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Diabetes has reached epidemic proportions in Asia and has dramatically increased the risk of premature death, especially among women and middle-aged people, a multinational study led by Vanderbilt University researchers has found.

There is an urgent need to implement diabetes management programs tailored to Asian populations, the researchers reported today in JAMA Network Open, a journal of the American Medical Association.

"We found that patients with diabetes are at a substantially elevated risk of premature death, and the risk associated with diabetes is much higher than that reported by most previous studies conducted in the United States and Europe," said the study's corresponding author, Wei Zheng, MD, MPH, Ph.D., director of the Vanderbilt Epidemiology Center.

China and India have the highest diabetes burdens in the world. Throughout Asia, more than 230 million people are living with diabetes. Given the increased prevalence of obesity and rapid adoption of a Westernized lifestyle in Asia, that figure is expected to exceed 355 million by 2040.

The Vanderbilt-led research team pooled 22 prospective cohort studies in multiple countries from mainland China to Bangladesh that participate in the Asia Cohort Consortium. More than 1 million individuals were followed for an average of 12.6 years.

The study, conducted by researchers from across Asia and the United States, is the largest prospective investigation of the impact of diabetes on all-cause and cause-specific mortality among Asian populations.

Diabetes was associated with a nearly twofold increase in the risk of death from all causes. The highest relative risk of death was due to diabetes itself, followed by kidney disease, coronary heart disease and ischemic stroke.

The diabetes-related risk of death from all causes was particularly high for women and patients who were diagnosed with diabetes when they were middle-aged adults. Surprisingly, the relative risk of death due to diabetes itself was much stronger among underweight people than among those who were overweight.

This result is particularly relevant for certain racial and ethnic groups in the United States, including Asian Americans, who are more susceptible to insulin resistance and are at higher risk of developing diabetes at a relatively lower obesity level than are people of European ancestry.

Whether this may increase their risk of premature death once they develop diabetes has not yet been determined, said Zheng, the Anne Potter Wilson Professor of Medicine in the Vanderbilt University School of Medicine.

Lack of access to diabetes care in Asia may contribute to the unusually higher risk of premature death among diabetes patients in the study, the researchers added.

Many Asian patients, especially women and underweight patients, may not be able to achieve good blood glucose control due to a lack of access to insulin and other anti-diabetic medications, health care services or education in managing their disease, they concluded.

This is also a problem in the United States. "Even in developed Western countries," the researchers said, "a substantial fraction of diabetes patients, particularly those from underserved populations, do not receive optimal care or adhere to recommended treatment."

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