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Adult-onset diabetes in Middle Eastern immigrants to Sweden : Novel subgroups and diabetic complications—The All New Diabetes in Scania cohort diabetic complications and ethnicity

Bennet, Louise LU orcid ; Nilsson, Christopher LU orcid ; Mansour-Aly, Dina LU ; Christensson, Anders LU ; Groop, Leif LU and Ahlqvist, Emma LU (2021) In Diabetes/Metabolism Research and Reviews 37(6).
Abstract

Background: Middle Eastern immigrants to Europe represent a high risk population for type 2 diabetes. We compared prevalence of novel subgroups and assessed risk of diabetic macro- and microvascular complications between diabetes patients of Middle Eastern and European origin. Methods: This study included newly diagnosed diabetes patients born in Sweden (N = 10641) or Iraq (N = 286), previously included in the All New Diabetes in Scania cohort. The study was conducted between January 2008 and August 2016. Patients were followed to April 2017. Incidence rates in diabetic macro- and microvascular complications were assessed using cox-regression adjusting for the confounding effect of age at onset, sex, anthropometrics, glomerular... (More)

Background: Middle Eastern immigrants to Europe represent a high risk population for type 2 diabetes. We compared prevalence of novel subgroups and assessed risk of diabetic macro- and microvascular complications between diabetes patients of Middle Eastern and European origin. Methods: This study included newly diagnosed diabetes patients born in Sweden (N = 10641) or Iraq (N = 286), previously included in the All New Diabetes in Scania cohort. The study was conducted between January 2008 and August 2016. Patients were followed to April 2017. Incidence rates in diabetic macro- and microvascular complications were assessed using cox-regression adjusting for the confounding effect of age at onset, sex, anthropometrics, glomerular filtration rate (eGFR) and HbA1c. Findings: In Iraqi immigrants versus native Swedes, severe insulin-deficient diabetes was almost twice as common (27.9 vs. 16.2% p < 0.001) but severe insulin-resistant diabetes was less prevalent. Patients born in Iraq had higher risk of coronary events (hazard ratio [HR] 1.84, 95% CI 1.06–3.12) but considerably lower risk of chronic kidney disease (CKD) than Swedes (HR 0.19; 0.05–0.76). The lower risk in Iraqi immigrants was partially attributed to better eGFR. Genetic risk scores (GRS) showed more genetic variants associated with poor insulin secretion but lower risk of insulin resistance in the Iraqi than native Swedish group. Interpretation: People with diabetes, born in the Middle East present with a more insulin-deficient phenotype and genotype than native Swedes. They have a higher risk of coronary events but lower risk of CKD. Ethnic differences should be considered in the preventive work towards diabetes and its complications.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
ethnicity, GRS, macrovascular diabetic complications, microvascular diabetic complications, novel subgroups of diabetes, SIDD, SIRD, ANDIS, diabetes
in
Diabetes/Metabolism Research and Reviews
volume
37
issue
6
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:33119194
  • scopus:85096654550
ISSN
1520-7552
DOI
10.1002/dmrr.3419
project
Aspects of ethnicity on blood pressure regulating mechanisms and kidney function
The MEDIM project
language
English
LU publication?
yes
id
cfd17829-2b2f-4582-bd26-853ce643bb1d
date added to LUP
2020-12-07 13:43:50
date last changed
2024-04-17 20:05:01
@article{cfd17829-2b2f-4582-bd26-853ce643bb1d,
  abstract     = {{<p>Background: Middle Eastern immigrants to Europe represent a high risk population for type 2 diabetes. We compared prevalence of novel subgroups and assessed risk of diabetic macro- and microvascular complications between diabetes patients of Middle Eastern and European origin. Methods: This study included newly diagnosed diabetes patients born in Sweden (N = 10641) or Iraq (N = 286), previously included in the All New Diabetes in Scania cohort. The study was conducted between January 2008 and August 2016. Patients were followed to April 2017. Incidence rates in diabetic macro- and microvascular complications were assessed using cox-regression adjusting for the confounding effect of age at onset, sex, anthropometrics, glomerular filtration rate (eGFR) and HbA1c. Findings: In Iraqi immigrants versus native Swedes, severe insulin-deficient diabetes was almost twice as common (27.9 vs. 16.2% p &lt; 0.001) but severe insulin-resistant diabetes was less prevalent. Patients born in Iraq had higher risk of coronary events (hazard ratio [HR] 1.84, 95% CI 1.06–3.12) but considerably lower risk of chronic kidney disease (CKD) than Swedes (HR 0.19; 0.05–0.76). The lower risk in Iraqi immigrants was partially attributed to better eGFR. Genetic risk scores (GRS) showed more genetic variants associated with poor insulin secretion but lower risk of insulin resistance in the Iraqi than native Swedish group. Interpretation: People with diabetes, born in the Middle East present with a more insulin-deficient phenotype and genotype than native Swedes. They have a higher risk of coronary events but lower risk of CKD. Ethnic differences should be considered in the preventive work towards diabetes and its complications.</p>}},
  author       = {{Bennet, Louise and Nilsson, Christopher and Mansour-Aly, Dina and Christensson, Anders and Groop, Leif and Ahlqvist, Emma}},
  issn         = {{1520-7552}},
  keywords     = {{ethnicity; GRS; macrovascular diabetic complications; microvascular diabetic complications; novel subgroups of diabetes; SIDD; SIRD; ANDIS; diabetes}},
  language     = {{eng}},
  number       = {{6}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Diabetes/Metabolism Research and Reviews}},
  title        = {{Adult-onset diabetes in Middle Eastern immigrants to Sweden : Novel subgroups and diabetic complications—The All New Diabetes in Scania cohort diabetic complications and ethnicity}},
  url          = {{http://dx.doi.org/10.1002/dmrr.3419}},
  doi          = {{10.1002/dmrr.3419}},
  volume       = {{37}},
  year         = {{2021}},
}