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Preventing diabetes — applying pathophysiological and epidemiological evidence

Published online by Cambridge University Press:  09 March 2007

Wilfred Y. Fujimoto ,
Richard W. Bergstrom ,
Edward J. Boyko ,
Kwang-Wen Chen ,
Steven E. Kahn ,
Donna L. Leonetti ,
Marguerite J. McNeely ,
Laura L. Newell ,
Jane B. Shofer  and
Christine H. Tsunehara
...Show all authors
Wilfred Y. Fujimoto*
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Richard W. Bergstrom
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Edward J. Boyko
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Kwang-Wen Chen
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Steven E. Kahn
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Donna L. Leonetti
Affiliation:
Departments of Anthropology, University of Washington, Seattle, Washington, USA
Marguerite J. McNeely
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Laura L. Newell
Affiliation:
Departments of Anthropology, University of Washington, Seattle, Washington, USA
Jane B. Shofer
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Christine H. Tsunehara
Affiliation:
Departments of Medicine, University of Washington, Seattle, Washington, USA
Patricia W. Wahl
Affiliation:
Biostatistics, University of Washington, Seattle, Washington, USA
*
*Corresponding author: Wilfred Y. Fujimoto, University of Washington, Department of Medicine, Box 356426, Seattle, Washington 98195-6426, USA. tel (206) 5430-3470, fax (206) 616-4341, email [email protected]
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Abstract

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This is a review of research carried out in Japanese Americans that points towards possible approaches to prevention of type 2 diabetes mellitus. The natural history of type 2 diabetes usually includes both insulin resistance and β-cell dysfunction. Insulin secretion may compensate for insulin resistance. Alternatively, enhanced insulin sensitivity may mask an insulin secretory defect. Epidemiological data support the view that in the vast majority of cases of type 2 diabetes, insulin resistance is essential to the pathogenesis of hyperglycemia. Increased diabetes prevalence as ethnic groups migrate to more urban or westernized regions has been attributed to increased occurrence of insulin resistance. Research among Japanese Americans in Seattle, Washington, showed a higher prevalence of type 2 diabetes than in Japan, which suggested that factors associated with ‘westernization’ might be playing a role in bringing out underlying susceptibility to diabetes. Our research has shown that these impressions were correct and that the abnormalities that characterize the metabolic syndrome play a significant role. Due to increased intra-abdominal fat deposition, Japanese Americans were likely to be ‘metabolically obese’ despite relatively normal BMI. A diet higher in animal fat and lower levels of physical activity were risk factors leading to increased intra-abdominal fat deposition, insulin resistance, and diabetes. Information from epidemiological studies such as these may be used to determine whether diabetes may be prevented through changes in lifestyle or application of specific therapies targeted towards identified metabolic abnormalities.

Keywords

βb-Cell dysfunctionInsulin resistanceMetabolic obesityWesternization
Type
Research Article
Information
British Journal of Nutrition , Volume 84 , Issue S2 , December 2000 , pp. S173 - S176
Copyright
Copyright © The Nutrition Society 2000

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