scholarly journals Type 2 diabetes risks and determinants in 2nd generation migrants and mixed ethnicity people of South Asian and African Caribbean descent in the UK

2019 ◽  
Author(s):  
Aliki-Eleni Farmaki ◽  
Victoria Garfield ◽  
Sophie V. Eastwood ◽  
Ruth E. Farmer ◽  
Rohini Mathur ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Ethnic Minority ◽  
Second Generation ◽  
South Asians ◽  
Self Report ◽  
The Uk ◽  
First And Second Generation ◽  
Mixed Ethnicity ◽  
Second Generation Migrants

AbstractBackgroundType 2 diabetes mellitus (T2DM) risk is markedly higher in UK South Asians (SA) and African Caribbeans (AC) compared to Europeans. Explanations for this excess are unclear. We therefore compared risks and determinants of T2DM in first- and second-generation (born in the UK) migrants, and in those of mixed ethnicity populations.MethodsData from the UK Biobank, a large population-based cohort of volunteers aged 40-69, were used. T2DM was assigned using self-report and glycated haemoglobin. Ethnicity was self-assigned. Using logistic regression and mediation analysis, we compared T2DM between first- and second-generation migrants, and between mixed European/South Asians (MixESA), or mixed European/African Caribbeans (MixEAC) with both Europeans and SA or AC respectively.ResultsT2DM prevalence was three to five times higher in SA and AC compared with Europeans [OR (95%CI): 4·80(3·60,6·40) and 3·30(2·70,4·10) respectively]. T2DM was 20-30% lower in second versus first generation SA and AC migrants [0·78(0·60,1·01) and 0·71(0·57,0·87) respectively]. T2DM in mixed populations was lower than comparator ethnic minority groups [MixESA versus SA 0·29(0·21,0·39), MixEAC versus AC 0·48(0·37,0·62)] and higher than Europeans, in MixESA 1·55(1·11, 2·17), and in MixEAC 2·06 (1·53, 2·78). Improved adiposity patterns in second generation migrants made an important contribution to risk reduction. Greater socioeconomic deprivation accounted for 17% and 42% of the excess risk of T2DM in MixESA and MixEAC compared to Europeans, respectively.ConclusionExcess T2DM risks in South Asians and African Caribbeans compared with Europeans in the UK are attenuated by ∼20% in second-generation migrants, demonstrating the marked benefits of favourable changes in environmental risk factors. T2DM prevalence in people of mixed ethnicity was also raised compared with Europeans, but considerably less than in the ethnic minority group; persistent socioeconomic disadvantage accounted for some of the residual excess.

scholarly journals Type 2 diabetes risks and determinants in second-generation migrants and mixed ethnicity people of South Asian and African Caribbean descent in the UK

Diabetologia ◽  
2021 ◽  
Author(s):  
Aliki-Eleni Farmaki ◽  
Victoria Garfield ◽  
Sophie V. Eastwood ◽  
Ruth E. Farmer ◽  
Rohini Mathur ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
South Asian ◽  
First Generation ◽  
Second Generation ◽  
African Caribbean ◽  
First Generation Migrants ◽  
The Uk ◽  
Mixed Ethnicity ◽  
Second Generation Migrants

