title: Type 2 diabetes in East Asians: similarities and differences with populations in Europe and the United States.
abstract: There is an epidemic of diabetes in Asia. Type 2 diabetes develops in East Asian patients at a lower mean body mass index (BMI) compared with those of European descent. At any given BMI, East Asians have a greater amount of body fat and a tendency to visceral adiposity. In Asian patients, diabetes develops at a younger age and is characterized by early β cell dysfunction in the setting of insulin resistance, with many requiring early insulin treatment. The increasing proportion of young-onset and childhood type 2 diabetes is posing a particular threat, with these patients being at increased risk of developing diabetic complications. East Asian patients with type 2 diabetes have a higher risk of developing renal complications than Europeans and, with regard to cardiovascular complications, a predisposition for developing strokes. In addition to cardiovascular-renal disease, cancer is emerging as the other main cause of mortality. While more research is needed to explain these interethnic differences, urgent and concerted actions are needed to raise awareness, facilitate early diagnosis, and encourage preventive strategies to combat these growing disease burdens.
authors.affiliation: Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, The Prince of Wales Hospital, Hong Kong, China. rcwma@cuhk.edu.hk
authors.forename: Ronald C W
authors.initials: RC
authors.lastname: Ma
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
mesh_terms: D000367:Age Factors; D044466:Asian People / Q000208:ethnology* / Q000235:genetics; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology / Q000235:genetics; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000208:ethnology* / Q000235:genetics; D005060:Europe / Q000208:ethnology; D005202:Asia, Eastern / Q000208:ethnology; D006801:Humans; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology* / Q000235:genetics
references.citation: Diabetes Care. 2009 Feb;32(2):335-41
references.pmid: 18957530
references.citation: JAMA. 2007 Jun 27;297(24):2716-24
references.pmid: 17595272
references.citation: Lancet. 2004 Jan 10;363(9403):157-63
references.pmid: 14726171
references.citation: Diabet Med. 2008 Apr;25(4):435-41
references.pmid: 18341596
references.citation: Diabetes Care. 2005 Aug;28(8):1876-81
references.pmid: 16043726
references.citation: Am J Epidemiol. 2008 Jun 1;167(11):1365-74
references.pmid: 18375949
references.citation: Ann N Y Acad Sci. 2010 Jul;1201:166-76
references.pmid: 20649553
references.citation: Diabetes. 2009 Feb;58(2):453-9
references.pmid: 19011170
references.citation: Value Health. 2009 Sep;12(6):923-9
references.pmid: 19824187
references.citation: BMJ. 2012 Mar 15;344:e1454
references.pmid: 22422870
references.citation: Diabetologia. 2001 Sep;44 Suppl 2:S82-6
references.pmid: 11587055
references.citation: N Engl J Med. 2011 Mar 03;364(9):829-841
references.pmid: 21366474
references.citation: Am J Epidemiol. 2008 Jun 15;167(12):1486-94
references.pmid: 18400769
references.citation: Diabetes Care. 2000 Sep;23(9):1353-8
references.pmid: 10977032
references.citation: Diabetes Res Clin Pract. 2012 Nov;98(2):226-35
references.pmid: 22658670
references.citation: Nat Genet. 2008 Sep;40(9):1092-7
references.pmid: 18711367
references.citation: Diabetes Res Clin Pract. 2008 Sep;81(3):370-6
references.pmid: 18649967
