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Professors reveal genetic causes of Type Two diabetes among British South Asians

A medical study published by Nature Medicine demonstrates two major genetic causes of Type Two diabetes among British South Asian populations.

Genes and Health have been collecting data examining DNA provided by 60,000 British-Pakistani and British-Bangladesh volunteers over the last ten years. 

Using the data, Queen Mary University of London (QMUL) researchers discovered that due to genetic predispositions causing lower levels of insulin production and a less healthy distribution of fat, South Asians have a higher risk of developing Type Two diabetes at a young age, in comparison to white European populations.

Dr Moneeza K. Siddiqui, lecturer in genetic epidemiology from the Clinical Effectiveness Group at QMUL Wolfson Institute of Population Health said: “Knowledge is power and understanding why a whole group of people, whether this is in India, in Pakistan, Bangladesh, or when migrant communities live overseas, have been more susceptible to Type Two in contrast to other communities, [is powerful]”. 

The research, funded by Wellcome and Barts Charity, demonstrated why genetic patterns across different demographics can  influence the risk of developing Type Two diabetes and how individuals react to medical treatment.

She explained that many practices in the UK are Euro-centric, causing many care pathways for diabetes to miss the mark for South Asians.

Pancreatic beta cells, the cells that produce insulin, lose their production abilities and they become unable to digest the sugar.

This heightens the genetic risk of storing your fat in unfavorable parts of the body, including the viscera or central organs rather than the thighs, buttocks or arms, which are considered safer places to store fat. 

Siddiqui explained that the  study now allows  doctors to  identify drug treatments that better suit South  Asians, tailor recommendations more specifically using  new or existing medications, and improve the management of the condition.

Sarah Finer, clinical professor in diabetes from the Wolfson Institute of Population Health and Diabetes Consultant at Barts Health NHS Trust, reported the research fell under what is called precision medicine, a  model which examines variability in a person’s genes, environment, and lifestyle to determine whether the treatment of a  disease will be successful for that particular patient.

It also allows researchers to identify aspects of health and disease in populations where health inequalities exist.

Siddiqui said: “We now  know  that there is a specific subgroup of individuals who are not going to respond well to our first line, second line, third line medication because of the reason why they have diabetes, and it is not the same reason why the majority of Europeans develop diabetes.”

Type Two diabetes can develop early in life and may lead to more devastating health outcomes. 

Finer said: “What I see as a diabetes doctor in East London, is that Type Two diabetes is commonly coming in quite young ages, people in their  20s and 30s, whereas it used to be thought of as an age  associated condition.

“Secondly, it can develop in South Asians who are really quite slim, which again challenges what we think about diabetes as being something associated with obesity.”

Finer reported that it is important not to place the blame of developing diabetes on people’s lifestyle or diet. 

She said: “There are plenty of people around with unhealthy lifestyles, or diets and that’s going to have a big contribution to their diabetes.

“But I guess it’s to say that there’s also a component that has nothing  to do with what they’re doing and that, rather, it’s just basic bad luck. 

Finer explained that patients diagnosed with diabetes early in life are shocked when they are diagnosed.

She said: “A lot of people say to us, well, my parents both have it, but I never quite believed it would happen to me”. 

 A poorly managed case of diabetes can lead to eye, kidney or heart disease, and complications during pregnancy.

 Finer also reported that Type Two diabetes can adversely impact small blood vessels in the body including the  back of a person’s eye, their kidneys and their feet, leading to  vision problems, or kidney failure. 

She explained that it can also harm larger blood vessels in the body, causing heart attacks and strokes.

Annie Quratulain, 42 year old British-Pakistani volunteer from Genes and Health became diabetic through gestation when pregnant with her second child.

Towards the end of her pregnancy, Quratulain’s sugar levels  began to drop.

She said: “They did warn me that I’d have a bigger baby as a result, so I was a little bit scared.

“The fact that I had to keep checking my sugars, recording them down, I had to keep my insulin patch with me all the time traveling.

“It was dangerously low at the point that I would sometimes wake up in palpitations. 

“It was as low as two, which is really, really dangerous, in fact, I could have gone into a glycolic.”

Finer emphasised the need to work hard with younger populations to keep their diabetes under control. 

She said: “They’ve got decades of life ahead of them and we want those decades to be healthy.”

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