Skip to main content
Top

11-23-2016 | Specific populations | Book chapter | Article

12. Diabetes in Ethnic Minorities and Immigrant Populations in Western Europe

Authors: Oliver Razum, Helmut Steinberg, MD

Publisher: Springer International Publishing

Abstract

All Western European countries have ethnic minorities and immigrant populations. The origin of these populations is largely due to resettlement from former colonies, due to need for labor, and, to a lesser degree, due to policies regulating the settlement of political refugees. Most research comes from local and regional studies with varying definitions of ethnicity and diabetes, and, therefore, cross-European comparisons are rare. Diabetes prevalence appears to be approximately twofold higher in ethnic minorities as compared to native populations; in addition, females are at higher risk to develop diabetes than their ethnic male counterparts. Most evidence points toward lifestyle, increased caloric intake, and decreased exercise, as the main driver of diabetes in these populations; there may be differences in metabolism and genetic susceptibility and the results of currently ongoing studies will shed more light into these issues. Earlier studies reported higher rates of microvascular complications in ethnic minorities, but more recent studies suggest that these between-population differences are becoming smaller. Access to health care is almost universal in Western European countries. Data for health-care delivery and utilization, however, are scarce mainly due to lack of recording ethnicity in the primary care setting. While available studies show similar access for health-care services between populations, they demonstrate lesser improvement in glucose control in ethnic minorities; language barriers, low health literacy, and cultural and religious norms are some factors that may explain the lesser success in treating diabetes. Development of culturally competent health-care systems, based on studies designed to identify successful interventions, is needed to reduce ethnic health disparities and improve outcomes.
Literature
1.
Agyemang C, Kunst AE, Bhopal R, Anujuo K, Zaninotto P, Nazroo J, Nicolaou M, Unwin N, van Valkengoed I, Redekop WK, Stronks K. Diabetes prevalence in populations of South Asian Indian and African origins: a comparison of England and the Netherlands. Epidemiology. 2011;22:563–7.CrossRefPubMed
2.
Anderson SG, Younger N, Heald AH, Tulloch-Reid MK, Simukonda WP, Mbanya JC, Jackson MD, Balkau B, Sharma S, Tanya A, Forrester T, Wilks R, Cruickshank JK. Nutrient intakes and dysglycaemia in populations of West African origin. Br J Nutr. 2011;105:297–306.CrossRefPubMed
3.
Anjana RM, Ranjani H, Unnikrishnan R, Weber MB, Mohan V, Narayan KM. Exercise patterns and behaviour in Asian Indians: data from the baseline survey of the Diabetes Community Lifestyle Improvement Program (D-CLIP). Diabetes Res Clin Pract. 2015;107:77–84.CrossRefPubMed
4.
Ballotari P, Caroli S, Ferrari F, Romani G, Marina G, Chiarenza A, Manicardi V, Giorgi Rossi P. Differences in diabetes prevalence and inequalities in disease management and glycaemic control by immigrant status: a population-based study (Italy). BMC Public Health. 2015;15:87.CrossRefPubMedPubMedCentral
5.
Baradaran HR, Jamieson J, Gardee R, Knill-Jones RP. Scottish survey of diabetes services for minority ethnic groups. BMC Health Serv Res. 2006;6:130.CrossRefPubMedPubMedCentral
6.
Benhalima K, Song SH, Wilmot EG, Khunti K, Gray LJ, Lawrence I, Davies M. Characteristics, complications and management of a large multiethnic cohort of younger adults with type 2 diabetes. Prim Care Diabetes. 2011;5:245–50.CrossRefPubMed
7.
Bindraban NR, van Valkengoed IG, Mairuhu G, Holleman F, Hoekstra JB, Michels BP, Koopmans RP, Stronks K. Prevalence of diabetes mellitus and the performance of a risk score among Hindustani Surinamese, African Surinamese and ethnic Dutch: a cross-sectional population-based study. BMC Public Health. 2008;8:271.CrossRefPubMedPubMedCentral
