Mortality and morbidity from diabetes in South Asians and Europeans: 11-year follow-up of the Southall Diabetes Survey,London, UK

Over 20 % of middle aged and elderly South Asian people throughout the world have diabetes. The associated mortality and morbidity risks are unclear. We compared mortality and morbidity in a cohort of South Asian and European people with diabetes in London, UK, in an 11-year follow-up of a population-based sample of 730 South Asians (mean age 55 in 1984) and 304 Europeans (mean age 67 in 1984) with diabetes aged 30 years and above in 1984. By 1995, 242 (33 %) of South Asians, and 172 (57 %) of Europeans had died. The all-cause mortality rate ratio (South Asian versus European) was 1.50 (95 % CI 0.72–3.12) for those aged 30–54 years at baseline. Ethnic differences in mortality rates were abolished or reversed in people aged 65 years and above at baseline. The mortality rate ratio for circulatory deaths was 1.80 (95 % CI 1.03–3.16, p < 0.05) and for heart disease was 2.02 (95 % CI 1.04–3.92, p < 0.05) in those aged 30–64 years at baseline. Seventy-seven per cent of South Asian deaths were caused by circulatory disease, compared with 46 % of European deaths. South Asian survivors were 3.8 times (95 % CI 1.8–8.0, p = 0.001) more likely to report a history of myocardial infarction than Europeans. South Asian adults with diabetes show a markedly increased predisposition to cardiovascular disease compared with Europeans, especially in younger people. This emphasizes the urgent need to reduce cardiovascular risk in this vulnerable group. © 1998 John Wiley & Sons, Ltd.     

Diabetes mellitus in older African-Americans, Hispanics, and whites in an academic hospital-based geriatrics practice.

BACKGROUND: Diabetes mellitus is a risk factor for target-organ damage/clinical cardiovascular disease in older persons. DESIGN: A retrospective analysis was performed of charts from all older persons (506 men and 1497 women, mean age 80 +/- 8 years) seen during the period from 1 January 1998 to October 1998 at an academic hospital-based geriatrics practice, to investigate the prevalence of diabetes mellitus, and the prevalence, in patients with diabetes, of target-organ damage/clinical cardiovascular disease, hypertension, hypertension or dyslipidaemia, obesity, the drugs used to treat diabetes, and poor glycaemic control. RESULTS: Diabetes mellitus occurred in 127 of 1150 whites (11%), in 93 of 444 African-Americans (21%), in 111 of 381 Hispanics (29%), and in four of 28 Asians (14%) (P < 0.001 comparing Hispanics with whites and comparing African-Americans with whites; P < 0.01 comparing Hispanics with African-Americans). Of 335 patients with diabetes, 146 (44%) had coronary disease, 94 (28%) had stroke or transient cerebral ischaemic attack, 86 (26%) had peripheral arterial disease, 65 (19%) had heart failure, 107 (32%) had nephropathy, 71 (21%) had retinopathy, 47 (14%) had neuropathy, 284 (85%) had target-organ damage/clinical cardiovascular disease, 252 (75%) had hypertension, 300 (90%) had hypertension or dyslipidaemia, and 152 (45%) had obesity. The prevalence of stroke or transient cerebral ischaemic attack was greater in older African-Americans with diabetes mellitus than in older whites with diabetes mellitus (P < 0.02). The prevalence of diabetic nephropathy and of target-organ damage/clinical cardiovascular disease was greater in older African-Americans with diabetes mellitus than in older whites (P < 0.02) and Hispanics (P < 0.05) with diabetes mellitus. Increased concentrations of glycosylated haemoglobin (> 7%) occurred in 28 of 86 African-Americans (33%), in 69 of 104 Hispanics (66%), and in 23 of 118 whites (19%) (P < 0.001 comparing Hispanics with whites and comparing Hispanics with African-Americans; P < 0.05 comparing African-Americans with whites). CONCLUSIONS: The prevalence of diabetes mellitus in 2003 older persons seen in an academic hospital-based geriatrics practice was 17% and was greater in Hispanics than in whites or African-Americans, and greater in African-Americans than in whites. The prevalence of target-organ damage/clinical cardiovascular disease was 85% in 335 older patients with diabetes. The prevalence of stroke or transient cerebral ischaemic attack was greater in older African-Americans with diabetes mellitus than in older whites with the disorder. The prevalence of diabetic nephropathy and of target-organ damage/clinical cardiovascular disease was greater in older African-Americans with diabetes mellitus than in older whites and Hispanics with diabetes mellitus. The prevalence of poor glycaemic control was greater in Hispanics than in whites or African-Americans and greater in African-Americans than in whites.     