references.citation: Lancet. 2010 Jun 12;375(9731):2073-81
references.pmid: 20483451
references.citation: Diabetes Care. 2012 Jan;35 Suppl 1:S64-71
references.pmid: 22187472
references.citation: Diabetologia. 2001 Sep;44 Suppl 2:S78-81
references.pmid: 11587054
references.citation: Am J Clin Nutr. 2005 Mar;81(3):555-63
references.pmid: 15755822
references.citation: Diabetes Care. 2011 Aug;34(8):1741-8
references.pmid: 21680722
references.citation: PLoS One. 2011;6(12):e28311
references.pmid: 22164267
references.citation: Nat Genet. 2012 Sep;44(9):981-90
references.pmid: 22885922
references.citation: Diabetes Care. 2007 Oct;30(10):2667-72
references.pmid: 17620449
references.citation: Clin Drug Investig. 2007;27(6):397-405
references.pmid: 17506590
references.citation: Diabetes Care. 2008 Dec;31(12):2357-61
references.pmid: 18835954
references.citation: Diabetes Care. 2006 May;29(5):1130-9
references.pmid: 16644654
references.citation: Diabetes. 1995 Aug;44(8):863-70
references.pmid: 7621989
references.citation: Diabetes Care. 2003 Feb;26(2):290-6
references.pmid: 12547851
references.citation: Diabetes Res Clin Pract. 2008 Aug;81(2):250-7
references.pmid: 18495287
references.citation: Sleep Med. 2012 Mar;13(3):307-9
references.pmid: 22305609
references.citation: J Telemed Telecare. 2009;15(2):77-82
references.pmid: 19246607
references.citation: Circulation. 2005 Aug 2;112(5):658-65
references.pmid: 16043645
references.citation: Int J Obes (Lond). 2007 Feb;31(2):254-60
references.pmid: 16718283
references.citation: Diabetes Care. 2008 May;31(5):899-904
references.pmid: 18223030
references.citation: Pediatrics. 2008 Dec;122(6):1229-34
references.pmid: 19047239
references.citation: JAMA. 2010 Aug 11;304(6):649-56
references.pmid: 20699456
references.citation: Lancet. 2012 Mar 3;379(9818):779-80
references.pmid: 22386013
references.citation: BMJ. 1998 Mar 14;316(7134):823-8
references.pmid: 9549452
references.citation: Diabetes Metab Res Rev. 2002 Sep-Oct;18 Suppl 3:S9-13
references.pmid: 12324979
references.citation: N Engl J Med. 2010 Dec 9;363(24):2339-50
references.pmid: 21142536
references.citation: Int J Gynaecol Obstet. 2009 Mar;104 Suppl 1:S42-5
references.pmid: 19150059
references.citation: N Engl J Med. 2005 Sep 15;353(11):1124-34
references.pmid: 16162883
references.citation: Kidney Int. 2006 Jun;69(11):2057-63
references.pmid: 16612330
references.citation: Diabet Med. 2007 Apr;24(4):333-43
references.pmid: 17367307
references.citation: Diabetes Res Clin Pract. 2008 Jul;81(1):2-12
references.pmid: 18544448
references.citation: Am J Epidemiol. 2004 Jun 15;159(12):1150-9
references.pmid: 15191932
references.citation: N Engl J Med. 2008 Jul 3;359(1):61-73
references.pmid: 18596274
references.citation: JAMA. 2003 Sep 10;290(10):1345-50
references.pmid: 12966126
references.citation: Diabetes Res Clin Pract. 2003 Jan;59(1):71-7
references.pmid: 12482644
references.citation: Diabetes Res Clin Pract. 1998 Mar;39(3):185-91
references.pmid: 9649950
references.citation: Diabetes Res Clin Pract. 2009 Jan;83(1):106-16
references.pmid: 19097665
references.citation: Diabetes Care. 2002 Oct;25(10):1862-8
references.pmid: 12351492
references.citation: Diabetes Res Clin Pract. 2009 Feb;83(2):233-40
references.pmid: 19118913
references.citation: Diabet Med. 2004 Apr;21(4):349-53
references.pmid: 15049937
references.citation: Endocr Relat Cancer. 2008 Jun;15(2):597-607
references.pmid: 18509007
references.citation: Pediatr Res. 2007 May;61(5 Pt 2):5R-10R
