“Diabetes sounds like you’re going to die when you hear it. I was immediately frightened.” This is the story of the 422 million people worldwide who have diabetes, the story of  every 1 in 6 adults. This is a problem that affects all of us, young or old, rich or poor, no matter where you live. In introduction, diabetes is a chronic health condition that impacts how the human body processes, metabolizes and creates energy from the food that you eat. It affects the release of insulin, a hormone that allows blood sugar into cells. In some cases, having diabetes can even be deadly, in fact it is the cause behind 1.5 million deaths globally. However, in some regions of the world, these numbers are growing increasingly concentrated. This list is topped by South Asia, and this prompts the question, why this region? The answer lies in epigenetics - how genetic expression is influenced by external or environmental factors, such as diet, lifestyle, and exposure to toxins. It is a rapidly growing field of research that looks at how changes in gene expression, without changing the underlying DNA sequence, can be passed down from one generation to the next. Epigenetic marks, or modifications, can be inherited and can even affect how genes are expressed in different tissues within the same individual. 

Firstly, to understand this phenomenon, we need to take a deep-dive into the disease itself. Diabetes can be classified into two different categories, Type 1 and Type 2. Type 1 diabetes is a type of diabetes mellitus characterized by the body’s inability to produce insulin, a hormone that helps the body use glucose for energy. Without insulin, the body cannot properly process and use glucose from food, leading to an increase in blood sugar levels. Furthermore, this condition is often genetic, affecting more children at a young age, hence its nickname “juvenile diabetes”. Type 2 diabetes is a chronic condition that affects how your body metabolizes glucose (sugar). It occurs when the body does not produce enough insulin or is unable to properly use the insulin it produces. Without enough insulin, glucose cannot be used by the body for energy and instead accumulates in the blood, leading to high blood sugar levels. Type 2 diabetes is typically diagnosed in adults, but is increasingly being diagnosed in children and adolescents as well. One commonality shared by the two types of diabetes is the presented symptoms that include, increased thirst, increased hunger, weight loss, fatigue, blurry vision, and frequent infections.

Now that we have a thorough understanding of the condition at hand, we need to take a look at South Asia’s history and environment. Famines in South Asia have been a recurring problem throughout history, with severe food shortages occurring due to a variety of factors including climate, war, and crop failures. In particular, the Bengal Famine of 1943 is the worst of the six famines in South Asia’s history, resulting in an estimated 3 million deaths. Recent research has suggested that the effects of famine can have an epigenetic impact on the descendants of those affected. It is thought that the effects of famine on gene expression, including reduced fertility, increased stress and anxiety, and altered metabolism, can be passed down to future generations. This suggests that a famine event can have lasting effects on the health and wellbeing of populations for generations to come, in turn explaining why so many people in South Asia have diabetes today.

Let us look at this occurrence through a scientific lens now. Epigenetics changes happen through a process called DNA methylation. DNA methylation is a form of epigenetic modification in which a methyl group is added to a cytosine nucleotide, typically within a CpG dinucleotide. In turn, imbalances in DNA methylation can lead to changes in gene expression and can cause abnormal development and disease. A 2016 study by Dr. Soo Heon Kwak and Dr. Kyong Soo Park found that epigenetic alterations are associated with the increased risk of Type 2 diabetes in South Asians, specifically in the promoter regions of genes involved in insulin production, secretion, and action. Additionally, these modifications have been linked to the development of obesity, which is a known risk factor for Type 2 diabetes. Thus, epigenetic modifications may be a key component in the development of Type 2 diabetes in South Asian populations.

A key consequence of this phenomenon that needs to be addressed is how it has affected the South Asian community psychologically. Many people with diabetes often face stigma, discrimination, and social exclusion. They may also be seen as a burden to their families and communities, leading to feelings of shame, guilt, and depression. People with diabetes often have difficulty accessing healthcare, and may feel socially isolated due to a lack of awareness and understanding about the disease. People with diabetes may also experience anxiety, fear, and stress due to the chronic nature of the disease and the need for ongoing monitoring and treatment. Furthermore, the financial strain of managing diabetes can also be a source of psychological stress, due to the lack of access to affordable healthcare and treatment in many South Asian countries. 

Understanding the genome and epigenetics can be a powerful tool for reversing diabetes. The genome can provide useful insight into genetic markers that are associated with diabetes, while epigenetics can help to uncover how environmental and lifestyle factors affect the expression of those markers. By understanding the genetic causes and environmental triggers of diabetes, we can begin to develop targeted therapies that can reduce or eliminate the symptoms of this debilitating disease. Additionally, this knowledge can help us find natural remedies that can help to keep diabetes at bay. People living with diabetes can take comfort in knowing that science is steadily uncovering ways to treat this complex disorder. With increased awareness and application of the knowledge we now have about the genome and epigenetics, the future for people with diabetes is incredibly hopeful.