Abstract Aims/hypothesis Excess risks of type 2 diabetes in UK South Asians (SA) and African Caribbeans (AC) compared with Europeans remain unexplained. We studied risks and determinants of type 2 diabetes in first- and second-generation (born in the UK) migrants, and in those of mixed ethnicity. Methods Data from the UK Biobank, a population-based cohort of ~500,000 participants aged 40–69 at recruitment, were used. Type 2 diabetes was assigned using self-report and HbA1c. Ethnicity was both self-reported and genetically assigned using admixture level scores. European, mixed European/South Asian (MixESA), mixed European/African Caribbean (MixEAC), SA and AC groups were analysed, matched for age and sex to enable comparison. In the frames of this cross-sectional study, we compared type 2 diabetes in second- vs first-generation migrants, and mixed ethnicity vs non-mixed groups. Risks and explanations were analysed using logistic regression and mediation analysis, respectively. Results Type 2 diabetes prevalence was markedly elevated in SA (599/3317 = 18%) and AC (534/4180 = 13%) compared with Europeans (140/3324 = 4%). Prevalence was lower in second- vs first-generation SA (124/1115 = 11% vs 155/1115 = 14%) and AC (163/2200 = 7% vs 227/2200 = 10%). Favourable adiposity (i.e. lower waist/hip ratio or BMI) contributed to lower risk in second-generation migrants. Type 2 diabetes in mixed populations (MixESA: 52/831 = 6%, MixEAC: 70/1045 = 7%) was lower than in comparator ethnic groups (SA: 18%, AC: 13%) and higher than in Europeans (4%). Greater socioeconomic deprivation accounted for 17% and 42% of the excess type 2 diabetes risk in MixESA and MixEAC compared with Europeans, respectively. Replacing self-reported with genetically assigned ethnicity corroborated the mixed ethnicity analysis. Conclusions/interpretation Type 2 diabetes risks in second-generation SA and AC migrants are a fifth lower than in first-generation migrants. Mixed ethnicity risks were markedly lower than SA and AC groups, though remaining higher than in Europeans. Distribution of environmental risk factors, largely obesity and socioeconomic status, appears to play a key role in accounting for ethnic differences in type 2 diabetes risk. Graphical abstract

scholarly journals The prevalence of vitamin D abnormalities in South Asians with type 2 diabetes mellitus in the UK

2010 ◽  
Vol 64 (3) ◽  
pp. 351-355 ◽  
Author(s):  
A. A. Tahrani ◽  
A. Ball ◽  
L. Shepherd ◽  
A. Rahim ◽  
A. F. Jones ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Vitamin D ◽  
Type 2 Diabetes Mellitus ◽  
South Asians ◽  
The Uk

scholarly journals Newly diagnosed type 2 diabetes in an ethnic minority population: clinical presentation and comparison to other populations

2018 ◽  
Vol 6 (1) ◽  
pp. e000568 ◽  
Author(s):  
Michael Morkos ◽  
Bettina Tahsin ◽  
Louis Fogg ◽  
Leon Fogelfeld
Keyword(s):  
Type 2 Diabetes ◽  
Ethnic Minority ◽  
Diabetes Complications ◽  
Clinical Presentation ◽  
Microvascular Complications ◽  
Macrovascular Complications ◽  
Minority Population ◽  
Newly Diagnosed ◽  
The Uk

ObjectiveTo characterize the clinical presentation of newly diagnosed type 2 diabetes of ethnic minority adults in Chicago and compare with other populations.Research design and methodsCross-sectional study examining the data of 2280 patients newly diagnosed with type 2 diabetes treated between 2003 and 2013 in a large Chicago public healthcare system.ResultsMean age of the patients was 49±11.3 years, men 54.4%, African-Americans 48.1%, Hispanics 32.5%, unemployed 69.9%, uninsured 82.2%, English-speaking 75.1%, and body mass index was 32.8±7.4 kg/m2. Microvascular complications were present in 50.1% and macrovascular complications in 13.4%. There was a presence of either macrovascular or microvascular complications correlated with older age, hypertension, dyslipidemia, inactivity, speaking English, and being insured (p<0.01). Glycosylated hemoglobin A1c (HbA1c) at presentation did not correlate with diabetes complications. In our cohort, when compared with a diverse population in the UK and insured population in the USA, HbA1c at presentation was 10.0% (86 mmol/mol), 6.6% (49 mmol/mol), and 8.2% (66 mmol/mol); nephropathy was 22.2%, 16.7%, and 5.7%; retinopathy was 10.7%, 7.9%, and 1.4%; and neuropathy was 27.7%, and 6.7% in the UK (p<0.001). There were no significant differences between groups in the prevalence of macrovascular complications.ConclusionThese results show the vulnerability of underserved and underinsured patients for developing diabetes complications possibly related to a delayed diagnosis.

scholarly journals Understanding the interrelationships of type-2 diabetes and hypertension with brain and cognitive health: a UK Biobank study

2021 ◽  
Author(s):  
Danielle Newby ◽  
Victoria Garfield
Keyword(s):  
Type 2 Diabetes ◽  
Population Based ◽  
Self Report ◽  
Uk Biobank ◽  
Linear Regression Models ◽  
Brain Health ◽  
Reasoning Task ◽  
Cognitive Health ◽  
The Uk

