Comparison of body mass index at diagnosis of diabetes in a multi-ethnic population:a case-control study with matched non-diabetic controls

Aims: To investigate the probability of developing type 2 diabetes mellitus (T2DM) at different body mass index levels compared to matched non-diabetic controls in a multi-ethnic population. Materials and methods: This was a case-control study of 90 367 patients with incident diabetes and 362 548 age-sex-ethnicity matched controls from UK primary care. The probability of developing T2DM was estimated. Results: Case and control patients were 56 years old at index and 56% were male. Patients with T2DM had significantly higher mean BMI levels by about 5 kg/m2 at diagnosis (32.2 kg/m2) compared to the matched controls (27.4 kg/m2). White Europeans (n = 79 270), African-Caribbeans (n = 4115) and South Asians (n = 7252) were 58, 48 and 46 years old with a mean BMI of 32.5, 31.1 and 29.2 kg/m2, respectively, at diagnosis. More South Asians developed T2DM at BMI below 30 kg/m2 (38%) than White Europeans (26%) and African-Caribbeans (29%) (all P <.01). Within the 18 to 70-year age range, South Asian males and females had a significantly higher probability of developing diabetes in the continuously measured BMI range of 18 to 30 kg/m2, compared to White Europeans and African-Caribbeans. Across all age groups <70 years, South Asians and African-Caribbeans had a significantly higher probability of developing T2DM in the normal weight and overweight categories, compared to White Europeans. However, this risk pattern of developing diabetes was reversed amongst the obese in all age groups. Conclusion: Risk patterns of developing diabetes at different levels of obesity varies among ethnic groups across all ages, while South Asians and African-Caribbeans carry the highest risk at a younger age and at lower adiposity burden

Blood lipid levels in relation to glucose status in seven populations of Asian origin without a prior history of diabetes: the DECODA study

Background: Dyslipidaemia commonly coexists with diabetes. We investigated the association of lipid profiles with glucose levels in populations of Asian origin without a prior history of diabetes. Methods: Cross-sectional data of 10 374 men and 12 552 women aged 30-74 years from 14 cohorts, representing seven populations of Asian origin were jointly analysed. Multivariable adjusted linear regression analyses with standardized regression coefficients (β) were performed to estimate relationships between lipids and plasma glucose. Results: Within each glucose category, fasting plasma glucose (FPG) levels were correlated with increasing levels of triglycerides (TGs), total cholesterol (TC), TC to high-density lipoprotein (HDL) ratio and non-HDL cholesterol (non-HDL-C) (p < 0.05 in most of the ethnic groups) and inversely associated with HDL-C (p < 0.05 in some, but not all, of the populations). The association of lipids with 2-h plasma glucose (2hPG) followed a similar pattern as that for the FPG, except that an inverse relationship between HDL-C and glucose was more commonly observed for 2hPG than for FPG among different ethnic groups. Conclusions: Hyperglycaemia is associated with adverse lipid profiles in Asians without a prior history of diabetes. The 2hPG appears to be more closely associated with lipid profiles than does FPG. When assessing the risk of cardiovascular disease, the association of the dyslipidaemia with intermediate hyperglycaemia needs to be considered. Copyright © 2009 John Wiley & Sons, Ltd.link_to_subscribed_fulltex

Distinct Ethnic Differences in Lipid Profiles across Glucose Categories

Context: Dyslipidemia coexists with hyperglycemia. However, little is known about the ethnic differences in lipid profiles at comparable glucose tolerance status. Objective: The aim was to study ethnic differences in lipid profiles stratified by glucose levels. Design and Setting: Data from 31 study cohorts of 12 countries, consisting of 24,760 men and 27,595 women aged 25-74 yr, were compared. The odds ratio for having dyslipidemia was estimated for each ethnic group stratified by glucose categories. Results: Compared with central and northern Europeans, multivariable adjusted odds ratios (95% confidence intervals) for having lower high-density lipoprotein-cholesterol were 4.74 (4.19-5.37), 5.05 (3.88-6.56), 3.07 (2.15-4.40), and 2.37 (1.67-3.35) in Asian Indian men, but 0.12 (0.09-0.16), 0.07 (0.04-0.13), 0.11 (0.07-0.20), and 0.16 (0.08-0.32) in Chinese men who had normoglycemia, prediabetes, and undiagnosed and diagnosed diabetes, respectively. Similar results were obtained for women. The prevalence of low high-density lipoprotein-cholesterol remained higher in Asian Indians (62.8% of the nondiabetic and 67.4% of the diabetic) than in central and northern Europeans (20.3 and 37.3%), Japanese (25.7 and 34.1%), or Qingdao Chinese (15.7 and 17.0%), even in individuals with low-density lipoprotein-cholesterol of less than 3 mmol/liter. Conclusion: There are distinct patterns of lipid profiles associated with ethnicity regardless of the glucose levels, suggesting that ethnic-specific strategies and guidelines on risk assessment and prevention of cardiovascular disease are required. Copyright © 2010 by The Endocrine Society.link_to_subscribed_fulltex

Prevalence of undiagnosed Type 2 diabetes and impaired fasting glucose in older British men and women.

AIM: To estimate the prevalence of undiagnosed diabetes and impaired fasting glucose in older British men and women, using the 1999 World Health Organization (WHO) thresholds based on fasting glucose measurements. METHODS: Participants in the British Regional Heart Study and the British Women's Heart and Health Study were selected from one socially representative general practice in 24 British towns. Included in this analysis were 3736 men and 3642 women aged 60-79 years (predominantly white), who provided a single fasting blood sample at a clinical examination between 1998 and 2001, and who had no previous diagnosis of diabetes. RESULTS: Two hundred and eleven men (5.7%) and 190 women (5.2%) had a fasting blood glucose level consistent with the WHO threshold for a diagnosis of diabetes (> or = 7.0 mmol/l), whilst a further 667 men (17.9%) and 642 women (17.6%) had impaired fasting glucose levels (6.1 < or = 7 mmol/l). When analyses were restricted to subjects who had fasted for at least 8 h, and whose blood sample was taken before 12.00 h, the predicted prevalence of undiagnosed diabetes (based on two separate measurements) was 6.7% in men and 6.0% in women. The predicted prevalence of impaired fasting glucose (based on two separate measurements) was approximately 20% in both sexes. CONCLUSIONS: More than one-fifth of older white British men and women have either undiagnosed diabetes or impaired fasting glucose according to new WHO criteria. Strategies for the primary and secondary prevention of Type 2 diabetes among older individuals are urgently needed