Comparison of prevalence and risk factors for microalbuminuria in South Asians and Europeans with Type 2 diabetes mellitus

Although Type 2 (non-insulin-dependent) diabetes mellitus (Type 2 DM) is more common in South Asians than in Europeans in the UK, very little is known about complications and their risk factors in South Asians. We sought microalbuminuria in a cross-sectional study of 583 European and 889 South Asian Type 2 DM clinic attenders to Ealing Hospital, London, over 1 year. Albumin/creatinine ratios were measured in early morning urines. Prevalence of microalbuminuria was greater in South Asians compared to Europeans (40 % versus 33 % in men, p = 0.003, and 33 % versus 19 % in women, p < 0.0001). Glycaemic control was worse and prevalence of hypertension, retinopathy and heart disease was higher in South Asians. Key risk factors for microalbuminuria in both ethnic groups were glycaemic control, diabetes duration, blood pressure, triglyceride and retinopathy, but none accounted for the higher microalbuminuria prevalence in South Asians. Age and sex adjusted odds ratio for microalbuminuria was 1.78 (95 % CI 1.02, 2.82, p = 0.02) in South Asians versus Europeans. After adjustment for confounders, this became 2.07, 95 % CI 1.13, 3.79, p = 0.02. We conclude that microalbuminuria is more common in South Asians with Type 2 DM than in Europeans and, although risk factor relationships appeared similar in both groups, and some risk factors were more prominent in South Asians, this cannot account for the high prevalence of microalbuminuria observed in South Asians. © 1998 John Wiley & Sons, Ltd.     

Prevalence of ischaemic heart disease: the Caerphilly and Speedwell surveys.

Mortality from ischaemic heart disease remains high in the United Kingdom, and the present report describes the prevalence of the various epidemiological manifestations of the disease in two recent community studies with a common core protocol, each containing samples of over 2000 men, carried out in South Wales (Caerphilly) and the West of England (Speedwell, Bristol). The prevalence of electrocardiographic evidence of ischaemia was similar in the two communities--8.7% of men aged 45-49 years rising to 18.6% in men aged 55-59 years in the samples from South Wales, and 8.0% and 17.2% respectively in the Bristol population. The overall prevalence of angina was 7.7% in Caerphilly and 7.8% in Speedwell in men aged 45-59 years, but symptoms of severe chest pain were more commonly reported in South Wales than in Speedwell (10.1% compared with 6.3%). The data, however, suggested that the overall prevalence of ischaemic heart disease was very similar in the two areas. The prevalence of ischaemic heart disease was compared with that found in other population studies carried out in the United Kingdom and was higher than that found when employed men only were studied. There were substantial differences in mortality between the two areas; possible reasons for this are differences in community or medical services, smoking habit, or unemployment rates.     

Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

Aims/hypothesis The aim of the study was to determine whether the risk of ischaemic heart disease (IHD) associated with diabetes mellitus differs between ethnic groups.Methods Registry linkage was used to identify IHD events in 5707 Chinese, Malay and Asian Indian participants from three cross-sectional studies conducted in Singapore between the years 1984 and 1995. The study provided a median of 10.2 years of follow-up with 240 IHD events experienced. We assessed the interaction between diabetes mellitus and ethnicity in relation to the risk of IHD events using Cox proportional hazards regression.Results Diabetes mellitus was more common in Asian Indians. Furthermore, diabetes mellitus was associated with a greater risk of IHD in Asian Indians. The hazard ratio when comparing diabetes mellitus with non-diabetes mellitus was 6.41 (95% CI 5.77–7.12) in Asian Indians and 3.07 (95% CI 1.86–5.06) in Chinese (p = 0.009 for interaction). Differences in the levels of established IHD risk factors among diabetics from the three ethnic groups did not appear to explain the differences in IHD risk.Conclusions/interpretation Asian Indians are more susceptible to the development of diabetes mellitus than Chinese and Malays. When Asian Indians do develop diabetes mellitus, the risk of IHD is higher than for Chinese and Malays. Consequently, the prevention of diabetes mellitus amongst this ethnic group is particularly important for the prevention of IHD in Asia, especially given the size of the population at risk. Elucidation of the reasons for these ethnic differences may help us understand the pathogenesis of IHD in those with diabetes mellitus.Electronic supplementary material Supplementary material is available in the online version of this article at and is accessible to authorised users.     

