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Why are South Asians prone to type 2 diabetes? A hypothesis based on underexplored pathways – published online 31/03/2020

K. M. Venkat Narayan, Alka M. Kanaya

People of South Asian ancestry, who total nearly 2 billion worldwide, are at heightened risk of type 2 diabetes, even at low body weights. Challenging the idea that this high risk for type 2 diabetes is primarily due to the population’s susceptibility to adiposity-driven insulin resistance, Narayan and Kanaya (https://doi.org/10.1007/s00125-020-05132-5) offer a novel hypothesis using data on underexplored pathways. Based on evidence from evolutionary biology and recent epidemiological data, the authors state that, compared with other ethnic groups, South Asians have evolutionarily acquired impaired insulin secretion resulting from compromised beta cell function, as well as impaired insulin action due to low lean-muscle mass.  These features lower the population’s metabolic capacity, and the reduced insulin action is further accentuated by increased fat deposition in the liver and muscle in response to lifestyle factors. Thus, the authors conclude that investigating the reasons for impaired insulin secretion in South Asians, and approaches to improve beta cell insulin secretion, insulin action in the muscle and hepatic fat deposition, are warranted. They suggest that lessons learnt from studying South Asians may be generalisable to other populations residing in or originating from low- and middle-income countries. The figure from this review is available as a downloadable slide.

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