Prevention of type 2 diabetes in India and China

Amelioration of the global diabetes pandemic can be effectively achieved by preventing the development of type 2 diabetes (T2D) among individuals with prediabetes. This approach is particularly important in low and middle-income countries (LMIC), especially India and China, that are home to high and rapidly increasing numbers of individuals with T2D. There is sufficient high-quality evidence, albeit mostly from high-income countries, that T2D can be prevented in those with prediabetes by lifestyle intervention, with or without medication. Similar studies in India and China have shown promising results, with growing evidence also emerging from other LMICs, but wider application of these strategies requires a deeper understanding of the pathophysiology of prediabetes, its heterogeneity and the challenges inherent in their implementation in resource-constrained settings. In particular, there is a pressing need to evaluate effective preventive strategies for individuals with impaired fasting glucose, who constitute a large proportion of those with prediabetes in south Asia and in whom lifestyle intervention appears to be less effective in preventing progression to T2D. Clarity is also needed on the best strategy to prevent diabetes in those individuals who do not have obesity, and on the role of newer drugs (such as the incretin-based therapies) and emerging digital technologies. This article mainly addresses the evidence on diabetes prevention in China and India, where the majority of clinical trials have been conducted.