Higher Levels of Microproteinuria in Asian Compared with European Patients with Diabetes Mellitus and Their Relationship to Dietary Protein Intake and Diabetic Complications

Asian patients with diabetes have a higher prevalence of renal disease than their European counterparts. The aim of the study was to investigate the pattern of the renal excretion of proteins in 70 Asian and 70 European patients with diabetes and to relate it to dietary intake of protein and prevalence of diabetic complications. Compared with matched Europeans, Asian patients had an increased urinary excretion of albumin and transferrin (p < 0.02) with 14 Asians and 6 Europeans having significant microalbuminuria (> 30 μg min^?1). In 12 Asians and all 6 Europeans this was associated with complications from diabetes, particularly vascular. Asian patients had significantly more ischaemic heart disease (p < 0.001) but less neuropathy (p < 0.001) and retinopathy (p < 0.05) than their matched European counterparts. Asian diets were lower in protein (median (range) Asian vs European: 12.5% (6–29%) vs 19% (11–27%); p <0.01) and carbohydrate but higher in fat than European diets. There was no correlation between dietary protein intake and excretion of any of the urinary proteins measured. However, a significant correlation was found in Asians between protein intake and length of residence in the UK (p < 0.005). Unless ways to reduce complications can be found then future allocation of resources will need to take this into consideration in areas with large Asian communities.     

Relationship of glucose intolerance to coronary risk in Afro-Caribbeans compared with Europeans

Summary Afro-Caribbeans have low mortality rates from coronary heart disease, despite a high prevalence of diabetes mellitus. We examined 1166 Afro-Caribbean and European men and women aged 40–64 years in a community survey in London, UK. Prevalence of glucose intolerance (combining impaired glucose tolerance, new and known diabetes) was 31% in Afro-Caribbeans and 14% in Europeans (p<0.001). In men, the prevalence of probable coronary heart disease was 6% in Afro-Caribbeans and 13% in Europeans (p<0.01). Triglyceride was lower in Afro-Caribbeans than Europeans; in men, HDL cholesterol was higher. Afro-Caribbean men were less centrally obese, while Afro-Caribbean women were more centrally obese than their European counterparts. Fasting and 2-h insulin levels were higher in Afro-Caribbeans than Europeans. Glucose intolerance was associated with high triglyceride, low HDL cholesterol and central obesity in European but not in Afro-Caribbean men. In Europeans, fasting triglyceride was 1.49 mmol/l in normoglycaemic and 1.89 mmol/l in glucose intolerant men (p<0.05), in Afro-Caribbean men triglyceride was 1.08 and 1.22 mmol/l, respectively. Waist hip ratio was 0.94 in normoglycaemic, and 0.98 in glucose intolerant European men (p<0.001). In Afro-Caribbean men, waist hip ratio was 0.93 in both groups. At each level of insulin, glucose or central obesity, triglyceride was lower in Afro-Caribbean men and women than in Europeans. We speculate that despite high insulin levels, Afro-Caribbeans have a favourable lipoprotein pattern which persists in the presence of glucose intolerance, and may be related to body fat distribution. This could begin to explain their low rates of coronary heart disease.Abbreviations CHD Coronary heart disease - WHR waist hip ratio - WTR waist thigh ratio - BMI body mass index - NIDDM non-insulin-dependent diabetes mellitus     

Prevalence of diabetes mellitus,coronary heart disease and hypertension in the families of insulin dependent and insulin independent diabetics

