Prevalence and Analysis of Diabetes Associated Risk Factors in South Asia

Running head: DIABETES IN SOUTH ASIA
Prevalence and Analysis of Diabetes Associated Risk Factors in South Asia
Name of the Student
Name of the University
Author Note

DIABETES IN SOUTH ASIA1
Undertaken Literature Search
Process of literature search:
To explore the available literature and research studies conducted in the past, a search
protocol was followed to search for relevant studies in databases using their advanced search
option. The databases, which were considered for the search of literature included EMBASE,
Cochrane Central, OVID and MEDLINE. The Medical Subject Headings (MeSH) which
were most relevant to the current research, included ‘diabetes mellitus’ and diabetes. The
MeSH subheading term was fixed to ‘Epidemiology.’ However, in addition to these MeSH
terms, the search was performed with the help of keywords relevant to the research topic.
These keywords included diabetes, prevalence, incidence rate, morbidity, mortality, South
Asia, type-2 diabetes, risk factors, India, Bhutan, Nepal, Sri Lanka, Bangladesh, Pakistan and
Maldives. The use of Boolean operators was made in the advanced search options in the
medical databases for conjuncture of keywords to increase the relevancy of the search results
to the research topic [1]. Both the Boolean operators ‘OR’ & ‘AND’ were used to make the
search, where the operator ‘AND’ was used initially to increase the count of search results
from the database and the operator ‘OR’ was used to increase the relevancy of search results,
refine and narrow down the search results. The count of search results in different databases
was high, with 6257 results in Cochrane Central, 8074 results in EMBASE, 2482 in
MEDLINE, and 2776 in Ovid.
Article selection:
The selection of relevant articles and research studies were made in compliance with
eligibility criteria. The inclusion criteria included the publishing year of the research studies
to be between 2012 and 2020, the publishing language of the journal articles to be only in
English, the age of the chosen sample population to be adults over 18 years of age, and only

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the species of humans. Exclusion criteria stated that all studies concerned with the diabetes
prevalence in countries other than South Asian countries were excluded. The resulting pieces
of literature were screened by the analysis of the study title and abstract provided in the peer-
published journal article.
Background Literature Review
One of the major health concern globally is the increasing incidence rate of the
disease, diabetes mellitus. Diabetes mellitus is a health condition present globally and affects
individuals from all age groups. The leading indicator of diabetes in the human body is the
increase in the blood sugar levels, causing the condition of hyperglycaemia [2]. High glucose
levels in the blood are defined by the dissemination of the fasting plasma glucose in a sample
population, which is higher than the theoretical dissemination derived from epidemiological
studies that would critically minimize the risks to the health of the population. The
determined level for fasting blood glucose level is 7 mmol/L and levels higher than this
indicate the condition of hyperglycaemia [3]. In the human body, the hormone, insulin, is
known for regulating blood glucose levels and several types of diabetes have different
underlying causes for the increase in the blood glucose levels. The three primary types of
diabetes mellitus include type-1 diabetes, type-2 diabetes, and gestational diabetes [2]. In
type-1 diabetes, the insulin producing cells get destroyed, which disables the body’s
capability to regulate blood glucose level. Genetic susceptibility is thought to be the
underlying cause of type-1 diabetes mellitus. In type-2 diabetes, the cells become resistant to
insulin’s action and the pancreas is unable to meet the body’s insulin hormone demand,
leading to building up of glucose in the bloodstream. In type-2 diabetes mellitus,
environmental factors in addition to genetic susceptibility, are deemed to be the cause of
diabetes and being overweight is strongly linked to the condition of type-2 diabetes mellitus
[2]. In gestational diabetes, the female body is undergoing several hormonal changes required

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to sustain a pregnancy. This makes the cells more resistant to the hormone insulin, leading to
a rise in the glucose levels in the blood. Diabetes is a severe health condition and a life-long
disease, and with the steep increasing incidence rates, it has become one of the major health
conditions globally. According to the World Health Organization’s 2014 report [3], the global
diabetes prevalence mellitus in 2014 was 8.5%, accounting for over 422 million individuals
globally. The numbers have increased from the global diabetes prevalence at 4.7% in 1980,
that is, over 108 million individuals, indicating a drastic increase in the incidence and
prevalence rate of diabetes. It is one of the major underlying causes of death with over 1.6
million reported deaths in the year 2016 due to the health condition of diabetes [3].
Many of the past conducted literature indicated diabetes to be epidemic but limited to
only developed countries. However, the current global reports indicate the incidence of
diabetes to be the highest in low and middle income countries [4]. The burden of diabetes is
severe in South Asian countries, which include several low and middle income countries
including India, Maldives, Bhutan, Sri Lanka, Nepal, Bangladesh, Afghanistan and Pakistan
[5]. These South Asian countries contribute to over 24% of the world’s total population, with
over 1.8 billion people. Due to lifestyle and biological factors, predisposition to the
development of diabetes in the population from South Asian countries can be observed [6].
The incidence of type-2 diabetes in South Asian countries is six time higher than the
European countries, which is a strong indicator of the growing health concern of diabetes in
South Asian countries. In addition to this, the risk of developing cardiovascular diseases in
the population from South Asia is three times higher than that of the population from
European countries, increasing the health burden among the South Asian countries [5].
Genetic susceptibility is found to be one of the major causes in addition to lifestyle factors,
which makes the population more susceptible to type-2 diabetes mellitus. According to Shah
and Kanaya [7], India, with its second largest population in the world, is one of the major