8.
Chowdhury TA, Lasker SS. Complications and cardiovascular risk factors in South Asians and Europeans with early-onset type 2 diabetes. QJM. 2002;95:241–6.CrossRefPubMed
9.
Correspondent EUR. Commission calls to break circle of Roma health exclusion across Europe. Eureporter. 2014.
10.
Denktaş S, Koopmans G, Birnie E, Foets M, Bonsel G. Underutilization of prescribed drugs use among first generation elderly immigrants in the Netherlands. BMC Health Serv Res. 2010;10:176.CrossRefPubMedPubMedCentral
11.
Dreyer G, Hull S, Mathur R, Chesser A, Yaqoob MM. Progression of chronic kidney disease in a multi-ethnic community cohort of patients with diabetes mellitus. Diabet Med. 2013;30:956–63.CrossRefPubMed
12.
Earle KK, Porter KA, Ostberg J, Yudkin JS. Variation in the progression of diabetic nephropathy according to racial origin. Nephrol Dial Transplant. 2001;16:286–90.CrossRefPubMed
13.
Ehehalt S, Popovic P, Muntoni S, Willasch A, Hub R, Ranke MB, Neu A, Baden-Wuerttemberg DG. Incidence of diabetes mellitus among children of Italian migrants substantiates the role of genetic factors in the pathogenesis of type 1 diabetes. Eur J Pediatr. 2009;168:613–7.CrossRefPubMed
14.
Fagerli RA, Lien ME, Wandel M. Experience of dietary advice among Pakistani-born persons with type 2 diabetes in Oslo. Appetite. 2005;45:295–304.CrossRefPubMed
15.
Goyder EC, McNally PG, Botha JL. Inequalities in access to diabetes care: evidence from a historical cohort study. Qual Health Care. 2000;9:85–9.CrossRefPubMedPubMedCentral
16.
Guell C. Tactics of diabetes control Turkish immigrant experiences with chronic illness in Berlin. Germany: The University of Edinburgh; 2009. 265 p.
17.
Gujral UP, Pradeepa R, Weber MB, Narayan KM, Mohan V. Type 2 diabetes in South Asians: similarities and differences with white Caucasian and other populations. Ann N Y Acad Sci. 2013;1281:51–63.CrossRefPubMedPubMedCentral
18.
Heidemann C, Du Y, Schubert I, Rathmann W, Scheidt-Nave C. Prevalence and temporal trend of known diabetes mellitus: results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56:668–77.CrossRefPubMed
19.
Hewitt J. Ethnicity and prevalence of diabetic complications in elderly patients. In: Gallen I, editor. Pract Diabetes Int. 2004;139–42.
20.
Hidvegi T, Hetyesi K, Biro L, Nadas J, Jermendy G. Screening for metabolic syndrome within a minority ethnic group (adult gypsy people) in Hungary. Bratisl Lek Listy. 2012;113:721–4.PubMed
21.
Hjellset VT, Bjørge B, Eriksen HR, Høstmark AT. Risk factors for type 2 diabetes among female Pakistani immigrants: the InvaDiab-DEPLAN study on Pakistani immigrant women living in Oslo. Norway: J Immigr Minor Health. 2011;13:101–10.PubMed
22.
Hjern A, Söderström U. Parental country of birth is a major determinant of childhood type 1 diabetes in Sweden. Pediatr Diabetes. 2008;9:35–9.PubMed
23.
Hussen HI, Yang D, Cnattingius S, Moradi T. Type I diabetes among children and young adults: the role of country of birth, socioeconomic position and sex. Pediatr Diabetes. 2013;14:138–48.CrossRefPubMed
24.
Icks A, Razum O, Rosenbauer J, Bachle C, Hungele A, Monkemoller K, Muller-Godeffroy E, Heidtmann B, Kapellen T, Scheuing N, Holl RW, D. P. V. I. for the, E, The German Federal Ministry For, M. Research Competence Network Diabetes. Lower frequency of insulin pump treatment in children and adolescents of Turkish background with type 1 diabetes: analysis of 21,497 patients in Germany. Diabetes Technol Ther. 2012;14:1105–9.CrossRefPubMedPubMedCentral
25.
Jenum AK, Holme I, Graff-Iversen S, Birkeland KI. Ethnicity and sex are strong determinants of diabetes in an urban western society: implications for prevention. Diabetologia. 2005;48:435–9.CrossRefPubMed
26.
Jenum AK, Mørkrid K, Sletner L, Vangen S, Vange S, Torper JL, Nakstad B, Voldner N, Rognerud-Jensen OH, Berntsen S, Mosdøl A, Skrivarhaug T, Vårdal MH, Holme I, Yajnik CS, Birkeland KI. Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study. Eur J Endocrinol. 2012;166:317–24.CrossRefPubMedPubMedCentral
27.
