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

Abstract

European populations are ethnically and culturally diverse due to international migration. Evidence indicates large ethnic inequalities in the prevalence of type 2 diabetes. This review discusses the burden of type 2 diabetes and its related complications, and the potential explanatory mechanisms among migrants in Europe. The current available data suggest that the rate of type 2 diabetes is higher in all migrant groups and that they develop this disease at an earlier age than the host European populations. The level of diabetes awareness among migrant populations is high, but glycaemic control remains suboptimal compared with Europeans. The culturally adapted lifestyle modification intervention trials to prevent type 2 diabetes mainly focus on South Asian adults in Europe. Diabetes-related microvascular and macrovascular complications remain a major burden among migrant populations in Europe. Earlier studies found higher mortality rates among migrants, but recent studies seem to suggest a shifting trend in favour of first-generation migrants. However, the extent of the burden of type 2 diabetes varies across migrant groups and European countries. Despite the higher burden of type 2 diabetes among migrants, the key underlying factors are not well understood mainly due to limited investment in basic science research and development of prospective cohort studies. We hypothesise that the underlying risk factors for the high burden of type 2 diabetes and its related complications in migrants are multifaceted and include pre-migration factors, post-migration factors and genetic predispositions. Given the multi-ethnic nature of the current European population, there is a clear need for investment in research among migrant populations to gain insight into factors driving the high burden of type 2 diabetes and related complications to facilitate prevention and treatment efforts in Europe. Graphical abstract

Socioeconomic Determinants of Cardiovascular Diseases, Obesity, and Diabetes among Migrants in the United Kingdom: A Systematic Review

“…Among SA subgroups, compared with Europeans, Bangladeshis had the highest odds of developing diabetes, followed by Pakistani and Indians, in a systematic review that assessed the variations in type 2 diabetes (T2D) risk among ethnic minority populations of different geographical origin compared with their host European populations [ 10 ]. In addition to the higher burden of T2D among migrant populations, the ways in which they manage this condition are poor compared to Western European populations, resulting in a high risk of death and complications [ 11 ]. The rates of ischaemic heart disease (myocardial infarction and angina) are also found to be about 30–40% higher amongst SA men than men in the general population [ 12 ].…”

Fetuin-A mediates the difference in adipose tissue insulin resistance between young adult pakistani and norwegian patients with type 2 diabetes

“…South Asian immigrants living in Western countries have a high prevalence of type 2 diabetes mellitus (T2DM) [1][2][3][4][5][6]. Norway has a growing population of Pakistani immigrants, especially in the capital Oslo, with a high prevalence of T2DM manifesting at a younger age than in ethnic Norwegians [7].…”

Psychosocial and Sociodemographic Determinants Related to Chronic Diseases in Immigrants Residing in Spain

“…Cumulative exposure to chronic stress has been seen to contribute to the worsening of health in immigrants who have lived in host countries for longer periods of time [ 8 , 9 ]. This means that migrating can have a negative impact on individuals’ health due to multiple physical and psychosocial tensions suffered during the migration process [ 10 , 11 ]. These tensions can lead to high levels of stress and an increase in risk-behaviors in immigrants, thus affecting their overall health [ 12 , 13 , 14 , 15 ] and potentially causing them to develop certain chronic diseases or worsening existing conditions.…”

“…The long-term negative consequences of chronic diseases on health are widely known. Studies such as the one carried out by Agyemang et al (2021) suggest that levels of type 2 diabetes are higher among immigrant populations in Europe compared to those of native populations [ 10 ]. Causes can be related to pre-migration factors as well as factors related to the migration process.…”

“…From a psychosocial point of view, and based on previous research [ 10 , 12 , 16 , 18 ], the present study aims to analyze the sociodemographic and psychosocial factors that affect chronic diseases in immigrants. For such purpose, common chronic diseases in immigrants have been selected based on long-term effects that can be considered as high risk for immigrants’ health.…”