Current Pharmacological Treatment of Type 2 Diabetes Mellitus in Undocumented Migrants: Is It Appropriate for the Phenotype of the Disease?

Abstract

Type 2 diabetes is increasingly recognized as a spectrum of metabolic disorders sharing chronic hyperglycaemia. In Europe, the continually growing number of migrants from developing countries could affect diabetes phenotypes. We evaluated a population of 426 Italians and 412 undocumented migrants. Using 17 variables (with the exclusion of ethnic origin) we performed a multiple component analysis to detect potential clusters, independently from ethnicity. We also compared the two groups to evaluate potential ethnicity associated differences. We found five clusters of patients with different disease phenotypes. Comparing Italians with undocumented migrants, we noted that the first had more often cardiovascular risk factors and neurologic involvement, while the latter had a higher frequency of diabetic ulcers and renal involvement. Metformin was used in a comparable percentage of patients in all clusters, but other antidiabetic treatments showed some differences. Italians were more often on insulin, due to a larger use of long acting insulin, and received a larger number of oral antidiabetics in combination. Pharmacological treatment of comorbidities showed some differences too. We suggest that type 2 diabetes should be considered as a spectrum of diseases with different phenotypes also in heterogeneous populations, and that this is not due only to ethnic differences.

Characterizing non-communicable disease trends in undocumented migrants over a period of 10 years in Italy

“…The relative risk of diabetes was significantly higher in Asians and Latin Americans. This is in keeping with the observation that the frequency of type 2 diabetes is higher in migrants of all ethnicities and that they develop this disease at an earlier age than native Europeans 35 , though ethnic origin does not appear to be the only explanation 30 .…”

“…Nevertheless, we have already shown that the treatment of chronic conditions—either alone or associated with other diseases—is limited to pharmacological interventions not very different from those implemented for patients belonging to the general population 29 , 30 . This could be due to the fact that NGOs have very scarce possibilities to impact on social and economic determinants; therefore, other types of intervention are almost impossible.…”

Pharmacological Treatment of Type-2-Diabetes and Cardiovascular Comorbidities: Differences between Undocumented Migrants and Natives in Italy

“…The considerations made above are far from explaining the differences in antidiabetic therapy between our groups of Italians and undocumented migrants with diabetes. Though the latter might have a different prevalence of diabetic phenotypes [13], we have already demonstrated that pharmacologic treatment of diabetes does not appear to be based on disease phenotypes [23] and the present observations also do not point in the direction of phenotype-based therapeutic decisions. To an even lesser extent do they seem to be explained by efforts to take into account the potential pharmacogenetics aspects of diabetes [24].…”

Non-communicable diseases in undocumented migrants: 10-year temporal trend, relative risk and pharmacological treatment

“…In spite of this, we have already shown that the treatment of chronic conditions, either alone or associated to other diseases is limited to pharmacological interventions not very different from those implemented for patients belonging to the general population [26,27]. This could be due to the fact that NGOs have very scarce possibilities to impact on social and economic determinants; therefore, other types of intervention are almost impossible.…”