Summary During an epidemiological study concerning the fate of diabetics in Warsaw, 2,356 subjects (aged 35–68 years with duration of diabetes mellitus of 3–11 years) were investigated with particular relevance to the presence of diabetes mellitus, coronary heart disease, and hypertension in their parents and siblings. Diabetics were classified into the following groups: insulin dependent, insulin independent nonobese, insulin independent obese, and a group in whom the distinction between insulin dependence and insulin independence was unclear. The findings in these groups were compared with the frequencies of these diseases in a random sample of the general population. There was an excess of diabetes in close relatives of all the diabetic groups. This was highest for insulin independent non-obese diabetics. There was no difference in the prevalence of coronary heart disease and hypertension in close relatives of insulin dependent diabetics when compared with the general population, but these were twice as prevalent in close relatives of the insulin independent non-obese group. Obese insulin independent diabetics reported a similar excess of coronary heart disease and hypertension in siblings, but the excess was less marked in parents. The prevalence of these diseases in families of probands with unclassified diabetes was intermediate between the other two groups. These results demonstrate an aggregation of diabetes mellitus with coronary heart disease and hypertension in families of insulin independent non-obese diabetics. This provides further evidence for heterogeneity in diabetes mellitus.     

Coronary artery disease epidemic in Pakistan: more electrocardiographic evidence of ischaemia in women than in men

Indo-Pakistani populations have one of the highest risks of coronary artery disease (CAD) in the world. A population-based, cross-sectional survey was conducted on 3143 adults aged >or=40 years from 12 randomly selected communities in Karachi, Pakistan. Apart from smoking, women had more CAD risk factors (diabetes, hypertension, obesity, dyslipidaemia) than men. Definite CAD (history and Q waves on ECG) was more prevalent in men than in women (6.1% vs 4.0%; p = 0.009). In contrast, ischaemic and major ECG changes were twice as prevalent in women as in men (29.4% vs 15.6%, and 21.0% vs 10.5%; p<0.001 for each, respectively). All measures of CAD were strongly predicted by the metabolic syndrome, but that failed to account for the greater prevalence of ECG abnormalities in women than in men. The findings indicate that one in five middle-aged adults in urban Pakistan may have underlying CAD. Women are at greater risk than men. Trial registration number: NCT00327574.     

Prevalence of coronary heart disease,left ventricular failure and hypertension in middle-aged,newly diagnosed Type 2 (non-insulin-dependent) diabetic subjects

Summary The prevalence of coronary heart disease, left ventricular failure and hypertension was examined in a representative group of 133 newly diagnosed Type 2 (non-insulin-dependent) diabetic subjects (70 men, 63 women), aged 45 to 64 years, and in a group of 144 randomly selected non-diabetic control subjects (62 men, 82 women) of the same age group. The prevalence of previous myocardial infarction (major Q-QS abnormalities in resting ECG and/or myocardial infarction verified at hospital) was increased 1.7-fold in male (NS) and 4.4-fold in female (p = 0.007) diabetic patients compared with that found in non-diabetic subjects. Chest pain symptoms and ischaemic ECG abnormalities were about twice as common among diabetic than among non-diabetic subjects. The frequency of coronary heart disease defined by chest pain symptoms and ECG abnormalities was 3.5 times higher in male (p = 0.001) and 3.1 times higher in female (p = 0.001) diabetic patients than in the respective non-diabetic subjects. The frequency of current digitalis therapy was increased 3.3-fold in male (p = 0.006) and 3.9-fold in female (p = 0.001) diabetic patients suggesting an increased frequency of left ventricular failure among diabetic subjects. The prevalence of hypertension, based on the elevated blood pressure levels and/or current use of antihypertensive drugs, was increased 1.6–1.7-fold among the diabetic patients.     

Diabetes mellitus as a risk factor for acute myocardial infarction in Asians and Europeans

Ischaemic heart disease is commoner among immigrants from the Indian subcontinent than among Europeans in the United Kingdom. The excess cannot be accounted for by differences in smoking, blood pressure, or lipid concentrations. There is, however, an increased prevalence of diabetes mellitus in the Asian population. Separate estimates of the relative risk of acute myocardial infarction associated with diabetes from parallel case-control studies were made to compare the importance of diabetes as a risk factor in the two ethnic groups. For Asians the relative risk was 3.3 (95% confidence interval 1.9 to 5.8) and for Europeans 1.3 (1.0 to 1.7). Calculations of population attributable risk indicated that clinical diabetes mellitus accounts for 21% of the incidence of myocardial infarction in Asians but only 3% of the incidence in Europeans. Diabetes mellitus is of sufficient quantitative importance as a risk factor to account for the whole of the observed excess of deaths from ischaemic heart disease among Asians in the United Kingdom.     

Diabetes mellitus as a risk factor for acute myocardial infarction in Asians and Europeans.

Ischaemic heart disease is commoner among immigrants from the Indian subcontinent than among Europeans in the United Kingdom. The excess cannot be accounted for by differences in smoking, blood pressure, or lipid concentrations. There is, however, an increased prevalence of diabetes mellitus in the Asian population. Separate estimates of the relative risk of acute myocardial infarction associated with diabetes from parallel case-control studies were made to compare the importance of diabetes as a risk factor in the two ethnic groups. For Asians the relative risk was 3.3 (95% confidence interval 1.9 to 5.8) and for Europeans 1.3 (1.0 to 1.7). Calculations of population attributable risk indicated that clinical diabetes mellitus accounts for 21% of the incidence of myocardial infarction in Asians but only 3% of the incidence in Europeans. Diabetes mellitus is of sufficient quantitative importance as a risk factor to account for the whole of the observed excess of deaths from ischaemic heart disease among Asians in the United Kingdom.     

Prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease and of associated risk factors in older men and women with and without diabetes mellitus

The authors performed a retrospective analysis of the prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease and of associated risk factors in 99 men (mean age 79±8 years) with diabetes mellitus vs. 368 men (mean age 81±8 years) without diabetes mellitus, and in 260 women (mean age 80±8 years) with diabetes mellitus vs. 1184 women (mean age 81±8 years) without diabetes mellitus. All patients were seen in an academic outpatient geriatrics practice. Diabetic men had a higher prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease (p<0.0001); a higher prevalence of smoking (p=0.023), hypertension (p<0.0001), and obesity (p=0.0007); higher levels of serum total and low density lipoprotein cholesterol (p<0.0001) and triglycerides (p=0.003); and lower levels of serum high density lipoprotein cholesterol (p=0.0001) than men without diabetes mellitus. Diabetic women had a higher prevalence of coronary artery disease, ischemic stroke, and symptomatic peripheral arterial disease (p<0.0001); a higher prevalence of hypertension and obesity (p<0.0001); higher levels of serum total and low density lipoprotein cholesterol (p=0.0001) and triglycerides (p=0.005); and lower levels of serum high density lipoprotein cholesterol (p=0.0001) than women without diabetes mellitus.     

Why are South Asians seemingly protected against the development of atrial fibrillation? A review of current evidence

Atrial fibrillation (AF) is the commonest sustained cardiac arrhythmia and is strongly associated with conditions such as valvular heart disease, coronary artery disease and particularly hypertension and diabetes mellitus. The South Asian ethnic group have high rates of these conditions and so would be expected to be at significant risk of AF. However, observational studies have consistently shown that South Asians have a lower prevalence of AF compared with Caucasians. This article summarizes current evidence surrounding the development of AF and its relationship to ethnicity, offers potential reasons for this disparity and identifies future areas of research.     

Heart failure among South Asians: a narrative review of risk, nature, outcomes and management

Individuals of South Asian descent have a high prevalence of comorbidities that are risk factors for the development of heart failure (HF), including diabetes mellitus and metabolic syndrome. However, little is known about the prevalence of HF, its management and prognosis for this population compared to Caucasians. Therefore, a literature review relating to the nature, outcome and treatment of HF in South Asian patients compared to Caucasians was conducted. It was anticipated that collating existing studies in this manner would be useful for guiding professionals in managing HF within this ethnic group, given that to achieve optimal care, regimens need to take into account cultural differences that may impact on adherence. Reviewed literature showed that South Asians with HF were more likely to be younger and have diabetes and hypertension. These papers also implied that outcomes for South Asians with HF were similar or even better than for Caucasians. The review highlighted the under-representation of South Asians in HF trials, meaning that evidence-based recommendations tailored to this specific population are limited. This is an important consideration because ethnic differences in response to medication have been reported; it cannot be assumed that treatments shown to work for Caucasians will be efficacious for those from minority ethnic groups.     

Insulin resistance, diabetes, and risk markers for ischaemic heart disease in Asian men and non-Asian in Bradford.

OBJECTIVE--To examine the hypothesis, in a community not studied before, that insulin resistance associated with centralised adiposity is the mechanism underlying the predisposition of Asian immigrant communities to both ischaemic heart disease and diabetes mellitus. DESIGN--Cross sectional study within one socioeconomic stratum. SETTING--Two factories in the textile sector in Bradford, West Yorkshire. SUBJECTS--Male manual workers of Asian (110) and non-Asian origin (156) aged 20-65 years. RESULTS--Diabetes was almost three times more prevalent in the Asian group. Two hours after an oral glucose load Asian men had double the serum insulin concentrations of non-Asian men (p < 0.0001). Asian men also had significantly lower concentrations of plasma total cholesterol (p < 0.03), high density lipoprotein cholesterol (HDL) (HDL2, p < 0.0001; HDL3, p < 0.0001), and apolipoprotein AI (p < 0.0001). Fasting plasma triglyceride concentrations were slightly higher (p = 0.072) in the Asian men; thus the ratio of triglyceride cholesterol was higher (p = 0.006). The inter-relation between serum insulin and plasma lipid concentrations indicated metabolic differences between the ethnic groups. Insulin concentrations were associated with cholesterol concentrations in the Asian men only and there was a lack of association between triglyceride, low density lipoprotein cholesterol, and HDL cholesterol in this group. The risk marker profile in the Asian men was therefore quite different to that of their non-Asian counterparts and was associated with a greater tendency to centralised adiposity. CONCLUSION--These data support the insulin resistance hypothesis and thus have important implications for strategies for the prevention of heart disease in Asian communities in the United Kingdom.     

Increased fibrinogen,von Willebrand factor and tissue plasminogen activator levels in insulin resistant South Asian patients with ischaemic stroke

The aim of this study was to determine differences in atherothrombotic risk factors in South Asian subjects with a history of ischaemic stroke and South Asian subjects free from personal and family history of clinically detectable stroke. Eighty South Asian patients with ischaemic stroke (confirmed on cranial computerised scan) and 80 South Asian controls with similar age and gender distributions were recruited at random. The frequency of hypertension (P=<0.0001), myocardial infarction (P=0.003) and diabetes mellitus (<0.0001) were significantly higher in stroke patients. Stroke patients had lower high-density lipoprotein cholesterol (0.95 vs. 1.1 mmol/l, P=<0.0001), higher plasma glucose (8.1 vs. 6.6 mmol/l, P=0.01) and trendwise higher HBA(1C) (6.4 vs. 6.0%, P=0.09). There was no difference in insulin levels but insulin resistance was significantly higher in stroke patients (3.75 vs. 2.66, P=0.01). Stroke patients showed elevated levels of fibrinogen (3.78 vs. 3.41 mg/dl, P=0.02), von Willebrand factor (1.78 vs. 1.50 IU/ml, P=0.006) and tissue plasminogen activator (12.8 vs. 11.3 ng/ml, P=0.04), but the differences did not persist after adjustment for glucose, triglycerides, HDL, WHR, and BMI. Higher levels of fibrinogen, von Willebrand factor and t-PA in South Asian stroke patients disappeared after adjustment for features of insulin resistance syndrome but persisted after adjustment for presence of diabetes, confirming that these changes are essentially dependant on features of insulin resistance syndrome. A prospective study would be required to elucidate the role of thrombotic risk factors in South Asians with ischaemic stroke.     

Pakistan National Diabetes Survey: Prevalence of glucose intolerance and associated factors in the Punjab Province of Pakistan

AimsThe prevalence of diabetes mellitus and impaired glucose tolerance (IGT) and their relationship to age and obesity were estimated in Punjab, Pakistan by a population-based survey done in 1998.MethodsOral glucose tolerance tests were performed in a stratified random sample of 1852 adults aged ≥25 years. The diagnosis of diabetes and IGT were made on the basis of WHO criteria.ResultsThe prevalence of diabetes was 12.14% in males and 9.83% in females. Overall total glucose intolerance (diabetes and IGT) was present in 16.68% males and 19.37% females. Central obesity, hypertension and positive family history were strongly associated with diabetes.ConclusionsThese results indicate that the prevalence of glucose intolerance is high in the studied population and comparable with the published data from the other three provinces of Pakistan i.e. Sindh, Baluchistan and North West Frontier Province, studied by the same group.     

