Food Plight

Indian woman at fresh foods market

by Rhonda Mullen

Can changing to a healthier diet prevent diabetes in india? An Emory researcher is studying risk factors there that have implications here.

Venkat narayan trained as a doctor in India, but during a residency in England, he became so interested in public health that he switched gears. instead of practicing clinical medicine, he pursued epidemiology at the university of edinburgh and then at aberdeen in Scotland, where he stayed to accept a faculty position.

When the chance came to put his public health skills into action in a landmark NIH study of Pima Indians in Arizona, he accepted what he thought was a temporary assignment to set up the first lifestyle intervention for diabetes in the Pima. In the end, he never went back to Scotland, snagged by a growing interest in diabetes.

Narayan’s career has focused on better understanding diabetes in order to translate findings for prevention and control. He led diabetes epidemiology at CDC for 10 years, where he was principal investigator of TRIAD, a diabetes quality-of-care study of 10 managed care plans and 12,500 participants. He was involved in a large number of national surveillance studies showing that type 2 diabetes was a growing problem in the general population, not just in the Pima.

Since he came to Emory three years ago—as the Hubert Professor of Global Health and Epidemiology at the Rollins School of Public Health—Narayan has been busy building a global network of diabetes researchers and continuing to participate in several multi-center studies on diabetes. “We have learned so much,” he says. “Still we are increasingly discovering how little we know.”

Large studies at lower cost

Worldwide some 220 million people have diabetes, with that number expected to double by 2030. More people die worldwide and in developing countries from cardiovascular disease and diabetes than from malaria, HIV, and tuberculosis combined.

In this country, which already spends $132 billion a year on diabetes, the lifetime risk of getting diabetes is 1 in 3 for whites and 1 in 2 for blacks and Hispanics.

Narayan’s studies have led him back to his native India. “The more you study things in the world, the more you come back to your own street,” he says. In addition, large diabetes studies can be done in India at lower cost than in the United States, with applicable data for addressing this problem worldwide.

Today, Narayan leads research at the Global Center of Excellence for Prevention and Control of Cardiometabolic Diseases in South Asia. Funded by $3.6 million from the National Heart, Lung, and Blood Institute, the center (one of nine worldwide) is studying the burden and risk factors for cardiovascular disease and diabetes in India and Pakistan. Emory is partnering with the Public Health Foundation of India on the grant.

The South Asia region includes three of the top 10 countries with the biggest populations of people with diabetes and the highest number of diabetes-related deaths—India, Pakistan, and Bangladesh. Asian Indians are projected to account for 40% to 60% of the global cardiovascular disease burden over the next 10 to 15 years.

The researchers’ first task is to establish three surveillance groups in Chennai, New Delhi, and Karachi. They will test 4,000 people in each of the cities for diabetes and heart disease and their risk factors, following them to see who develops diabetes and cardiovascular disease. They also are running a trial at eight sites in India with 1,200 people who have diabetes, half of whom will receive routine care, while the other half will get a structured care management program, using a combined strategy of a low-cost care coordinator and a decision-support system that monitors glucose, blood pressure, and lipids, includes a regular eye exam, and has a training component on decision-making.

Such a study would be too costly to conduct in the United States, says Narayan, who estimates a cost upwards of $200 million to do the same research here. But with lower costs in India and Pakistan and strong partnerships (the Madras Diabetes Research Foundation, the All India Institute of Medical Science, and the Aga Khan University), the research becomes feasible.

Furthermore, Narayan believes that what they are learning in India will have implications for diabetes in the United States.

“We are clearly on the path to establishing that the epidemics of diabetes and cardiovascular disease are not just rich country diseases,” Narayan says. “But the resolutions to problems are pretty universal. What you learn in other countries is applicable here.” EH


Understanding diabetes in the United States

On the domestic front, Narayan participates in several research studies on diabetes, including:

  • a National Heart, Lung, and Blood Institute study that is determining the best ways to decrease the high rate of heart attack and stroke in people with type 2 diabetes,
  • research examining diabetes in children and youth, sponsored by the CDC and the National Institute of Diabetes and Digestive and Kidney Diseases,
  • the Diabetes Prevention Program, a clinical study to discover whether modest weight loss through dietary changes and increased physical activity or treatment with medication can prevent or delay the onset and complications of type 2 diabetes.



Basic facts

Diabetes is a disease with elevated blood glucose levels. People with the disease have difficulty converting food to energy.

Diabetes testing strips

In type 1 diabetes—usually diagnosed in children, teens, or young adults—the beta cells of the pancreas no longer make insulin because the body’s immune system attacks and destroys them.

Type 2 diabetes (formerly known as adult-onset diabetes) is the most common form. It usually begins with insulin resistance, a condition in which fat, muscle, and liver cells fail to use insulin properly. Overweight and inactive people are likely to develop this type.

Women may also develop gestational diabetes late in pregnancy, which usually goes away after they give birth.


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