabetes in South Asians children and adolescents. According to several reports, diabetes tends to develop about ten years younger in South Asians as compared to Europeans. Despite the increased prevalence of diabetes among South Asians, the majority of the cases remain undiagnosed and poorly controlled. Several studies have shown that many South Asians present with diabetic complications at the time of their diagnosis, indicating the prolonged latent phase of undiagnosed diabetes. Therefore, we should start screening high risk South Asian ethnic population at a younger age than the currently recommended 40 years of age by the diabetes guidelines. Early diagnosis and treatment in more youthful people should prevent or delay the onset of complications related to diabetes.
Suboptimal treatment of diabetes in South Asians may be due to several barriers including lack of knowledge about diabetes, negative beliefs and attitudes towards diabetes and non-compliance of lifestyle changes such as diet, weight control and physical activity, all of which are compounded by a lack of culturally sensitive and ethnic language-specific diabetic education centers in Canada. Treatment of diabetes should follow the current Clinical Practice Guidelines of the Canadian Diabetes Association (CDA) now called Diabetes Canada (DC). Diabetes affects the whole body from head to toe and requires comprehensive care. Patients with diabetes should have excellent control of diabetes and associated risk factors. Due to the high cardiovascular mortality in patients with diabetes; early and aggressive vascular protection and simultaneous management of all the cardiovascular risk factors is recommended by excellent control of hypertension (high BP) and dyslipidemia (high cholesterol) in addition to diabetes.
ABC of diabetes
Since diabetes is such a complicated chronic disease affecting multiple organ systems, it is difficult for a patient to remember all the points of care and get comprehensive care continuingly. Therefore, a simple tool (ABC) is recommended for the management of diabetes.
A stands for glycated hemoglobin (A1C), the target should be <7.0 in most individuals and should be monitored at least every 3-6 months or earlier as indicated. A1C is a measure of glycemic control over the past about three months.
B stands for blood pressure; the target should be < 130/80. B also reminds for ‘blood glucose’ monitoring for the patient with pre-prandial (before meals) target 4-7 mmol/L and postprandial (after meals) target 5-10 mmol/L.
C stands for cholesterol, LDL (low-density lipoprotein) target should be <2.0. C also reminds for assessment of ‘cardiovascular risk.’ Newer drugs such as sodium glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like protein-1 (GLP-1) receptor agonists should be considered in patients with diabetes and established ‘cardiovascular disease’ based upon the recent cardiovascular outcome trials. BC Pharmacare just recently approved one of these newer agents called Empagliflozin (brand names Jardiance/Synjardy)
D stands for ‘diet’ and ‘drugs,’ the patient should be compliant with diabetic diet and drugs.
E stands for exercise. Lifestyle interventions, including regular physical activity (150 minutes/week), healthy diet and weight, are crucial for the prevention and management of diabetes. E reminds for annual ‘eye’ examination.
Summary: South Asians patients should be screened for diabetes at a relatively younger age and more frequently than the general population with appropriate prevention efforts starting in childhood and adolescence. South Asians should be aggressively managed for cardiovascular risk factors due to their high mortality rates from cardiovascular disease. A structured culturally and linguistically relevant program of lifestyle modifications that includes a healthy diet, weight control, and regular exercise should be implemented to reduce the risk and burden of type 2 diabetes in South Asians. Improvements in the primary prevention and aggressive management of diabetes are required to reduce the global burden of diabetes and its associated complications.
Disclaimer: This article provides a brief overview of diabetes. You should talk to your doctor for further details, particularly the pros/cons of various drugs available for the management of diabetes.
Dr. P.S. Sohal MD, Ph.D., CCFP, FCFP & T. K. Sohal MPH at Surrey Medical & Travel Clinic 102, 15420 Fraser Highway, Surrey, BC. Dr. Sohal is a Clinical Professor in the Department of Family Practice at the University of British Columbia, Vancouver.