Bittersweet research: Exploring diabetes and sugar’s effects on diet and health

As inconsistent as it sounds, America does not have the largest population of diabetics.  Despite all the hype about America’s ever-expanding waistlines and billions of health care dollars that are spent every year treating diseases related to obesity, the U.S. trails behind other countries in its population of diabetes sufferers.  Specifically, Southeast Asia and the Western Pacific regions suffer acutely from the burden of the disease where, according to figures tallied by the International Diabetes Federation, upwards of 200 million people are afflicted.

Research output in these regions, however, has not yet reached a level commensurate with the growing disease burden there. The significance of that omission became apparent to me after reading a recent New York Times op-ed by the health and science journalist Gary Taubes, which chronicled the sometimes confusing state of affairs surrounding nutrition-related scientific research.

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Taubes noted that, despite tens of thousands of articles published in just the last few years on diabetes and obesity, the precise causes and mechanisms underlying these conditions remain frustratingly unclear and subject to disagreement, as do the optimal means for remedy and prevention. Expert opinion seems to rest more on hypothesis than on research with the scope and duration necessary to establish certainty regarding cause and effect.

Is Taubes’ thesis correct: that inept clinical trials and incomplete data are to blame for the lack of an effective treatment for the obesity epidemic?  Or, is there something more?

To find out, a team of our analysts conducted a deep-dive to determine where in the world the bulk of diabetes research – and funding for that research – is coming from.  

As I noted earlier, their analysis revealed that, contrary to what may be general perception, the largest population afflicted with diabetes is coming from Southeast Asia and the Western Pacific.  Of the 382 million people worldwide living with diabetes in 2013, 138 million of them live in the Western Pacific.  That compares to just 37 million in North America and the Caribbean and 56 million in Europe. Yet, there is a disproportionately small amount of diabetes funding and research in the regions with the largest populations of diabetics. Comparatively, the U.S. has 60 percent of the top 10 diabetes funding organizations globally.

Whatever the potential causes, to Taubes’ point, more testing needs to be done. Could the hypothesis be that rice and other grains are converting to sugars which then cause glycaemic spikes that eventually lead to diabetes? This is not my area of expertise, but it certainly warrants further investigation and testing across the proper scientific process.  And perhaps a good place to start would be where the largest population of diabetic people lives.

In general, it is well documented that an enduring dietary villain is sugar. So, we dug further to explore sugar-related research trends as well. Between 2009 and 2014, upwards of 5,000 papers resulted.

Of the top 15 most-prolific institutions and researchers covering this area, half are from the United States. Europe has the next-highest showing of research institutions and researchers combined. Notably absent is representation from such nations as Japan, China, and other countries of the Pacific Rim. The most highly-cited paper for the period, with 309 citations, appeared in the U.S.-based Journal of Clinical Investigation and addressed the comparative benefits of fructose-sweetened versus glucose-sweetened beverages. And, a number of the other papers also cover sugary beverages, obesity and cardiovascular health.

What does this all mean? Some conclusions that I draw from this are:

-       There is a lot of research being done on diabetes, but not in regions of the world with the largest populations afflicted

-       There is a lot of research being done on the ill effects of sugar in the human diet, and the United States is most prominent in terms of prolific research institutions and researchers on this topic

-       Regions of the world with the largest populations of diabetics do not have proportionate research funding for the disease

-       There is a direct correlation to regions with higher amounts of funding and the research produced in those regions

All in all, more research and testing need to be done, and diabetes needs to become much more global in focus, drawing insights not just from wealthy nations where diabetes is as much a pop culture phenomenon as it is a population health challenge, but also from nations where the largest populations of diabetics reside.

Moftah is president of Thomson Reuters Intellectual Property and Science.

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