The number of people who live with diabetes has been increasing worldwide over the last several decades, but there has been a significant jump in the number of people with diabetes — particularly type 2 diabetes — in Asia and China.

Currently, more than 60 percent of people with type 2 diabetes live in Asia, primarily in China and India.

There are many complicated factors that play a role in why diabetes diagnoses are increasing in this part of the world. Rapid industrialization and urbanization lead to lifestyle changes that factor into the increasing rate of diabetes in Asia.

Some reasons for this increase may include:

  • limited access to affordable and healthy foods in urban areas
  • changing preferences for certain types of foods
  • living a more sedentary lifestyle

China has the highest population of people living with type 2 diabetes, followed by India.

Numbers in other Asian countries are on the rise, too.

The number of people living with type 2 diabetes in Japan has increased significantly over the last two decades. In 2013, it was estimated that 7.2 million people were living with diabetes in Japan.

That trend has also been noted in other Western Pacific regions. People in American Samoa have one of the highest rates of diabetes, and in 2014, they were 2.8 times more likely to have diabetes than the white population.

Diabetes is most prevalent in lower income communities, where healthy food choices may be limited or unaffordable. Rates of people who have obesity are climbing in these areas.

The prevalence of people having overweight — considered a BMI of 25 and up — in China jumped from 14.6 percent to 21.8 percent between 1992 and 2002.

In 2016, Native Hawaiians and Pacific Islanders were 80 percent more likely to have obesity than non-Hispanic white people.

Asian Americans are 40 percent more likely to be diagnosed with diabetes than non-Hispanic whites. Asians are also more likely to develop diabetes at a lower BMI. According to the Centers for Disease Control and Prevention, this may be, in part, because many Asian Americans have less muscle and more visceral fat than other ethnic groups.

Visceral fat is internal fat that is wrapped around your internal organs. It can drive changes in the body that are associated with a higher risk for heart disease, stroke, and type 2 diabetes.

So why are these problems happening in Asian nations, specifically?

According to a number of organizations tracking the increased prevalence of diabetes in Asia, there are a number of lifestyle changes that are occurring and contributing to the growth of diabetes. These include:

  • increased urbanization, which has lead to less physical activity
  • higher rates of smoking
  • increased abdominal fat
  • increased insulin resistance
  • lower muscle mass
  • increased consumption of white rices and refined grains
  • increased fat intake
  • increased red meat consumption
  • more fast food intake
  • poor prenatal nutrition
  • higher levels of air pollution

Comparing a traditional Asian diet to a Western diet

Traditional Asian diets have some benefits and some risks for type 2 diabetes, compared to a Western diet.

Benefits include:

Risks include:

  • reliance on white rice and other refined carbohydrates
  • animal fat and palm oil
  • snacks high in salt, sugar, and trans fats
  • added sugar in tea and coffee

In addition, Western diet influences, such as fast food, are becoming more common in Asia as urbanization and modernization transform Asian countries.

Negative risks of Western diet include:

  • more red meat and processed meat
  • more refined carbohydrates
  • use of high fructose corn syrup and added sugar
  • fried foods
  • large portion sizes
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Diet and lifestyle changes are important for the management and treatment of diabetes in every country. However, first-line medications to treat diabetes differ in Asia.

In Western countries, metformin is the gold standard treatment for type 2 diabetes.

In Asia, medications like alpha-glucosidase inhibitors are more popular. They are particularly effective at lowering post-meal sugar spikes due to high carbohydrate intake and impaired insulin release. These medications, including acarbose and miglitol, have been found to work just as well as metformin. They may also help decrease risk for cardiovascular disease and high blood pressure.

Side effects like gas and diarrhea have led to decreased popularity of these medications in Western countries. About 2 percent of people in China stop these medications because of those side effects, compared to 61 percent in the United Kingdom.

The use of dipeptidyl peptidase 4 (DPP-4) inhibitors, which increase insulin production and help post-meal blood sugar spikes, are also more popular in Asian countries.

According to a 2015 review, DPP-4 inhibitors have been shown to help decrease HbA1c levels — a measurement of blood sugar over the course of 2 to 3 months — in Asians better than in non-Asians. They also seem to work better in people with lower BMIs.

Rates of diabetes in Asian countries have increased significantly over the last several decades. Diet and lifestyle trends play a big role, with many people in Asian nations adopting more Western eating practices.

Asian people may also have a higher risk of type 2 diabetes at lower BMIs due to less muscle mass and more visceral fat.

Lifestyle changes, medications, and education about type 2 diabetes are important in curbing this upward trend of diagnoses in Asian countries and around the world.