references.pmid: 17413851
references.citation: Diabetologia. 2008 Oct;51(10):1781-9
references.pmid: 18726585
references.citation: Nat Genet. 2011 Dec 11;44(1):67-72
references.pmid: 22158537
references.citation: Diabetes. 2000 Dec;49(12):2208-11
references.pmid: 11118027
references.citation: Am J Clin Nutr. 2002 Jul;76(1):5-56
references.pmid: 12081815
references.citation: Diabetologia. 2001 Sep;44 Suppl 2:S3-13
references.pmid: 11587047
references.citation: J Am Coll Cardiol. 2008 May 27;51(21):2045-50
references.pmid: 18498959
references.citation: JAMA. 2002 May 15;287(19):2519-27
references.pmid: 12020332
references.citation: Nature. 2009 Dec 17;462(7275):868-74
references.pmid: 20016592
references.citation: Diabetes Care. 2010 Nov;33(11):2396-8
references.pmid: 20693350
references.citation: Curr Cardiovasc Risk Rep. 2011 Jun;5(3):230-239
references.pmid: 21654912
references.citation: Diabetes Care. 2012 Jul;35(7):1492-8
references.pmid: 22619080
references.citation: Diabetes. 1998 Apr;47(4):640-5
references.pmid: 9568698
references.citation: Eur Heart J. 2009 Dec;30(24):3055-63
references.pmid: 19778928
references.citation: Exp Clin Endocrinol Diabetes. 2012 Apr;120(4):217-23
references.pmid: 22187293
references.citation: Diabetes Care. 2007 Oct;30(10):2453-7
references.pmid: 17536077
references.citation: Annu Rev Genet. 2005;39:359-407
references.pmid: 16285865
references.citation: JAMA. 2004 Jun 2;291(21):2591-9
references.pmid: 15173150
references.citation: Diabetes. 2003 Nov;52(11):2759-66
references.pmid: 14578294
references.citation: Diabetes Res Clin Pract. 2000 Oct;50 Suppl 2:S73-6
references.pmid: 11024587
references.citation: Diabetes Care. 1991 Nov;14(11):968-74
references.pmid: 1797510
references.citation: Prev Chronic Dis. 2005 Apr;2(2):A19
references.pmid: 15888230
references.citation: Diabetes Res Clin Pract. 2008 Nov 13;82 Suppl 1:S15-20
references.pmid: 18952313
references.citation: Diabetes Res Clin Pract. 2012 Feb;95(2):179-88
references.pmid: 22019271
references.citation: Trends Endocrinol Metab. 2000 Oct;11(8):327-32
references.pmid: 10996528
references.citation: Diabetes Care. 2007 Jun;30(6):1544-8
references.pmid: 17384342
references.citation: Nat Rev Endocrinol. 2010 Oct;6(10):589-93
references.pmid: 20680035
references.citation: Diabetes. 2006 Aug;55(8):2379-86
references.pmid: 16873704
references.citation: J Diabetes. 2011 Jun;3(2):109-18
references.pmid: 21599865
references.citation: Sleep Med. 2011 Aug;12(7):659-65
references.pmid: 21689984
references.citation: Lancet. 1991 Feb 16;337(8738):382-6
references.pmid: 1671422
references.citation: Diabet Med. 2009 Jul;26(7):693-9
references.pmid: 19573118
references.citation: Diabetes Care. 1998 Dec;21(12):2094-7
references.pmid: 9839099
references.citation: Minerva Med. 2010 Apr;101(2):115-9
references.pmid: 20467410
references.citation: Diabetologia. 2006 Aug;49(8):1777-84
references.pmid: 16736132
references.citation: Kidney Int. 2003 Jan;63(1):225-32
references.pmid: 12472787
references.citation: Diabetes Res Clin Pract. 2008 Dec;82(3):346-52
references.pmid: 18926583
references.citation: Ophthalmology. 2009 Mar;116(3):461-7
references.pmid: 19168222
references.citation: Diabetes Care. 2008 Nov;31(11):2126-30
references.pmid: 18694977
references.citation: Diabetes Care. 2001 Apr;24(4):663-71
references.pmid: 11315828
references.citation: PLoS Med. 2010 Feb 23;7(2):e1000236
references.pmid: 20186272
