Racial differences in risk for poor diabetes outcomes highlighted
medwireNews: A large systematic review and meta-analysis has identified racial/ethnic differences in the risk for complications and all-cause mortality among people with diabetes.
“Our findings reinforce the need for improving identification of high-risk groups, and for intensive control of cardiovascular [CV] risk factors across ethnically diverse populations, which may help delay and/or prevent a considerable proportion of future diabetic complications,” say Antonio García-Hermoso (Public University of Navarra, Pamplona, Spain) and co-authors.
The team analyzed data from 23 cohort studies involving more than 2.4 million people with diabetes, among whom there were 37,530 deaths, 5121 CV events, 90,125 cases of nephropathy, and 69,107 amputations over an average follow-up of 8.15 years.
As reported in Diabetologia, Māori people (n=56,966) had a significant 88% higher risk for mortality than White people (n=1,433,975), at estimated rates of 0.42% versus 0.15%. There were no significant differences in mortality risk among Black, Hispanic–American, or Pacific Islander versus White people, however.
These findings “are consistent with previous studies, which also reported Indigenous disparities in mortality risk among individuals with diabetes,” say García-Hermoso et al.
The researchers suggest that variables such as poor glycemic control, obesity, and socioeconomic disadvantage could partly explain the elevated mortality risk in Māori people, but note that these factors “do not explain the magnitude of the difference between Māori and other minority groups, such as Pacific Islanders,” considering their shared ancestry and similar access to care.
“The modifiable risk factors and health barriers contributing to the health disparities among Māori individuals with diabetes should, therefore, be identified and explored,” they say.
In the analysis of complications, Hispanic–American individuals (n=57,416) had a significant 34% lower risk for CV events and Black people (n=270,279) had a significant 54% higher risk for end-stage renal disease than their White counterparts. García-Hermoso and team note that other racial/ethnic groups (East and South Asian, Native American, or Pacific Islander) had a comparable risk for diabetes complications relative to White people.
These findings suggest that “[s]creening for early kidney disease, rigorous management of risk factors and further research on the aetiology of renal disease among Black individuals with diabetes” is warranted, say the study authors.
Despite the reduced risk for CV events among Hispanic–American people, the researchers stress that “intensive control of cardiovascular risk factors is recommended as in other racial/ethnic groups,” given that “it is unknown whether a protective effect against the development of macrovascular complications is present in Hispanic-American individuals.”
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