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Review
. 2023 Mar 21:1-22.
doi: 10.1007/s41745-022-00354-5. Online ahead of print.

A Strategic Research Framework for Defeating Diabetes in India: A 21st-Century Agenda

K M Venkat Narayan  1   2 , Jithin Sam Varghese  1   2 , Yara S Beyh  3 , Soura Bhattacharyya  4 , Shweta Khandelwal  5 , Gokul S Krishnan  6 , Karen R Siegel  1   2 , Tinku Thomas  7 , Anura V Kurpad  8
Affiliations
Review

A Strategic Research Framework for Defeating Diabetes in India: A 21st-Century Agenda

K M Venkat Narayan et al. J Indian Inst Sci. .

Abstract

Indian people are at high risk for type 2 diabetes (T2DM) even at younger ages and lower body weights. Already 74 million people in India have the disease, and the proportion of those with T2DM is increasing across all strata of society. Unique aspects, related to lower insulin secretion or function, and higher hepatic fat deposition, accompanied by the rise in overweight (related to lifestyle changes) may all be responsible for this unrelenting epidemic of T2DM. Yet, research to understand the causes, pathophysiology, phenotypes, prevention, treatment, and healthcare delivery of T2DM in India seriously lags behind. There are major opportunities for scientific discovery and technological innovation, which if tapped can generate solutions for T2DM relevant to the country's context and make leading contributions to global science. We analyze the situation of T2DM in India, and present a four-pillar (etiology, precision medicine, implementation research, and health policy) strategic research framework to tackle the challenge. We offer key research questions for each pillar, and identify infrastructure needs. India offers a fertile environment for shifting the paradigm from imprecise late-stage diabetes treatment toward early-stage precision prevention and care. Investing in and leveraging academic and technological infrastructures, across the disciplines of science, engineering, and medicine, can accelerate progress toward a diabetes-free nation.

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Figures

Box 1:
Box 1:
Research opportunities
Figure 1:
Figure 1:
Four thematic pillars of the strategic framework.
Figure 2:
Figure 2:
Research framework for diabetes etiology. The figure above (modified from Narayan and Kanaya, 2020) proposes a pathophysiological pathway connecting both common causes leading to diabetes in Asian Indians. The natural evolution leads to the poor beta cell function and hence an impaired insulin secretion; while the intrahepatic and intramuscular fat accumulation caused by lifestyle and inadequate body composition leads to impaired insulin action. Further, the diagram summarizes the proposed areas for research to better understand the etiology of diabetes in Asian Indians to curate a more targeted treatment and prevention.
Figure 3:
Figure 3:
Research framework for precision medicine.
Figure 4:
Figure 4:
Research framework for implementation research.
Figure 5:
Figure 5:
Research framework for health policy.
See this image and copyright information in PMC

References

    1. Corsi DJ, Subramanian SV. Socioeconomic gradients and distribution of diabetes, hypertension, and obesity in India. JAMA Netw Open. 2019;2(4):e190411. doi: 10.1001/jamanetworkopen.2019.0411. - DOI - PMC - PubMed
    1. International Diabetes Federation (2022) IDF diabetes atlas. International Diabetes Federation. https://diabetesatlas.org/. Accessed 6 October 2022
    1. Soniwala A. Global equity in diabetes precision medicine research (personal communication).
    1. Narayan KMV, Kanaya AM. Why are South Asians prone to type 2 diabetes? A hypothesis based on underexplored pathways. Diabetologia. 2020;63(6):1103–1109. doi: 10.1007/s00125-020-05132-5. - DOI - PMC - PubMed
    1. Mathur P, Leburu S, Kulothungan V. Prevalence, awareness, treatment and control of diabetes in India from the countrywide national NCD monitoring survey. Front Public Health. 2022;10:748157. doi: 10.3389/fpubh.2022.748157. - DOI - PMC - PubMed

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