Metabolic and Clinical Characteristics of South Asians and Europeans in Coventry

Abstract

A house to house survey in Foleshill, Coventry, compared risk factors for Type 2 diabetes and ischaemic heart disease (IHD) among adult United Kingdom Europeans (n = 5508, 64% screened) and South Asians (n = 4395, 84% screened). Those with a high glucose and a randomized 10% of others had a glucose tolerance test while those with previously diagnosed diabetes (104 Europeans, 223 South Asians) were re-interviewed in more detail. By the age of 29 years, South Asians had higher 2 h glucose 5.4 +/- 1.0 vs 4.84 +/- 1.2 mmol l-1, p < 0.005) and insulin (45.6 vs 23.8 mU l-1, p < 0.001) concentrations and in males, a higher cholesterol concentration (5.1 +/- 0.9 vs 4.6 +/- 1.2 mmol l-1, p < 0.05). South Asians with known Type 2 diabetes had an earlier age at diagnosis (48 +/- 11 vs 57 +/- 14 years, p < 0.001), a lower body mass index in the past (29.0 +/- 4.8 vs 32.1 +/- 6.9 kg m-2, p < 0.001) and currently (27.1 +/- 3.7 vs 29.1 +/- 6.4 kg m-2, p < 0.001), were more likely to present with acute symptoms, were less likely to attend the hospital clinic (14% vs 31%, p < 0.001), and were less likely to be treated with diet alone (14% vs 21%) or with insulin (9% vs 16%) than Europeans. Glycaemic control was similar in the two ethnic groups. These findings suggest an earlier onset of the disease processes involved in diabetes in South Asians. Important ethnic differences in patterns of care exist that make clinical comparisons difficult.

A population-based study of the association between areca nut chewing and Type 2 diabetes mellitus in men (Keelung Community-based Integrated Screening programme No. 2)

“…In the present study, the younger age of onset of Type 2 diabetes in chewers compared with non-chewers is consistent with the fact that a study conducted in Coventry (UK) revealed that South Asian subjects developed Type 2 diabetes at an earlier age than the European subjects [19]. Furthermore, these individuals required supplemental hypoglycaemic medication more frequently and at a younger age than the Europeans [19].…”

“…Furthermore, these individuals required supplemental hypoglycaemic medication more frequently and at a younger age than the Europeans [19]. The younger age of onset observed in our study also paralleled the increased prevalence of the areca nut habit in younger people, reflecting the comparatively recent uptake of the habit over the last 40 years.…”

Foot Ulcer Risk Is Lower in South-Asian and African-Caribbean Compared With European Diabetic Patients in the U.K.

“…Hyperglycemia, for example, is consistently the strongest risk factor for both diabetic peripheral neuropathy (36,37) and PAD (38), yet glycemic control in Asians is, paradoxically, either similar to or worse than Europeans (31,39). Similarly, Asian lipid profiles are also worse than Europeans (2), yet dyslipidemia predicts incidence of diabetic PAD and neuropathy (38,40).…”

Fetal Overnutrition in Polynesian Pregnancies and in Gestational Diabetes May Lead to Dysregulation of the Adipoinsular Axis in Offspring

“…This differs from other ethnic groups, such as South Asians, who are intrinsically hyperinsulinemic, independent of any given level of obesity (34). An inherited change to adapt to this mitochondrial haplotype may have occurred, therefore, to assist with survival of babies (i.e., as a counterbalance to the "small baby" drive while maintaining any benefits of the mitochondrial haplotype later in life).…”