Cited by 1,954Diabetes, Cardiovascular Risks, and LipoproteinsObesity, Physical Activity, DietAdipokines, Inflammation, and Metabolic Diseases

The DOI matches its Crossref record, with a small difference in title or year; 64 of the 64 references it cites were found in a registry or an index; none of the 37 sources its claims cite is checked for support yet.

Globalization of Diabetes

Open access
Hu, Frank B.·2011·Diabetes Care

Abstract

Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Fueled by rapid urbanization, nutrition transition, and increasingly sedentary lifestyles, the epidemic has grown in parallel with the worldwide rise in obesity. Asia's large population and rapid economic development have made it an epicenter of the epidemic. Asian populations tend to develop diabetes at younger ages and lower BMI levels than Caucasians. Several factors contribute to accelerated diabetes epidemic in Asians, including the “normal-weight metabolically obese” phenotype; high prevalence of smoking and heavy alcohol use; high intake of refined carbohydrates (e.g., white rice); and dramatically decreased physical activity levels. Poor nutrition in utero and in early life combined with overnutrition in later life may also play a role in Asia's diabetes epidemic. Recent advances in genome-wide association studies have contributed substantially to our understanding of diabetes pathophysiology, but currently identified genetic loci are insufficient to explain ethnic differences in diabetes risk. Nonetheless, interactions between Westernized diet and lifestyle and genetic background may accelerate the growth of diabetes in the context of rapid nutrition transition. Epidemiologic studies and randomized clinical trials show that type 2 diabetes is largely preventable through diet and lifestyle modifications. Translating these findings into practice, however, requires fundamental changes in public policies, the food and built environments, and health systems. To curb the escalating diabetes epidemic, primary prevention through promotion of a healthy diet and lifestyle should be a global public policy priority.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that type 2 diabetes has become a global epidemic driven by urbanization, nutrition transition, and sedentary lifestyles, with Asia now the epicenter because Asian populations develop diabetes at younger ages and lower BMI levels than Caucasians. It concludes that most cases are preventable through diet and lifestyle change, but that this requires public policy shifts in food, built, and social environments.

Key findings

  • Global burden: diabetes affects at least 285 million people worldwide, projected to reach 438 million by 2030, with two-thirds of cases in low- to middle-income countries; impaired glucose tolerance is expected to rise from 344 million (2010) to 472 million (2030). Diabetes accounted for 12% of health expenditures in 2010 (~$376 billion), projected at $490 billion by 2030.
  • Asia accounts for 60% of the world's diabetic population; Chinese adult diabetes prevalence rose from <1% in 1980 to nearly 10% by 2008 (>92 million diabetic, 148 million prediabetic), while urban south India reached nearly 20%.
  • Diet: a 2 serving/day increment in whole-grain intake was associated with 21% lower diabetes risk; highest SSB intake (1–2 servings/day) carried a 26% greater risk (RR 1.26 [95% CI 1.12–1.41]); white rice intake in the Shanghai Women's Health Study showed RR 1.78 (95% CI 1.48–2.15) comparing extreme quintiles.
  • Lifestyle: in the NHS, women in a low-risk group (BMI <25, healthy diet, ≥30 min/day activity, no smoking, ≥half-serving alcohol/day) had RR 0.09 (95% CI 0.05–0.17), with 91% of cases (95% CI 83–95%) attributable to the five factors; trials reduced incidence by 31–58% (Daqing 31/46/42% for diet/exercise/combined; Finnish DPS and U.S. DPP 58%; IDPP 28.5% lifestyle).

Methods

Narrative review synthesizing global burden data (International Diabetes Federation estimates), population-based cross-sectional surveys (e.g., Chinese National Nutrition Survey, Shanghai Women's Health Study), prospective cohorts (Nurses' Health Study, NHS II, Health Professionals' Follow-up Study), meta-analyses, genome-wide association studies, and randomized prevention trials (Daqing, Finnish DPS, U.S. DPP, IDPP). Includes a reduced rank regression analysis in a nested case-control sample of 656 diabetes cases and 694 controls, and a gene–diet interaction analysis using a 10-SNP genetic risk score.