references.citation: Diabetes Res Clin Pract. 1995 Jun;28(3):191-9
references.pmid: 8529498
references.citation: Int J Obes Relat Metab Disord. 2001 May;25(5):748-52
references.pmid: 11360160
references.citation: Obes Rev. 2007 May;8(3):191-6
references.pmid: 17444961
references.citation: J Clin Endocrinol Metab. 2003 May;88(5):2300-8
references.pmid: 12727989
references.citation: Diabetes. 2008 May;57(5):1269-75
references.pmid: 18299316
references.citation: Acta Diabetol. 2013 Apr;50(2):129-34
references.pmid: 20953640
references.citation: Diabetes Care. 2004 Apr;27(4):874-9
references.pmid: 15047641
references.citation: Public Health Nutr. 2002 Feb;5(1A):169-74
references.pmid: 12027281
references.citation: Am J Cardiol. 2008 Mar 1;101(5):596-601
references.pmid: 18308005
references.citation: J Affect Disord. 2012 Oct;142 Suppl:S56-66
references.pmid: 23062858
references.citation: Nephrol Dial Transplant. 2012 May;27(5):1840-6
references.pmid: 21917731
references.citation: Diabetes Care. 2000 Jan;23(1):127-8
references.pmid: 10857985
references.citation: Diabetes Res Clin Pract. 2006 Aug;73(2):126-34
references.pmid: 16563548
references.citation: Diabetes Care. 2007 Jun;30(6):1430-6
references.pmid: 17337491
references.citation: Hum Mol Genet. 2012 Jul 1;21(13):3042-9
references.pmid: 22456796
references.citation: Diabetes Metab Res Rev. 2006 Jan-Feb;22(1):46-52
references.pmid: 16021651
references.citation: Diabetes Care. 2012 Mar;35(3):520-5
references.pmid: 22279028
references.citation: Int J Obes Relat Metab Disord. 1999 Nov;23(11):1136-42
references.pmid: 10578203
references.citation: Diabetes. 1988 May;37(5):622-8
references.pmid: 3360218
references.citation: Diabetes Care. 2004 Feb;27(2):354-61
references.pmid: 14747213
references.citation: Diabetologia. 2000 Dec;43(12):1470-5
references.pmid: 11151755
references.citation: Lancet. 2006 Nov 11;368(9548):1681-8
references.pmid: 17098087
references.citation: J Clin Endocrinol Metab. 2001 Apr;86(4):1620-5
references.pmid: 11297594
references.citation: Am J Clin Nutr. 2007 Aug;86(2):353-9
references.pmid: 17684205
references.citation: Diabetes Res Clin Pract. 2002 May;56(2):125-31
references.pmid: 11891020
references.citation: Diabetes. 2004 Dec;53(12):3193-200
references.pmid: 15561950
references.citation: BMC Public Health. 2012 Nov 23;12:1025
references.pmid: 23176627
references.citation: Diabetes Care. 2009 Jun;32(6):977-82
references.pmid: 19460913
references.citation: J Am Soc Nephrol. 2005 Jan;16(1):219-28
references.pmid: 15563572
references.citation: Diabetes. 1990 Jan;39(1):104-11
references.pmid: 2210052
references.citation: Diabetes Care. 2009 Feb;32(2):227-33
references.pmid: 19033410
references.citation: Lancet. 2008 May 24;371(9626):1753-60
references.pmid: 18502299
references.citation: J Am Coll Cardiol. 2008 May 27;51(21):2040-4
references.pmid: 18498958
references.citation: JAMA. 2005 Jan 12;293(2):194-202
references.pmid: 15644546
references.citation: Diabetes Res Clin Pract. 2006 Aug;73(2):198-204
references.pmid: 16621117
references.citation: Diabetes Care. 2003 Nov;26(11):3011-6
references.pmid: 14578232
references.citation: Nat Rev Endocrinol. 2011 Nov 08;8(4):228-36
references.pmid: 22064493
references.citation: Endocr J. 2010;57(10):931-8
references.pmid: 20724797
references.citation: Diabetes Care. 2004 Nov;27(11):2597-602
references.pmid: 15504992
references.citation: Diabetes Care. 2012 May;35(5):1150-7
