When K.M. Venkat Narayan first began studying type 2 diabetes in the early 1990s, it was considered a disease of adults in affluent countries. Nowadays diabetes has spread to every country in the world, to both urban and rural areas. It afflicts the poor as much as if not more than the rich and strikes children and teens as well as adults. A possible new phenotype of type 2 diabetes has emerged that is affecting younger, thinner people.

The number of people with diabetes has quadrupled from 1980 to 2014, and 415 million adults in the world now have diabetes, according to Rollins researchers. Globally, it was estimated that diabetes accounted for 12 percent of health expenditures in 2010, or at least $376 billion – a figure expected to hit $490 billion in 2030.

"In the years since I began working in this field, diabetes has grown to become one of the biggest public health threats we face," says Narayan, Ruth and O.C. Hubert Professor of Global Health. "The spread of some of the ills of a modern lifestyle – sedentary behaviors, a diet of processed and unhealthy foods, and an increase in obesity – has made diabetes a worldwide crisis. And at least in its most common form, it is substantially preventable. "When K.M. Venkat Narayan first began studying type 2 diabetes in the early 1990s, it was considered a disease of adults in affluent countries. Today diabetes has spread to every country in the world, to both urban and rural areas. It afflicts the poor as much as if not more than the rich and strikes children and teens as well as adults. A possible new phenotype of type 2 diabetes has emerged that is affecting younger, thinner people.

The number of people with diabetes has quadrupled from 1980 to 2014, and 415 million adults in the world now have diabetes, according to Rollins researchers. Globally, it was estimated that diabetes accounted for 12 percent of health expenditures in 2010, or at least $376 billion – a figure expected to hit $490 billion in 2030.

"In the years since I began working in this field, diabetes has grown to become one of the biggest public health threats we face," says Narayan, Ruth and O.C. Hubert Professor of Global Health. "The spread of some of the ills of a modern lifestyle—sedentary behaviors, a diet of processed and unhealthy foods, and an increase in obesity – has made diabetes a worldwide crisis. And at least in its most common form, it is substantially preventable."

Despite the great strides in treating diabetes in high–income countries, much about the disease in low– to middle–income countries remains a mystery. Can interventions that have been proven effective in places like the U.S. be successfully translated in poorer countries? Why are thinner and younger people in some countries developing diabetes, and how does this form of the disease differ from the more common type that occurs in overweight people?

The gap in knowledge has a straightforward explanation. About 75 percent of the burden of diabetes is borne in low– and middle–income countries, but more than 95 percent of the research is being conducted in high–income countries. Narayan and his team have been working to build up the research base in low– and middle–income countries, particularly in India and Pakistan.

Mary Beth Weber, assistant professor of global health, partnered with the Madras Diabetes Research Foundation in Chennai, India, on a study that showed the interventions that have proven successful in the U.S. and elsewhere in preventing prediabetes from advancing to diabetes can work as well in India in some segments of the population. After three years, the study group that got the recommended intervention – lifestyle education plus the glucose–lowering drug metformin if needed – was 30 percent less likely to develop diabetes than the control group.