‘Strikingly different’ drivers of early type 2 diabetes onset in Asians, Europeans
medwireNews: The “classic” metabolic contributors to early-onset type 2 diabetes risk in European people explain little of the risk in Asian people, shows a comparison of Scottish and Asian Indian cohorts.
Metabolic syndrome features such as adiposity, blood pressure, and lipid profiles explained 25% of the variance in age at type 2 diabetes diagnosis in the White European cohort, composed of 42,551 people from the east of Scotland.
But these explained just 9% of the variance in age among 55,148 people from Chennai, India, Moneeza Siddiqui (University of Dundee, UK) told delegates at the 55th EASD Annual Meeting in Barcelona, Spain.
She noted that the countrywide prevalence of type 2 diabetes in India is nearly double that in the UK, and Asian Indian people develop the condition 5 to 10 years earlier, on average, than European people.
Indeed, in the current study, the average age at diagnosis was 47 versus 62 years for the Indian and Scottish cohorts, respectively. Men were diagnosed at a younger age than women in both cohorts.
The Indian cohort had high glycated hemoglobin at diagnosis, irrespective of their age at the time, whereas Scottish men had high levels only when diagnosed young (in their 30s or 40s), and Scottish women had relatively low levels at all ages.
In the Scottish cohort, both BMI and waist circumference were higher with earlier age at diagnosis, whereas this was not the case for the Indian cohort. Blood pressure was markedly higher overall in the Scottish than Indian people with diabetes.
Lipid profiles related more to gender than to ethnicity, although they were worst overall in Indian men, Siddiqui reported.
In the Indian cohort, beta-cell function was lower the younger people were at diagnosis, whereas insulin sensitivity did not change with diagnosis age. Data on beta-cell function were not available for the Scottish cohort, but data from other European studies have shown no association between this and age at diabetes diagnosis.
Accounting for beta-cell function, as well as family history and inflammation, in addition to the other metabolic risk factors, much improved the explanation of variance in diagnosis age in the Indian people with diabetes, accounting for 26%.
“We believe our data show that an ethnic-specific approach to risk prediction, disease prevention, and treatment is essential,” concluded Siddiqui.
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