Age, ethnicity and deprivation levels determine type 2 diabetes risk: new study
“Our findings emphasise that clinicians need to recognise the differing risk across their patient populations to implement appropriate prevention strategies,” the researchers wrote.
The study “Risk of progression from pre-diabetes to type 2 diabetes in a large UK adult cohort” was published in Diabetic Medicine.
While all ethnic groups are affected by type 2 diabetes, South Asians and Blacks have a two to a four-fold higher risk of developing the condition than Caucasians. Moreover, older adults and those with high levels of social deprivation have an increased risk.
Pre-diabetes is when blood sugar levels are higher than normal but not high enough to be classified as type 2 diabetes. It considerably increases the risk of type 2 diabetes in all ethnic groups. Although past studies have shown links between ethnicity, social deprivation and age on the risk of developing pre-diabetes or type 2 diabetes, very few have investigated if the risk of progressing from pre-diabetes to type 2 diabetes differs by ethnicity, deprivation and age.
Now, UK researchers analysed patient data from over 787 general practices across the UK collected between January 2005 and December 2017. Patient data included demographics, co-existing conditions and treatments.
At the start of the study, 397,853 adults [mean age 63 years, BMI 29.7, 50.4% male] were diagnosed with pre-diabetes. A total of 45.1% were white, 3.1% were South Asian, 1.6% were Black, and 0.7% were Mixed-Race.
The diabetes incident rate for the cohort was 53.5 per 1000 person-years. Compared to white Europeans, South Asians and Mixed-Race individuals had a 31% and 22% higher risk of progressing from pre-diabetes to type 2 diabetes, respectively, even after considering age, gender, BMI, ethnicity, deprivation, smoking status, medication, high blood pressure and previous heart disease. The risk of progression from pre- to type 2 diabetes was similar in Black and white Europeans.
“A higher risk of progression from pre-diabetes to type 2 diabetes in South Asian individuals compared with white Europeans might be due to biological susceptibility,” the researchers wrote. “South Asian individuals develop type 2 diabetes at a younger age than white European individuals, are more insulin resistant and experience earlier decline in beta cell function.”
They also “appear to be less physically active than local white Europeans and have diets richer in carbohydrates and saturated fats.” These factors increase type 2 diabetes risk.
A greater percentage of Black (28%) and South Asian (18%) individuals were from the most socially deprived groups, compared with 12% for white Europeans. Compared to the least deprived, the most deprived had a 17% higher risk of progression from pre- to type 2 diabetes. Interestingly this finding was most evident among White Europeans.
Besides a lack of access to healthy food options and physical activity amenities, there are several reasons why social deprivation may increase the risk of progression to type 2 diabetes. “As well as behavioural factors, the physical and social environments such as poor living conditions, and unemployment, might exacerbate risk…Unemployment might lead to chronic stress, anxiety, unhealthy foods choices and hence an increased risk of type 2 diabetes,” the researchers wrote
Individuals younger than 30 years and those older than 65 had a 37% and 15% lower risk of progressing to type 2 diabetes, respectively than those aged 40 to 65. ‘As expected,’ individuals with overweight or obesity had a 58% higher risk of progression than underweight or normal-weight individuals.
The researchers highlighted some limitations to the study, including missing ethnicity data for 49% of the cohort.
Still, the results showed that South Asian, Mixed-Rice individuals and people with social deprivation have a higher risk of progression from pre-diabetes to type 2 diabetes.
“These findings are key to improving referral for highest risk individuals to appropriate interventions,” the researchers concluded.
The Take-home Message
South Asians, Mixed Race, Black individuals have a higher risk of type 2 diabetes than white Europeans. Higher BMIs, social deprivation and being older also increases the risk of the condition. However, diabetes is becoming common in younger individuals because of unhealthy diets and sedentary lifestyles.
If you are overweight, with high blood pressure, over age 25 and Black, South Asian or Mixed Race with a family history of diabetes, it is worth scheduling a blood test with your doctor to check your blood sugar levels. Whether or not you have prediabetes or type 2 diabetes, adopting a healthy diet with moderate, regular exercise can lower your blood sugar and boost your health.
Schedule a free consultation here if you need help changing your lifestyle.