Aims/hypothesis: Diabetes and hypertension are associated with poorer cognitive and brain health. Less is known about comorbid diabetes and hypertension and: cognitive and brain health in mid-life. We hypothesised that individuals with both diabetes and hypertension have worse cognitive and brain health. Methods: Data from the UK Biobank, a population-based study which recruited 500,000 individuals, aged 40-69 years. Type-2 diabetes was assigned using self-report, HbA1c and clinical data, while hypertension was defined based on self-report. Our outcomes included a breadth of brain structural magnetic resonance imaging (MRI) parameters and cognitive function tests in a maximum of 38918 individuals. We tested associations between comorbid diabetes/hypertension (reference category, n=1283) and our outcomes by comparing this group with those with only diabetes (n=760), hypertension (n=9649) and neither disease (n=27226). Our analytical approach comprised linear regression models, with adjustment for a range of demographic and health factors. Results: Those with diabetes had worse overall brain health, as indexed by multiple neuroimaging parameters, with the exception of gFA (white matter integrity) and the amygdala. The largest difference was observed in the pallidum (β=0.179, 95%CI=0.137;0.220). Individuals with diabetes had poorer performance on certain cognitive tests, with the largest difference observed in the symbol digit substitution test (β=0.132, 95%CI=0.079;0.187). Compared to individuals with comorbid diabetes and hypertension, those with only hypertension had better brain health overall, with the largest difference observed in the pallidum (β=0.189, 95%CI=0.241;0.137), while those with only diabetes differed in total grey volume (β=0.150, 95%CI=0.122;0.179). Compared with individuals who had comorbid diabetes and hypertension, those with only diabetes performed distinctly better on the verbal and numeric reasoning task (β=0.129, 95%CI=0.077;0.261), whereas those with only hypertension performed better on the symbol digit substitution task (β=0.117, 95%CI=0.048;0.186) Conclusions/interpretation: Individuals with comorbid diabetes and hypertension have worse brain and cognitive health compared to those with only one of these diseases. These findings potentially suggest that prevention of both diabetes and hypertension may delay changes in brain structure, as well as cognitive decline and dementia diagnosis.

scholarly journals Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10 year nationwide cohort study

Diabetologia ◽  
2020 ◽  
Vol 64 (1) ◽  
pp. 95-108
Author(s):  
Louise Bennet ◽  
Ruzan Udumyan ◽  
Carl Johan Östgren ◽  
Olov Rolandsson ◽  
Stefan P. O. Jansson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
First Generation ◽  
Second Generation ◽  
Cox Regression ◽  
First Generation Immigrants ◽  
Cox Regression Analysis ◽  
Second Generation Immigrants ◽  
First And Second Generation ◽  
Incident Cases

Abstract Aims/hypothesis Non-Western immigrants to Europe are at high risk for type 2 diabetes. In this nationwide study including incident cases of type 2 diabetes, the aim was to compare all-cause mortality (ACM) and cause-specific mortality (CSM) rates in first- and second-generation immigrants with native Swedes. Methods People living in Sweden diagnosed with new-onset pharmacologically treated type 2 diabetes between 2006 and 2012 were identified through the Swedish Prescribed Drug Register. They were followed until 31 December 2016 for ACM and until 31 December 2012 for CSM. Analyses were adjusted for age at diagnosis, sex, socioeconomic status, education, treatment and region. Associations were assessed using Cox regression analysis. Results In total, 138,085 individuals were diagnosed with type 2 diabetes between 2006 and 2012 and fulfilled inclusion criteria. Of these, 102,163 (74.0%) were native Swedes, 28,819 (20.9%) were first-generation immigrants and 7103 (5.1%) were second-generation immigrants with either one or both parents born outside Sweden. First-generation immigrants had lower ACM rate (HR 0.80 [95% CI 0.76, 0.84]) compared with native Swedes. The mortality rates were particularly low in people born in non-Western regions (0.46 [0.42, 0.50]; the Middle East, 0.41 [0.36, 0.47]; Asia, 0.53 [0.43, 0.66]; Africa, 0.47 [0.38, 0.59]; and Latin America, 0.53 [0.42, 0.68]). ACM rates decreased with older age at migration and shorter stay in Sweden. Compared with native Swedes, first-generation immigrants with ≤ 24 years in Sweden (0.55 [0.51, 0.60]) displayed lower ACM rates than those spending >24 years in Sweden (0.92 [0.87, 0.97]). Second-generation immigrants did not have better survival rates than native Swedes but rather displayed higher ACM rates for people with both parents born abroad (1.28 [1.05, 1.56]). Conclusions/interpretation In people with type 2 diabetes, the lower mortality rate in first-generation non-Western immigrants compared with native Swedes was reduced over time and was equalised in second-generation immigrants. These findings suggest that acculturation to Western culture may impact ACM and CSM in immigrants with type 2 diabetes but further investigation is needed.

