We are in the midst of a global race toward development. As a consequence, we see a consequent shift in cultural norms: the symptoms of Western society are spreading to impact the rest of the world.
Let’s look at India.
India, among many other nations, has seen a rapid economic transition, which has corresponded to changes in day-to-day life. The typical Indian male today leads a sedentary life, probably working long hours in a call center, lab, or bank. Physical exercise such as jogging or even walking to work is out of the question—it would entail navigating a perilous traffic scheme and choking on the thick fumes of the city. His dietary habits probably follow the growing national trend of high-fat, high-calorie food consumption. The transmission of fast food restaurants from the United States to its Eastern counterparts condones this busy, nutritionally-challenged lifestyle. Our typical man probably stops at McDonald’s during his lunch breaks.
But the symptoms of Westernization—these behavioral and lifestyle changes—have further consequences. The International Diabetes Foundation reports that 65 million adults in India have diabetes and expects that number to increase to 109 million by 2035. Where did this come from? Rapid urbanization and increasingly sedentary lifestyles have spurred the onslaught of obesity and diabetes, diseases that were previously deemed “Western” and associated with affluence. The result? An increased prevalence of Type 2 diabetes in developing countries. A Harvard researcher has found that globalization of the Western lifestyle has also sparked dietary changes like increased consumption of animal fat and energy-dense foods, decreased intake of fiber, and more frequent intake of fast foods. Furthermore, he found that while Type 2 diabetes was once more common among adults, the rising rate of childhood obesity has brought the disease to a younger demographic worldwide.
A population’s level of obesity and consumption of high-fat foods correlates to the prevalence of diabetes and insulin resistance. But the nature of the diabetes epidemic—what makes it so extensive and threateningly unconventional—is the prevalence of diabetes in populations where obesity is not a major health problem. In fact, many third world countries suffering from widespread malnutrition have seen an increase in diabetes.
Is malnutrition, then, linked to diabetes?
Israeli researchers found evidence that may suggest this. Between 1997 and 2010, the prevalence of Type 2 diabetes almost doubled in Africa. To put this in perspective, the rate of diabetes in Africa (2.4 percent) is lower than in Europe or North America (7.85 percent), but Africa – especially the rural regions – faces a severe lack of economic and medical resources for diagnosis and treatment. Looking at diabetes in low-resource countries, these researchers found that malnutrition, combined with the physical work typically accompanied by a rural lifestyle and iron or protein deficiencies, increases the prevalence of low-birth-weight newborns. GDM—gestational diabetes mellitus—can develop during pregnancy due to the increased production of hormones that inhibit efficient use of insulin. GDM and pre-gestational diabetes mean a higher chance of fetal death and various childbirth complications. In fact, untreated GDM often causes late-onset diabetes and thus later health issues for offspring. In one study conducted by these researchers, children who were very small at birth—due to the malnutrition of their mothers—typically have a reduced number of pancreatic beta cells and cannot handle insulin well, rendering them susceptible to the disease.
A potential cause? They suggest insufficient access to resources for nutritional and medical purposes. It’s difficult to diagnose and manage diabetes in developing countries. A family living in rural Africa may live many miles away from the nearest health clinic; even if they can make the journey there and their child shows elevated blood sugar levels, the family may lack the financial means for adequate treatment, or the doctor may not have the proper resources to proceed. Low income, long distances from health centers, and low educational levels inhibit proper treatment. Approximately 25 million Americans have diabetes, but through treatment and early detection we keep the disease under control. But patients elsewhere in the world face much steeper health risks from diabetes due to inhibited access to health care and supplies such as insulin, blood pressure pills, and other medicines. The costs associated with diabetes treatments are enormous. In some developing countries, diabetic patients living on one or two dollars per day would have to spend nearly 50 percent of their monthly income to purchase a single vial of insulin.
But what can explain the actual onslaught of diabetes in third world countries? Two hypotheses have been proposed. The “thrifty phenotype hypothesis” suggests that infants with low birth weights are more likely to develop Type 2 diabetes. The “thrifty genotype hypothesis” proposes the existence of diabetic genes persisting in populations that have undergone the transition to a modern lifestyle with an abundance of food. In the newer context, these genes become detrimental by facilitating the development of obesity and diabetes. According to latter hypothesis, populations that have faced malnutrition in the past are more prone to the development of diabetes when becoming Westernized. Europeans are less likely to possess thrifty genotypes because they evolved in environments that were less affected by the feast and famine cycles. Perhaps the diabetes epidemic in malnourished countries illustrates the clashing of ancestral genes with modern lifestyles.
Type 2 diabetes, of course, is very preventable, and typically staved off by healthy eating and physical activity. But even the United States has been unable to implement these habits on a large scale – we are still a nation crushed by its obesity rates. To address the rising of diabetes in developing countries, affordable medications may need to be introduced. The treatment of diabetes also calls for medical systems that are geared toward chronic care and foster long-term partnership between patients and a clinical team. Approaches to treatment also require a consideration of cultural beliefs on a regional basis – in some rural areas of the world, indigenous groups believe diabetic patients to be bewitched and will first consult a traditional healer over a medical health professional; similarly, in many low-income countries, obesity is considered desirable. Another approach entails the distribution of user-friendly blood glucose measuring devices, as well as inexpensive oral glucose-lowering agents.
Essentially, diabetes in the developing world stems from a combination of malnutrition and modernized lifestyles. How can it be that national development (correlating to the spread of obesity, sedentary lifestyles, and Western customs) and underdevelopment (analogous to malnutrition and the lack of proper medical and financial resources) both contribute to the diabetes epidemic? We usually equate the development of a nation with advancement, but perhaps our interpretation of “development” is at fault. This word is used interchangeably with “Westernization,” but there may exist a fundamental difference. Perhaps low-income and third world countries need development, but not Westernization. After all, even the United States has been unable to tackle the diabetes epidemic due to the lifestyle choices and habits underlying Western Civilization. We see this global race toward development, but we fail to develop in a sustainable and health-conscious manner, thereby propelling the invasion of diabetes.
 Hu, F. B. 2011. “Globalization of Diabetes: The Role of Diet, Lifestyle, and Genes.” Diabetes Care 34 (6): 1249–57.