Jenum AK, Sommer C, Sletner L, Mørkrid K, Bærug A, Mosdøl A. Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: a review. Food Nutr Res. 2013;57. doi:10.​3402/​fnr.​v57i0.​18889.
28.
Johnson M, Everson-Hock E, Jones R, Woods HB, Payne N, Goyder E. What are the barriers to primary prevention of type 2 diabetes in black and minority ethnic groups in the UK? Qual Evid Synth Diabetes Res Clin Pract. 2011;93:150–8.CrossRef
29.
Khalil A, Rezende J, Akolekar R, Syngelaki A, Nicolaides KH. Maternal racial origin and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol. 2013;41:278–85.CrossRefPubMed
30.
Kodama K, Tojjar D, Yamada S, Toda K, Patel CJ, Butte AJ. Ethnic differences in the relationship between insulin sensitivity and insulin response: a systematic review and meta-analysis. Diabetes Care. 2013;36:1789–96.CrossRefPubMedPubMedCentral
31.
Kósa Z, Moravcsik-Kornyicki Á, Diószegi J, Roberts B, Szabó Z, Sándor J, Ádány R. Prevalence of metabolic syndrome among Roma: a comparative health examination survey in Hungary. Eur J Public Health. 2015;25:299–304.CrossRefPubMed
32.
Kühlbrandt C, Footman K, Rechel B, McKee M. An examination of Roma health insurance status in Central and Eastern Europe. Eur J Public Health. 2014;24:701–2.CrossRef
33.
Leggetter S, Chaturvedi N, Fuller JH, Edmonds ME. Ethnicity and risk of diabetes-related lower extremity amputation: a population-based, case-control study of African Caribbeans and Europeans in the United Kingdom. Arch Intern Med. 2002;162:73–8.CrossRefPubMed
34.
Marchesini G, Bernardi D, Miccoli R, Rossi E, Vaccaro O, De Rosa M, Bonora E, Bruno G. Under-treatment of migrants with diabetes in a universalistic health care system: the ARNO observatory. Nutr Metab Cardiovasc Dis. 2014;24:393–9.CrossRefPubMed
35.
McHardy M. Necessity, concepts and feasibility of culturally tailored diabetes education for migrants in the Netherlands and the United Kingdom: a qualitative study on experts’ views. Hamburg: Hamburg University of Applied Sciences; 2014. 134 p.
36.
Nazroo JY, Falaschetti E, Pierce M, Primatesta P. Ethnic inequalities in access to and outcomes of healthcare: analysis of the Health Survey for England. J Epidemiol Community Health. 2009;63:1022–7.CrossRefPubMed
37.
Nicolaou M, Vlaar E, van Valkengoed I, Middelkoop B, Stronks K, Nierkens V. Development of a diabetes prevention program for Surinamese South Asians in the Netherlands. Health Promot Int. 2014;29:680–91.CrossRefPubMed
38.
Pallayova M, Rayner H, Taheri S, Dasgupta I. Is there a difference in progression of renal disease between South Asian and white European diabetic adults with moderately reduced kidney function? J Diabetes Complications. 2015;29:761–5.CrossRefPubMed
39.
Parry G, Van Cleemput P, Peters J, Walters S, Thomas K, Cooper C. Health status of Gypsies and Travellers in England. J Epidemiol Community Health. 2007;61:198–204.CrossRefPubMedPubMedCentral
40.
Patel JV, Vyas A, Prabhakaran D, Bhatnagar D, Durrington PN, Heald A, Hughes EA, Mackness MI, Reddy KS, Cruickshank JK. Nonesterified fatty acids as mediators of glucose intolerance in Indian Asian populations. Diabetes Care. 2005;28:1505–7.CrossRefPubMed
41.
Razum O, Spallek J. Addressing health-related interventions to immigrants: migrant-specific or diversity-sensitive? Int J Public Health. 2014;59:893–5.CrossRefPubMed
42.
Reeske A, Zeeb H, Razum O, Spallek J. Differences in the incidence of gestational diabetes between women of Turkish and German Origin: an analysis of Health Insurance Data from a Statutory Health Insurance in Berlin, Germany (AOK), 2005–2007. Geburtshilfe Frauenheilkd. 2012;72:305–10.CrossRefPubMedPubMedCentral
43.
RKI. Gesundheit in Deutschland. In: Koch-Institut R, editor, Gesundheitsberichterstattung des Bundes. Gemeinsam getragen von RKI und Destatis. Berlin: Robert Koch-Institut; 2015. p. 516.
44.
Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, Karsidag K, Genc S, Telci A, Canbaz B, Turker F, Yilmaz T, Cakir B, Tuomilehto J, Group T-IS. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013;28:169–80.CrossRefPubMedPubMedCentral
