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South Asians have a high burden of diabetes at younger ages. We compared diabetes risk in South Asians aged 20-44 years living in India (Delhi and Chennai) and Pakistan (Karachi) with Pima Indians, a population with the world's highest incidence of diabetes. We analyzed prospective cohort data from the Pima Indian Study (Pima, n=1852), and the Center for Cardiometabolic Risk Reduction in South Asia Study (CARRS, South Asians, n=6676). We defined diabetes as fasting glucose ≥126 mg/dl, HbA1c ≥ 6.5%, or medication use. At baseline, on average, the South Asians were less obese than Pima (BMI, kg/m2: 24.4 vs. 33.8; Waist, cms 82.5 vs.107). Age-standardized diabetes incidence (cases/1000 person-years, 95% CI) was lower in South Asians than in Pima (Men: 14.2, 12.2-16.2 vs. 37.3, 31.8-42.8; Women: 14.8, 13.0-16.5 vs. 46.1, 41.2-51.1). Incidence among 20-24 year old were 80% and 87% lower, respectively, among South Asian men and women, but the risk differential narrowed at older ages (Table). In those with BMI <25 kg/m2, the risk of diabetes was over five times higher in South Asian men than in Pima. Among those with BMI ≥30 kg/m2, diabetes incidence in South Asians was nearly as high as in Pima. Intriguingly, diabetes incidence is higher in nonobese South Asian than in Pima men but not in women. In obese South Asians, diabetes incidence is perilously close to that in the Pima, and is a cause for major concern, as obesity levels continue to rise in South Asia. Disclosure: K. Narayan: None. D. Kondal: None. S. Kobes: None. M. Deepa: None. N.R. Daya: None. S.A. Patel: None. R. Anjana: None. L.R. Staimez: None. M.K. Ali: None. U. Gujral: None. D. Prabhakaran: None. R. Shivashankar: None. M. Kadir: None. E. Selvin: None. V. Mohan: None. R.L. Hanson: None. N. Tandon: None. Funding: National Heart, Lung, and Blood Institute; Department of Health and Human Services (HHSN268200900026C); United Health Group, Minneapolis, MN; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024) [ABSTRACT FROM AUTHOR]

Populations in economic transition have a high diabetes prevalence even at lower body mass indices (BMI). We compared diabetes incidence in South Asians ≥45 years in urban India (Delhi and Chennai) and Pakistan (Karachi) with blacks and whites in U.S. Prospective analyses were done using data from the Center for Cardiometabolic Risk Reduction in South Asia Study (CARRS, South Asians, n=3,136), and the Atherosclerosis Risk in Communities Study (ARIC, blacks, n=3,059; whites, n=9,924). We defined diabetes as fasting glucose ≥126 mg/dl, HbA1c ≥ 6.5%, or medication use. South Asians were less obese than blacks and whites (BMI, kg/m2: 24.9 vs. 28.2 vs. 26.0; Waist, cms 87.5 vs.97.5 vs. 95.2). Age-standardized diabetes incidence (cases/1000 person-years, 95% CI) in South Asian men was similar to blacks and 1.6 times than whites (26.0, 22.2-29.8 vs. 26.2, 22.7-29.7 vs. 16.1, 14.8-17.4); and in South Asian women slightly higher than blacks and 3 times than whites (31.9, 27.5-36.2 vs. 28.6, 25.7-31.6 vs. 11.3, 10.2-12.3). In those with BMI <25 kg/m2, the diabetes risk was 2.6 times higher in South Asian men, and 5.3 times in women than in whites. In those with BMI ≥30 kg/m2, diabetes incidence in South Asian men and women were 2.6 and 2.1 times higher than in whites. Adults in urban India/Pakistan have higher diabetes incidence than U.S. whites. Even nonobese South Asian adults have markedly higher risk of diabetes compared to whites. Disclosure: K. Narayan: None. D. Kondal: None. N.R. Daya: None. S.A. Patel: None. M. Deepa: None. R. Anjana: None. L.R. Staimez: None. U. Gujral: None. S. Kobes: None. R. Shivashankar: None. M.K. Ali: None. M. Kadir: None. D. Prabhakaran: None. R.L. Hanson: None. V. Mohan: None. E. Selvin: None. N. Tandon: None. Funding: National Heart, Lung, and Blood Institute; Department of Health and Human Services (HHSN268200900026C); United Health Group, Minneapolis, MN; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK111024) [ABSTRACT FROM AUTHOR]

Background: To our knowledge, no estimates of lifetime risk of diabetes have been produced for India, a country with a high propensity to developing diabetes and a low overall body weight compared to high-income countries. Data: We estimated the lifetime risk of diabetes in metropolitan India, and its variation by sex, age and BMI. We used government mortality statistics, diabetes prevalence from the Indian Council for Medical Research INdia DIABetes study (2008-15) and incidence from the Centre for Cardiometabolic Risk Reduction in South Asia (2010-2018). We limited estimates Indians aged 20 or more years. Results: Overall lifetime risk of diabetes in women in metropolitan cities aged 20 was 74.7% (95%CI: 65.4-83.3%), and 69.0% (95%CI: 58.9-78.7%) in men. Remaining risk is highest among the obese (92.9% (95%CI: 88.0-96.0%) in women and 92.4% (95%CI: 86.6-96.1%) in men aged 20) and is lowest among underweight/normal weight people (56.4% (95%CI: 46.9-66.3%) in women and 54.2% (95%CI: 44.5-64.6%) in men). Lifetime risk declines with age (to 67.3% (95%CI: 57.4-77.1%) in women aged 40 to 42.5% (95%CI: 33.8-52.9%) at age 60). Conclusion: In metropolitan India, 1 in 2 underweight/normal weight, and 9 in 10 obese, people aged 20 are projected to develop diabetes during their life. This portends a serious epidemic and indicates what may develop elsewhere in India in the absence of urgent action. Table. Lifetime risk of diabetes by sex, age and BMI Disclosure: S. Luhar: None. S. Kinra: None. V. Mohan: None. D. Kondal: None. R. Anjana: None. S.A. Patel: None. M.K. Ali: Research Support; Self; Merck & Co., Inc. D. Prabhakaran: None. N. Tandon: None. K. Narayan: None. Funding: Economic and Social Research Council (ES/J500021/1) [ABSTRACT FROM AUTHOR]