references.pmid: 22338107
references.citation: Diabetes. 2010 Oct;59(10):2400-6
references.pmid: 20622161
references.citation: Diabetes Care. 2000 Apr;23(4):465-71
references.pmid: 10857936
references.citation: J Formos Med Assoc. 2012 Nov;111(11):599-604
references.pmid: 23217595
references.citation: Obes Rev. 2008 Mar;9 Suppl 1:53-61
references.pmid: 18307700
references.citation: Lancet. 2010 Jan 30;375(9712):408-18
references.pmid: 19875164
references.citation: Diabetes Care. 2006 Sep;29(9):2046-52
references.pmid: 16936151
references.citation: CMAJ. 2008 Aug 26;179(5):427-37
references.pmid: 18725615
references.citation: Endocr Rev. 2008 May;29(3):303-16
references.pmid: 18314421
references.citation: Diabetes Care. 2012 Jun;35(6):1364-79
references.pmid: 22517736
references.citation: Curr Med Res Opin. 2010 May;26(5):1013-22
references.pmid: 20199137
references.citation: N Engl J Med. 2010 Mar 25;362(12):1090-101
references.pmid: 20335585
references.citation: Diabetologia. 2005 Jan;48(1):17-26
references.pmid: 15616801
references.citation: Nat Genet. 2010 Jul;42(7):579-89
references.pmid: 20581827
references.citation: Br J Nutr. 2008 Apr;99(4):840-5
references.pmid: 17903341
references.citation: JAMA. 2009 May 27;301(20):2129-40
references.pmid: 19470990
references.citation: Diabet Med. 2012 Mar;29(3):366-71
references.pmid: 21913963
references.citation: Trop Med Int Health. 2010 Jun;15(6):659-63
references.pmid: 20406430
references.citation: Diabetologia. 2003 Sep;46(9):1190-8
references.pmid: 12879248
references.citation: J Korean Med Sci. 2011 Aug;26(8):1068-73
references.pmid: 21860558
references.citation: Diabetes Care. 2008 Jan;31(1):93-5
references.pmid: 17914029
references.citation: Diabetes Care. 1996 Mar;19(3):241-5
references.pmid: 8742569
references.citation: Pediatrics. 2005 Mar;115(3):e290-6
references.pmid: 15741354
references.citation: Diabetes Res Clin Pract. 2000 Oct;50 Suppl 2:S49-59
references.pmid: 11024584
references.citation: Diabetes Care. 2012 Nov;35(11):2226-34
references.pmid: 22833490
references.citation: Diabetes. 2008 Aug;57(8):2226-33
references.pmid: 18469204
references.citation: Diabetes. 2011 Jul;60(7):1849-55
references.pmid: 21709280
references.citation: Diabetes Res Clin Pract. 2009 Nov;86(2):89-95
references.pmid: 19747747
references.citation: Diabetologia. 2008 Apr;51(4):602-8
references.pmid: 18251004
references.citation: Diabetes Care. 2006 Dec;29(12):2625-31
references.pmid: 17130195
references.citation: Diabetes Care. 2011 Apr;34(4):930-7
references.pmid: 21350114
references.citation: J Diabetes Investig. 2012 Feb 20;3(1):24-33
references.pmid: 24843541
references.citation: Lancet. 2012 Jun 16;379(9833):2252-61
references.pmid: 22683130
references.citation: Nat Rev Endocrinol. 2009 May;5(5):253-61
references.pmid: 19444258
references.citation: Diabet Med. 2011 Jun;28(6):652-7
references.pmid: 21569085
references.citation: Lancet. 2003 May 31;361(9372):1861-5
references.pmid: 12788573
references.citation: Diabetologia. 2007 Feb;50(2):286-92
references.pmid: 17180353
references.citation: Diabetes Care. 2003 Mar;26(3):650-5
references.pmid: 12610016
references.citation: Curr Diab Rep. 2008 Jun;8(3):173-8
references.pmid: 18625112
references.citation: Diabetes Care. 2010 Jun;33(6):1382-4
references.pmid: 20215448
references.citation: Clin Ther. 2007 Feb;29(2):316-25
references.pmid: 17472823
references.citation: Diabetes Care. 2000 May;23(5):710-2
references.pmid: 10834441