45.
Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, Bastar I, Tütüncü Y, Sargin M, Dinççag N, Karsidag K, Kalaça S, Ozcan C, King H. Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care. 2002;25:1551–6.CrossRefPubMed
46.
Scheuing N, Wiegand S, Bächle C, Fröhlich-Reiterer E, Hahn E, Icks A, Ludwig KH, Mönkemöller K, Razum O, Rosenbauer J, Holl RW, Initiative D. Impact of maternal country of birth on type-1-diabetes therapy and outcome in 27,643 children and adolescents from the DPV Registry. PLoS One. 2015;10:e0135178.CrossRefPubMedPubMedCentral
47.
Schrier AC, Ujcic-Voortman JK, de Wit MA, Verhoeff AP, Kupka R, Dekker J, Beekman AT. Ethnic differences in the association between cardiovascular risk factors and psychological distress in a population study in the Netherlands. BMC Public Health. 2012;12:1090.CrossRefPubMedPubMedCentral
48.
Seale C, Rivas C, Kelly M. The challenge of communication in interpreted consultations in diabetes care: a mixed methods study. Br J Gen Pract. 2013;63:e125–33.CrossRefPubMedPubMedCentral
49.
Sivaprasad S, Gupta B, Gulliford MC, Dodhia H, Mohamed M, Nagi D, Evans JR. Ethnic variations in the prevalence of diabetic retinopathy in people with diabetes attending screening in the United Kingdom (DRIVE UK). PLoS One. 2012;7:e32182.CrossRefPubMedPubMedCentral
50.
Telle-Hjellset V, Råberg Kjøllesdal MK, Bjørge B, Holmboe-Ottesen G, Wandel M, Birkeland KI, Eriksen HR, Høstmark AT. The InnvaDiab-DE-PLAN study: a randomised controlled trial with a culturally adapted education programme improved the risk profile for type 2 diabetes in Pakistani immigrant women. Br J Nutr. 2013;109:529–38.CrossRefPubMed
51.
Tillin T, Hughes AD, Godsland IF, Whincup P, Forouhi NG, Welsh P, Sattar N, McKeigue PM, Chaturvedi N. Insulin resistance and truncal obesity as important determinants of the greater incidence of diabetes in Indian Asians and African Caribbeans compared with Europeans: the Southall and Brent REvisited (SABRE) cohort. Diabetes Care. 2013;36:383–93.CrossRefPubMedPubMedCentral
52.
Tillin T, Hughes AD, Mayet J, Whincup P, Sattar N, Forouhi NG, McKeigue PM, Chaturvedi N. The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, south Asians, and African Caribbeans: SABRE (Southall and Brent revisited) – a prospective population-based study. J Am Coll Cardiol. 2013;61:1777–86.CrossRefPubMedPubMedCentral
53.
Wallia S, Bhopal RS, Douglas A, Bhopal R, Sharma A, Hutchison A, Murray G, Gill J, Sattar N, Lawton J, Tuomilehto J, Mcknight J, Forbes J, Lean M, Sheikh A. Culturally adapting the prevention of diabetes and obesity in South Asians (PODOSA) trial. Health Promot Int. 2014;29:768–79.CrossRefPubMed
54.
Wandel M, Råberg M, Kumar B, Holmboe-Ottesen G. Changes in food habits after migration among South Asians settled in Oslo: the effect of demographic, socio-economic and integration factors. Appetite. 2008;50:376–85.CrossRefPubMed
55.
Wilson C, Alam R, Latif S, Knighting K, Williamson S, Beaver K. Patient access to healthcare services and optimisation of self-management for ethnic minority populations living with diabetes: a systematic review. Health Soc Care Community. 2012;20:1–19.CrossRefPubMed
56.
Winkley K, Thomas SM, Sivaprasad S, Chamley M, Stahl D, Ismail K, Amiel SA. The clinical characteristics at diagnosis of type 2 diabetes in a multi-ethnic population: the South London Diabetes cohort (SOUL-D). Diabetologia. 2013;56:1272–81.CrossRefPubMed
57.
Yilmaz-Aslan Y, Brzoska P, Bluhm M, Aslan A, Razum O. Illness perceptions in Turkish migrants with diabetes. Qual Study Chron Illn. 2014;10:107–21.CrossRef
58.
Zeh P, et al. Cultural barriers impeding ethnic minority groups from accessing effective diabetes care services: a systematic review of observational studies. Divers Equal Health Care. 2014;11:9–33.
59.
Nazroo JY. The health of Britian’s ethnic minorities: findings from a national survey. London: Policy Studies Institute, 1997.

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »