Diabetes problems differ in keeping with ethnicity, disease-related subgroups

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January 27, 2021

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The risk of diabetes complications varies by subgroup in terms of age of onset, HbA1c, obesity, and insulin use. According to study data, there are racial and ethnic differences in the composition of each subgroup.

“Our results contribute to a growing body of research showing that type 2 diabetes can be broken down into finer subgroups of diseases that vary in risk of complications.” Mike Bancks, PhD, an assistant professor at the Wake Forest School of Medicine, said Healio. “In our study, we included a clinical population of South Asian, non-Hispanic White, Chinese, Hispanic, and Black Americans to make this area of ​​research more applicable to a wider audience.”

Bancks is an assistant professor at the Wake Forest School of Medicine.

Bancks and colleagues analyzed pooled data from two observational epidemiological studies in the United States, the Mediators of Atherosclerosis in South Asians Living in America (MASALA) and the Multiethnic Study of Atherosclerosis (MESA). The MASALA study enrolled South Asian adults aged 40 to 84 who lived in metropolitan areas of Chicago and San Francisco. The participants had no cardiovascular diseases during their basic visit from 2010 to 2013. Follow-up visits were carried out from 2015 to 2018. MESA included white, black, Hispanic, and Sino-American adults aged 45 to 84 years without CVD from six metropolitan areas in the US From 2000 to 2002, base visits were made, and participants were invited to attend five follow-up visits. Researchers received and analyzed data on demographics, medical history, drug use, health behavior, blood samples, and CT scans.

Ethnic composition of subgroups

The study enrolled 1,293 participants (46.4% women) with diabetes, of whom 217 were South Asian, 240 were white, 125 were Chinese-American, 387 were black, and 324 were Spanish. The researchers divided the cohorts into five subgroups: older age at onset of diabetes (n = 554), severe hyperglycemia (n = 340), severe obesity (n = 259), younger age at onset of diabetes (n = 19), and insulin use (n = 121). The subgroup assignment differed according to ethnicity. The most likely subgroup assignment was older age at the onset of diabetes, with the exception of South Asians, who were the most likely subgroup to have severe hyperglycemia.

“The diabetes subgroups were not racially / ethnically composed,” said Bancks. “We know that experienced racism and structural differences in life situations and access to health care affect the health of individuals in obvious and less subtle ways. These factors can also affect what subtype of diabetes a person will develop. This is worrying as the risk of subclinical kidney and heart disease was not uniform across the diabetes subgroups. These results provide a framework for future research to identify the social determinants of belonging to a diabetes subgroup and to develop more effective prevention and treatment strategies. “

Risk of complications by subgroup, ethnicity

Of the five diabetes subgroups, those with severe hyperglycemia and severe obesity had the highest mean systolic blood pressure. The severe hyperglycemia subgroup had the highest total cholesterol, while the severe obesity group had the lowest HDL cholesterol. The group with severe hyperglycemia had the highest risk of atherosclerotic CVD, while the younger age in the cohort with diabetes had the lowest risk. The subgroup for severe hyperglycemia also had the highest adjusted mean estimated glomerular filtration rate, while the subgroup for insulin use had the lowest.

There were 176 cases of chronic kidney disease at baseline. Among the ethnic groups, the prevalence of CRF was highest in white participants. After adjusting for ethnicity and clinical risk factors, the insulin subgroup had the highest likelihood of predominant CRF and the subgroup of severe hyperglycemia the lowest. Among those without baseline CKD, there were 176 cases of CKD at follow-up. Black and Hispanic participants were most likely to have CKD incidents, greater than 20% for both. In custom analyzes, the insulin use subgroup had the highest risk of CRF incidents.

There were 782 participants with a coronary artery calcium (CAC) greater than 0 Agatston units at baseline and 435 participants with a CAC greater than 100 Agatston units. When broken down by ethnicity, black participants were least likely to have a predominant baseline CAC. In adapted analyzes, the young age at the onset of diabetes and insulin-consuming groups had the highest probability of a predominant CAC. There were 127 cases of CAC incidents at follow-up among subjects with a baseline CAC of 0 Agatston Units. South Asians had the highest likelihood of CAC incidents by ethnicity, and Chinese, Black, and Hispanic participants had the lowest. Adjusted analyzes showed that those in the severe hyperglycemia subgroup were most likely to have CAC events, and younger ages were the lowest in the diabetes subgroup.

The results of the study can be used by providers to develop individual strategies for diabetics, the researchers wrote.

“Health care providers can identify which diabetes subgroup their patient is most likely to target and what subclinical complications are most likely for that diabetic subgroup, and then work with their patient to develop strategies to prevent clinical events from occurring,” said Bancks.

For more informations:

Mike Bancks, PhD, can be reached at mbancks@wakehealth.edu.

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Race and medicine

Race and medicine