The South-East Asian Region comprises only seven countries. The adult population of India accounts for 85% of that of the region. Mauritius has the highest per capita GDP at US$13,300, while the other countries all have per capita GDPs of less than US$5,000, although India with a current annual growth of 7.1% is experiencing economic development at a faster pace than almost anywhere in the world except its neighbour, China   1 . 

At a glance

Diabetes and IGT prevalence
There will be an estimated 46.5 million people, or 6.0% of the adult population, with diabetes in the region in 2007 (see Table 1). Economic progress is inevitably associated with increasing urbanization, and it appears that features of urban life tend to increase the prevalence of diabetes among persons of Indian ethnic background to a greater extent than for other populations   2 .

The second edition of the Diabetes Atlas used data from a single report   3 , based on a population-based survey from the six largest Indian cities, and extrapolated these results nationwide, applying a 4:1 urban:rural ratio from these findings for diabetes prevalence (the majority of the Indian population is classified as rural). For this report, two additional reports of population data collected on a nationwide basis   4   5  were used, which suggest that diabetes prevalence in smaller urban centres (100,000 – 1,000,000 inhabitants) tends to be about half of the larger cities, but still twice that of rural areas (less than 100,000 persons). This has led to a 30% reduction in expected urban diabetes cases, but no change to rural diabetes estimates.

The anticipated increase in regional diabetes prevalence from 6.0% to 7.4% in 2025 is very much a consequence of the increasing life expectancy in India, where the proportion of the population over 50 years is expected to increase from 16% to 22% between 2007 and 2025   6 , and the urban proportion from 31% to 43%   7  (see Table 2). Evidence suggests that in more affluent parts of the country, the rural prevalence is higher than less affluent rural areas   8 , indicating that increasing economic growth will increase diabetes prevalence in India even more than these possibly conservative estimates have indicated.

With regard to IGT, the same nationwide study indicated the same pattern as for diabetes, suggesting large cities to have twice the prevalence of smaller cities, for which the prevalence is twice those of rural areas. As India is a predominantly rural country, this has led to a marked reduction in the overall IGT numbers projected for 2007 and 2025 (see Tables 1 and 2), such that both are about half those previously projected in the second edition of the Diabetes Atlas.

Mauritius, the second smallest country of the region, highlights the extent to which persons of Indian ethnicity appear predisposed to diabetes, when exposed to more affluent economic circumstances. This island has the world’s eighth highest diabetes prevalence (of countries with representative prevalence data); currently 11% and expected to be 13% by 2025, and a similarly high IGT prevalence of 16%, likely to rise to nearly 18%.

Additional data have also become available for Nepal   9   10 , Bangladesh   11  and Sri Lanka   12 . These additional studies have not markedly affected the Bangladeshi or Nepali estimates, but have markedly increased those for Sri Lanka.