Ischaemic heart disease in Turkish migrants with type 2 diabetes mellitus in The Netherlands: wait for the next generation?

OBJECTIVE: To study the prevalence of ischaemic heart disease in Turkish and Surinam-Asian migrants with type 2 diabetes mellitus in the Netherlands as compared with Europeans. METHODS: In a consecutive case-control study, 59 Turkish and 62 Surinam-Asian patients were compared with 185 Europeans referred to a diabetes clinic for treatment of type 2 diabetes in the period 1992 to 1998. Main outcome measures were ischaemic heart disease and its associated risk factors. RESULTS: The prevalence of ischaemic heart disease was lower (9%) in the Turks (p < 0.02), but higher (29%) in the Surinam-Asians compared with the Europeans (23%). The Turks (52 +/- 10 years) and Surinam-Asians (46 +/- 12 years) were younger than the Europeans (64 +/- 11 years, p < 0.001). Body mass index was 32 +/- 5 (p < 0.001) in the Turks, 27 +/- 5 in the Surinam-Asians (p < 0.05) and 29 +/- 5 in the Europeans. Turkish patients smoked less (23%, p < 0.05) and used less alcohol (4%, p < 0.05) than the Europeans. Proteinuria was found in 24% of the Turks (p < 0.05), 37% of the Surinam-Asians (NS) and 46% of the Europeans. In univariate analysis ischaemic heart disease was related to Turkish origin, OR 0.34 (0.14-0.83) p < 0.02, to Surinam-Asian origin, OR 1.84 (1.00-3.38) p = 0.05, and smoking, OR 1.78 (1.18-2.68) p < 0.01. Other variables were not related to ischaemic heart disease. Multivariate analysis in a model with ethnicity and smoking showed significant relations between ischaemic heart disease and Turkish ethnicity, OR 0.19 (0.06-0.65) p = 0.007, Surinam-Asian origin, OR 2.77 (1.45-5.28) p = 0.002, and smoking, OR 1.79 (1.20-2.66) p = 0.004. CONCLUSION: Type 2 diabetes mellitus in different ethnic groups results in a significant difference in incidence of ischaemic heart disease. The most remarkable finding is a low incidence of ischaemic heart disease in the Turkish patients with type 2 diabetes, independent of smoking. The high prevalence of ischaemic heart disease in young migrant Asians with diabetes is confirmed.     

A comparison of the clinical features and vascular complications of diabetes between migrant Asians and Caucasians in Leicester, U.K.

907 consecutive patients, (456 Asian and 451 Caucasian) were assessed, employing a similar methodology to the multi-centre WHO study. The Asians were older at diagnosis (46.5 years compared with 40.6 years, P less than 0.01); they had a shorter duration of diabetes (6.3 years versus 11.4 years, P less than 0.1), a higher rate of diabetes in the first degree relatives (29.5% compared with 16%, P less than 0.1), less ketonuria at presentation (85.3% compared with 47.8%, P less than 0.1), and fewer were treated with insulin (31.4% compared with 68.7%). Comparing the prevalence of complications between Asians and Caucasians, the ischaemic heart disease rate was similar; peripheral vascular disease was less (3.7% Asian, 9.3% Caucasian, P less than 0.05); retinopathy was less (11.6% Asian, 32.3% Caucasian, P less than 0.01) but renal disease was more (22.3% Asian, 12.6% Caucasian, P less than 0.01). After adjusting for age, sex, duration of diabetes, age at diagnosis, hypertension, smoking and treatment with or without insulin, these differences remained significant. Multivariate logistic regression failed to reveal a significant contribution due to any of the above variables, or due to body mass index (BMI), haemoglobin A (HbA1), or physical activity in the prevalence of complications in Asians compared with Caucasians. Marked heterogeneity in the complications of diabetes in the two ethnic groups studied was found, but must be confirmed from population-based studies.