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Comorbidities, complications and mortality in people of South Asian ethnicity with type 1 diabetes compared with other ethnic groups: a systematic review

Abstract

Objective The aim of this systematic review is to explore the association of South Asian (SA) ethnicity on comorbidities, microvascular and macrovascular complications and mortality compared with other ethnic groups in people with type 1 diabetes mellitus (T1DM).

Design Systematic review.

Method A systematic literature search strategy was designed and carried out using Medline and Embase for full-text and abstract studies published in English from 1946 to February 2016. The initial search identified 4722 papers. We assessed 305 full-text articles in detail for potential inclusion. Ten papers met the inclusion criteria for review and an additional one paper was included from our secondary search strategy using the bibliography of included studies. In total, 11 studies were included.

Eligibility criteria for selecting studies Studies were included if they were published in English, involved SA participants with T1DM and compared them with non-SA participants and assessed one of the outcomes of comorbidities, microvascular complications, macrovascular complications and mortality.

Results SA with T1DM have higher mortality compared with white Europeans (WE), mainly contributed to by excess cardiovascular disease. SA have significantly higher glycated haemoglobin (HbA1c), lower high-density lipoprotein (HDL) and lower rates of neuropathy compared with WE. There were no differences in rates of retinopathy and nephropathy. Compared with Africans, SA had lower levels of microalbuminuria, HbA1c and systolic blood pressure and higher HDL levels. There were no significant differences in the remaining outcomes: cardiovascular disease, retinopathy, neuropathy and body mass index. Furthermore, SA have higher HbA1c levels than Malay and Chinese and higher waist–hip ratio and lower HDL levels compared with Chinese only.

Conclusion Our analysis highlights ethnic disparity in macrovascular outcomes that is so evident for type 2 diabetes mellitus may also be present for SA patients with T1DM. We highlight the need for a large, prospective, cohort study exploring the effect of ethnicity in a uniform healthcare setting.

  • type 1 diabetes mellitus
  • ethnicity
  • south asian

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Footnotes

  • Contributors KNS: involvement in the design of the work, data collection, data analysis, writing the paper, drafting and revision of the paper. PC:

    involvement in the design of the work, data collection, data analysis, helped with drafting and revision of the paper. PS:

    involvement in the design of the work, reviewed all drafts of the paper, helped with revision of the paper. KK:

    involvement in the design of the work, reviewed all drafts of the paper, helped with revision of the paper. KN:

    responsible for the conception and design of the work, reviewed all drafts of the paper, helped with revision of the paper. PN:

    responsible for the conception and design of the work, reviewed all drafts of the paper, helped with revision of the paper.

  • Competing interests KK (co-chair), PS and PN are the members of the South Asian Health Foundation Working group on diabetes.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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