Too little action and too late

The south Asian diaspora in the United Kingdom comprises Indians (predominantly Gujaratis and Punjabis), Sri Lankans, Pakistanis, and Bangladeshis. A dramatic increase in the prevalence of type 2 diabetes in south Asians is observed in many parts of the world including the United Kingdom.1 While marked cultural and social differences arise within this racial group, south Asians have the unenviable distinction of achieving the highest death rates of coronary heart disease in the United Kingdom,2 with Bangladeshis being particularly disadvantaged.3 Much of this excess risk may be attributed to the increased risk of type 2 diabetes (four times that of Europeans), which develops about 10 years earlier than in Europeans,4 and renal and cardiac complications are encountered more commonly.5

Although genetic factors are important, the increased incidence of type 2 diabetes is strongly associated with increasing central (intra-abdominal) obesity and hyperinsulinaemia.6 South Asians seem to be more insulin resistant, even at an early age.7 The relation between obesity and insulin resistance may occur at lower levels of …