Limitations

The paper is a review and states no formal limitations of its own. Evident from the text: much of the mechanistic and gene–environment evidence comes from a small number of cohorts (largely NHS and U.S. male health professionals), limiting generalizability to Asian and other populations; the author notes that identified genetic loci are insufficient to explain ethnic differences or the rapid rise in prevalence and have limited clinical predictive utility; the thrifty genotype hypothesis is described as lacking identified genes and receiving little support from preliminary analyses, and famine-exposure findings are inconsistent across cohorts (Dutch Famine vs. Leningrad Siege).

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Integrity signals

Registry

Crossref · 10.2337/dc11-0442

Cites

64 of 64 references verified0 citation errors · 0 not checkable

Statistics

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Verification

Claims the paper makes

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Show all 55 claims

  • It may state two separate claims as one. 17
  • Probably not a substantial claim. 5
20 of 20
  • The paper relies on this without support.

    The Western dietary pattern derived from principal component analysis of 40 food groups adequately represents the dietary exposure relevant to type 2 diabetes risk.

    “a Western dietary pattern derived from principle component analysis of 40 food groups”
    “intake of processed meat, red meat, and heme iron, which characterize the Western dietary pattern”
  • The paper relies on this without support.

    The genetic risk score based on 10 established single nucleotide polymorphisms adequately captures genetic susceptibility to type 2 diabetes.

    “a genetic risk score (GRS) of type 2 diabetes susceptibility based on 10 established single nucleotide polymorphisms”
  • The paper relies on this without support.

    The five low-risk variables (BMI, diet, physical activity, smoking, alcohol) are causally related to diabetes risk and their combined effect can be estimated from observational data.

    “we defined a low-risk group according to five variables: 1) BMI <25; 2) a diet high in cereal fiber and polyunsaturated fat and low in trans fat and GL; 3) moderate-to-vigorous physical activity for at least half an hour/day; 4) no current smoking; and 5) an average intake of at least a half-serving of an alcoholic beverage/day.”
  • The paper relies on this without support.

    The Chinese National Nutrition and Health Survey data accurately classify famine exposure and hyperglycemia.

    “we examined the association between famine exposure in fetal life and adult hyperglycemia in the Chinese National Nutrition and Health Survey (57).”
  • The paper relies on this without support.

    The currently identified genetic susceptibility loci are representative of overall genetic susceptibility to type 2 diabetes.

    “the currently identified genetic susceptibility loci”
5 of 5

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Citations

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  1. Yang, 2011, Tobacco control necessary, China Daily

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Metadata

Authors
Hu, F. B.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Hu, Frank B.
Venue
Diabetes Care
Published
2011-05-20
Volume
34
Issue
6
Pages
1249-1257
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
OpenAlex
W2045362322
Cited by
1,954
References
64
Citations by year
2026: 81 · 2025: 91 · 2024: 145 · 2023: 109 · 2022: 129 · 2021: 152 · 2020: 142 · 2019: 133 · 2018: 141 · 2017: 164 · 2016: 187 · 2015: 158 · 2014: 150 · 2013: 97 · 2012: 65
FWCI
83.85
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Diabetes Care (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • American Diabetes Association
  • National Institutes of Health
  • National Heart, Lung, and Blood Institute (HL60712, R01HL060712)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK058845, DK58845)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
Keywords
type 2 diabetes, diabetes epidemic, Asia, nutrition transition, obesity, smoking, alcohol consumption, white rice consumption, physical inactivity, in utero nutrition, genetic susceptibility, Western diet, lifestyle modification, diabetes prevention, public health policy, built environment, health care system
MeSH terms
Adult, Alcohol Drinking, Asia, Developing Countries, Diabetes Mellitus, Type 2, Diet, Dietary Carbohydrates, Health Promotion, Humans, Inflammation, Insulin Resistance, Life Style, Motor Activity, Smoking, Exercise, Prevalence, Genetic Predisposition to Disease, Asian People, Genetic Association Studies

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