Gene-environment Interaction on the Risk of Type 2 Diabetes Among Ethnic Minority Populations Living in Europe and North America: A Systematic Review

2020 ◽  
Vol 16 (5) ◽  
pp. 457-470 ◽  
Author(s):  
Mohammad H. Zafarmand ◽  
Parvin Tajik ◽  
René Spijker ◽  
Charles Agyemang
Keyword(s):  
Type 2 Diabetes ◽  
North America ◽  
Ethnic Minority ◽  
Ethnic Minorities ◽  
Minority Groups ◽  
Environment Interaction ◽  
Ethnic Minority Groups ◽  
Gene Environment Interaction ◽  
Gene Environment

Background: The body of evidence on gene-environment interaction (GEI) related to type 2 diabetes (T2D) has grown in the recent years. However, most studies on GEI have sought to explain variation within individuals of European ancestry and results among ethnic minority groups are inconclusive. Objective: To investigate any interaction between a gene and an environmental factor in relation to T2D among ethnic minority groups living in Europe and North America. Methods: We systematically searched Medline and EMBASE databases for the published literature in English up to 25th March 2019. The screening, data extraction and quality assessment were performed by reviewers independently. Results: 1068 studies identified through our search, of which nine cohorts of six studies evaluating several different GEIs were included. The mean follow-up time in the included studies ranged from 5 to 25.7 years. Most studies were relatively small scale and few provided replication data. All studies included in the review included ethnic minorities from North America (Native-Americans, African- Americans, and Aboriginal Canadian), none of the studies in Europe assessed GEI in relation to T2D incident in ethnic minorities. The only significant GEI among ethnic minorities was HNF1A rs137853240 and smoking on T2D incident among Native-Canadians (Pinteraction = 0.006). Conclusion: There is a need for more studies on GEI among ethnicities, broadening the spectrum of ethnic minority groups being investigated, performing more discovery using genome-wide approaches, larger sample sizes for these studies by collaborating efforts such as the InterConnect approach, and developing a more standardized method of reporting GEI studies are discussed.

Relationship between medication adherence and psychosocial adjustment in patients with type 2 diabetes: A cross-sectional study

2020 ◽  
Vol 40 (3) ◽  
pp. 116-122
Author(s):  
Duygu Kes ◽  
Feray Gökdoğan
Keyword(s):  
Type 2 Diabetes ◽  
Psychosocial Adjustment ◽  
Large City ◽  
Psychosocial Care ◽  
Self Report ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Adherence To Medication ◽  
The Relationship

Adherence to drug treatment is a multidimensional concept. It is affected by many factors, such as physiological, psychological, family, environmental and social conditions. However, relatively little is known about the relationship between adherence to medication and psychosocial adjustment. The aim was to explore the relationship between adherence to antidiabetic drugs and the psychosocial adjustment of patients with type 2 diabetes mellitus. This cross-sectional descriptive correlational study was conducted between March and June 2018. A convenience sample of participants was recruited from seven internal disease outpatient clinics at a public tertiary hospital, located in a large city that serves as a gateway to nearby rural and urban areas in the north-west region of Turkey. Data were collected using the Adherence to Refills and Medications Scale (ARMS-7), and the Psychosocial Adjustment to Illness Scale–Self Report (PAIS–SR). This study is reported in accordance with STROBE. Pearson’s correlation analysis found a significant weak positive correlation between all domains of the PAIS–SR and the total scores on the ARMS‐7. The participants’ scores on medication refill were found to be significantly and positively correlated with all of the PAIS–SR domain scores except the sexual relationships domain. Psychosocial care could play a crucial role in improving drug regimen adherence among patients with diabetes. Therefore, nurses should integrate psychosocial care into daily practice.

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