Characteristics of the pathophysiology of type 2 diabetes in Asians

Young Min Cho

Abstract

Asia is considered as the epicenter of recent worldwide epidemic of diabetes owing to its large population and high prevalence of diabetes. In Asia, type 1 diabetes is relatively rare in comparison with European countries. Therefore, the rapid increase in the prevalence of type 2 diabetes is the driving force of the epidemic. Interestingly, the phenotypes of Asian type 2 diabetes are distinct as compared by non-Asians, particularly Caucasians. Asian type 2 diabetes patients are generally non-obese, have a prominent impairment in insulin secretion and a better insulin sensitivity than non-Asians. Whereas incretin effect is remarkably reduced in European patients with type 2 diabetes, Asian patients with type 2 diabetes exhibited a similar incretin effect compared to non-diabetic subjects. Type 2 diabetes diagnosed by isolated postprandial hyperglycemia is more common in Asia than in Europe. Interestingly, glucose lowering efficacy is greater in Asians than in non-Asians. Genetic backgrounds in both nuclear and mitochondrial genome are different among ethnic groups, which may contribute to unique features of type 2 diabetes found in Asians. Considering the differences in pathophysiology and clinical features of Asian type 2 diabetes, we need to use different approach in diagnosis and management of type 2 diabetes including selecting patients eligible for bariatric/metabolic surgery.