Microvascular and macrovascular complications in type 2 diabetes in a multi-ethnic population based in Amsterdam. The HELIUS study

Abstract

Objective: To assess ethnic differences in diabetes-related microvascular and macrovascular complication rates in a multi-ethnic population in the Netherlands. Study, design and setting: Data from the HELIUS study comprising of 165 Dutch, 591 South-Asian Surinamese, 494 African Surinamese, 272 Ghanaian, 368 Turkish, and 444 Moroccan participants with diabetes were analyzed. Logistic regression was used to assess ethnic differences in microvascular (nephropathy) and macrovascular (coronary heart disease (CHD), peripheral artery disease (PAD) and stroke) complications, with adjustments for age, sex, education, and the conventional risk factors. Results: In an age-sex adjusted model, ethnic minorities had higher odds of nephropathy than Dutch except for Ghanaians and African Surinamese. The difference remained statistically significant in South-Asian Surinamese (odds ratio: 2.29; 95% CI, 1.09-4.80), but not in the Turkish (1.01; 0.43-2.38) and Moroccan (1.56; 0.68-3.53) participants. The odds of CHD was higher in all ethnic minorities than in Dutch, with the odds ratios ranging from 2.73 (1.09-6.84) in Ghanaians to 6. 65 (2.77-15.90) in Turkish in the fully-adjusted model. There were no ethnic differences in the odds of PAD and stroke. Conclusions: The findings suggest ethnic inequalities in macrovascular and microvascular complications in diabetes, with nephropathy and CHD being the most common complications affecting ethnic minorities.

Type 2 diabetes burden among migrants in Europe: unravelling the causal pathways

“…Complications The prevalence of diabetes-related complications also differs between migrant groups and Europeans [10,20]. Evidence indicates a high risk of microvascular and macrovascular complications in migrants with type 2 diabetes than their European counterparts [21][22][23] but with great variations across migrant populations. In the recent Healthy Life in an Urban Setting (HELIUS) study, South Asian Surinamese, Moroccan and Turkish migrants had age-and sex-adjusted higher odds of nephropathy than European Dutch.…”

“…A lower risk of death has also been observed among South Asian and Chinese people with diabetes in Canada [29]. The emerging mortality advantage among migrants with type 2 diabetes is surprising and difficult to explain especially given their relatively high risk of microvascular and macrovascular complications [21][22][23]. It is probable that this mortality advantage may be explained, at least in part, by biological or lifestyle factors that contribute to low mortality, such as low epigenetic age acceleration [30] or beneficial effect of lifestyle intervention and medication at a young age in migrants as they appear to develop type 2 diabetes earlier than Europeans [28].…”

“…In the recent Healthy Life in an Urban Setting (HELIUS) study, South Asian Surinamese, Moroccan and Turkish migrants had age- and sex-adjusted higher odds of nephropathy than European Dutch. The rate of coronary heart disease (CHD) was also higher in all migrant groups, with ORs ranging from nearly threefold higher in Ghanaian migrants to nearly sevenfold higher in Turkish migrants compared with European Dutch in the fully adjusted model [ 21 ]. In an 11-year follow-up of the Southall Diabetes Study, South Asians with type 2 diabetes were almost fourfold more likely than Europeans to report a history of myocardial infarction, but there was no significant difference in the risk of hypertension, stroke or amputation [ 10 ].…”

Sex and ethnic differences in the cardiovascular complications of type 2 diabetes

“…(Dutch n = 165, South Asian n = 591) reported no difference in rates of PAD between the native Dutch population and South Asian Surinamese minority (6.7% versus 10.8%, p = 0.156; OR 0.91, 95% CI 0.39–2.08). 103 Overall, South Asians are not disadvantaged with regards to the excess risk of PAD associated with T2D compared with white people.…”

Multi-Mechanistic In Vitro Evaluation of Antihyperglycemic, Antioxidant and Antiglycation Activities of Three Phenolic-Rich Indian Red Rice Genotypes and In Silico Evaluation of Their Phenolic Metabolites

“…A major problem faced by diabetic people is the development of microvascular (nephropathy, neuropathy, and retinopathy) and macrovascular complications (cardio vascular disease, and cerebrovascular disease) reducing their quality of life greatly [12]. Persistent hyperglycemia leading to the formation of advanced glycated end products (AGEs) is implicated in the development of diabetic complications [13].…”