Comparison of body mass index at diagnosis of diabetes in a multi‐ethnic population: A case‐control study with matched non‐diabetic controls

Abstract

Aims:To investigate the probability of developing type 2 diabetes mellitus (T2DM) at different body mass index levels compared to matched non-diabetic controls in a multi-ethnic population. Materials and methods:This was a case-control study of 90 367 patients with incident diabetes and 362 548 age-sex-ethnicity matched controls from UK primary care. The probability of developing T2DM was estimated. (29%) (all P < .01). Within the 18 to 70-year age range, South Asian males and females had a significantly higher probability of developing diabetes in the continuously measured BMI range of 18 to 30 kg/m 2 , compared to White Europeans and African-Caribbeans. Across all age groups <70 years, South Asians and African-Caribbeans had a significantly higher probability of developing T2DM in the normal weight and overweight categories, compared to White Europeans. However, this risk pattern of developing diabetes was reversed amongst the obese in all age groups. Conclusion:Risk patterns of developing diabetes at different levels of obesity varies among ethnic groups across all ages, while South Asians and African-Caribbeans carry the highest risk at a younger age and at lower adiposity burden. K E Y W O R D Sbody mass index, matched case-control study, multi-ethnic comparisons, probability of developing type 2 diabetes

Ethnicity and Type 2 diabetes in the UK

“…In the recent South London Diabetes Study, HbA 1c was significantly higher in black African or Caribbean people with newly diagnosed Type 2 diabetes compared with white Europeans [74]. Paul et al [8] also recognized significantly higher HbA 1c , and a greater proportion of people with HbA 1c ≥ 58 mmol/mol, among black African or Caribbean participants compared to South Asians or white Europeans. In a longitudinal analysis of 24 111 adults from inner London, ethnicity was independently associated with HbA 1c , and both South Asian and black African or Caribbean adults demonstrated worse glycaemic control despite more intensive management [75].…”

“…Furthermore, a significantly greater proportion of people from minority ethnic backgrounds develop Type 2 diabetes before the age of 40 years compared with white Europeans (Fig. ) . The significant variability in diabetes prevalence within a given ethnic group between different environments (e.g.…”

Prevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta‐analysis

“…5 It is well established that South Asian and African Caribbean adults develop T2DM at a much younger age compared with their white counterparts, and exhibit a marked predisposition to cardiovascular disease and ESRD. 6,7 In the United Kingdom, a higher incidence of central obesity and vascular disease has been reported in migrant South Asian people when compared with white Europeans despite lower levels of cardiovascular risk factors. 7,8 It is likely that higher levels of insulin resistance drive the higher rates of vascular disease and diabetes in this population.…”

“…6,7 In the United Kingdom, a higher incidence of central obesity and vascular disease has been reported in migrant South Asian people when compared with white Europeans despite lower levels of cardiovascular risk factors. 7,8 It is likely that higher levels of insulin resistance drive the higher rates of vascular disease and diabetes in this population. 9 A number of studies indicate that the risk of the development and progression of diabetic nephropathy varies among different populations.…”

Intensive versus standard multifactorial cardiovascular risk factor control in screen‐detected type 2 diabetes: 5‐year and longer‐term modelled outcomes of the ADDITION‐Leicester study

“…It is therefore important that robust data relating to complications risk is available to aid decision makers across a range of populations over time. This is particularly pertinent in people with type 2 diabetes identified through screening and within perceived high risk ethnic minority populations, where a significant number of cardiovascular risk factor treatments are indicated and many years of diabetes exposure potentially accrued . Screening activity has dramatically increased over the last 20 years and is now recommended in many countries, yet the long‐term effects of earlier identification remain unknown.…”