Characteristics of the pathophysiology of type 2 diabetes in Asians

Asia is considered as the epicenter of recent worldwide epidemic of diabetes owing to its large population and high prevalence of diabetes. In Asia, type 1 diabetes is relatively rare in comparison with European countries. Therefore, the rapid increase in the prevalence of type 2 diabetes is the driving force of the epidemic. Interestingly, the phenotypes of Asian type 2 diabetes are distinct as compared by non-Asians, particularly Caucasians. Asian type 2 diabetes patients are generally non-obese, have a prominent impairment in insulin secretion and a better insulin sensitivity than non-Asians. Whereas incretin effect is remarkably reduced in European patients with type 2 diabetes, Asian patients with type 2 diabetes exhibited a similar incretin effect compared to non-diabetic subjects. Type 2 diabetes diagnosed by isolated postprandial hyperglycemia is more common in Asia than in Europe. Interestingly, glucose lowering efficacy is greater in Asians than in non-Asians. Genetic backgrounds in both nuclear and mitochondrial genome are different among ethnic groups, which may contribute to unique features of type 2 diabetes found in Asians. Considering the differences in pathophysiology and clinical features of Asian type 2 diabetes, we need to use different approach in diagnosis and management of type 2 diabetes including selecting patients eligible for bariatric/metabolic surgery.