references.citation: Diabetes Res Clin Pract. 1996 Aug;33(3):173-9
references.pmid: 8922539
references.citation: Ann Clin Biochem. 1998 Nov;35 ( Pt 6):761-7
references.pmid: 9838990
references.citation: Obes Rev. 2002 Aug;3(3):141-6
references.pmid: 12164465
references.citation: Diabetes Res Clin Pract. 2008 May;80(2):224-30
references.pmid: 18207602
references.citation: Diabetes Res Clin Pract. 2011 Aug;93(2):220-227
references.pmid: 21612838
references.citation: Diabetologia. 2003 Jan;46(1):3-19
references.pmid: 12637977
references.citation: Health Qual Life Outcomes. 2010 Jun 26;8:62
references.pmid: 20579389
references.citation: Diabetes Care. 2003 Feb;26(2):372-9
references.pmid: 12547865
references.citation: Diabetes Res Clin Pract. 2009 Nov;86(2):e34-6
references.pmid: 19631400
references.citation: Metabolism. 2004 Jul;53(7):831-5
references.pmid: 15254872
references.citation: Ophthalmology. 2008 Nov;115(11):1869-75
references.pmid: 18584872
references.citation: Am J Epidemiol. 2010 May 15;171(10):1079-89
references.pmid: 20421221
references.citation: BMJ. 2010 May 17;340:c2249
references.pmid: 20478961
references.citation: Sleep Med Rev. 2010 Dec;14(6):371-8
references.pmid: 20207558
references.citation: PLoS Genet. 2010 Feb 19;6(2):e1000847
references.pmid: 20174558
references.citation: J Diabetes Investig. 2012 Jun 1;3(3):212-224
references.pmid: 22798980
references.citation: Invest Ophthalmol Vis Sci. 2006 Jun;47(6):2341-50
references.pmid: 16723443
references.citation: Diabetes Care. 2009 Apr;32(4):741-50
references.pmid: 19131466
references.citation: Diabetes Res Clin Pract. 2006 Feb;71(2):146-55
references.pmid: 16005097
references.citation: PLoS One. 2011;6(6):e19930
references.pmid: 21731609
references.citation: Am J Clin Nutr. 2010 Dec;92(6):1468-77
references.pmid: 20980490
references.citation: J Telemed Telecare. 2011;17(7):365-70
references.pmid: 21933896
references.citation: Lancet. 2005 Apr 16-22;365(9468):1398-405
references.pmid: 15836888
references.citation: Diabetes Care. 2003 Jan;26(1):61-9
references.pmid: 12502659
references.citation: Int J Obes Relat Metab Disord. 1998 Dec;22(12):1164-71
references.pmid: 9877251
references.citation: Int J Obes (Lond). 2010 Feb;34(2):332-9
references.pmid: 19884891
references.citation: Dev Disabil Res Rev. 2010;16(2):114-9
references.pmid: 20818725
references.citation: Diabetes Care. 2007 Jul;30 Suppl 2:S141-6
references.pmid: 17596462
references.citation: Diabetes Care. 2003 Jun;26(6):1770-80
references.pmid: 12766108
references.citation: Ann Intern Med. 2000 Aug 1;133(3):183-91
references.pmid: 10906832
references.citation: Lancet. 1993 Apr 10;341(8850):938-41
references.pmid: 8096277
references.citation: Diabetes Care. 2003 Feb;26(2):360-6
references.pmid: 12547863
references.citation: Arch Intern Med. 2007 Nov 26;167(21):2310-6
references.pmid: 18039989
references.citation: Nat Rev Endocrinol. 2009 Jul;5(7):401-8
references.pmid: 19488075
references.citation: Diabetes Res Clin Pract. 2005 Oct;70(1):46-52
references.pmid: 16126123
references.citation: Diabetes. 2003 Jan;52(1):102-10
references.pmid: 12502499
references.citation: Endocr Pract. 2009 Sep-Oct;15(6):540-59
references.pmid: 19858063
references.citation: Nutr Rev. 2001 Dec;59(12):379-90
references.pmid: 11766908
references.citation: Lancet. 1997 Nov 1;350(9087):1288-93
references.pmid: 9357409
references.citation: Diabetes Care. 1998 Aug;21(8):1221-5
references.pmid: 9702423