Abstract
PurposeEthnic variation in risk of type 2 diabetes is well established, but its impact on mortality is less well understood. This study investigated the risk of all-cause and cardiovascular mortality associated with newly diagnosed type 2 diabetes in White, Asian and Black adults who were overweight or obese.MethodsThis population-based cohort study used primary care records from the UK Clinical Practice Research Datalink, linked with secondary care and death registry records. A total of 193,528 obese or overweight adults (BMI of 25 or greater), with ethnicity records and no pre-existing type 2 diabetes were identified between 01 January 1995 and 20 April 2018. Multivariable Cox proportional hazards regression estimated hazards ratios (HR) for incident type 2 diabetes in different ethnic groups. Adjusted hazards ratios for all-cause and cardiovascular mortality were determined in individuals with newly diagnosed type 2 diabetes.ResultsDuring follow-up (median 9.8 years), the overall incidence rate of type 2 diabetes (per 1,000 person-years) was 20.10 (95% CI 19.90–20.30). Compared to Whites, type 2 diabetes risk was 2.2-fold higher in Asians (HR 2.19 (2.07–2.32)) and 30% higher in Blacks (HR 1.34 (1.23–1.46)). In individuals with newly diagnosed type 2 diabetes, the rates (per 1,000 person-years) of all-cause mortality and cardiovascular mortality were 24.34 (23.73–24.92) and 4.78 (4.51–5.06), respectively. Adjusted hazards ratios for mortality were significantly lower in Asians (HR 0.70 (0.55–0.90)) and Blacks (HR 0.71 (0.51–0.98)) compared to Whites, and these differences in mortality risk were not explained by differences in severity of hyperglycaemia.Conclusions/InterpretationType 2 diabetes risk in overweight and obese adults is greater in Asian and Black compared to White ethnic populations, but mortality is significantly higher in the latter. Greater attention to optimising screening, disease and risk management appropriate to all communities with type 2 diabetes is needed.
Highlights
The global prevalence of type 2 diabetes mellitus (T2DM) has been increasing steadily for the past 3 decades [1], with 80–85 percent of this burden resulting from obesity and overweight [2]
In the non-White ethnic groups, the prevalence of overweight and obesity increased with increasing levels of deprivation, with the steepest gradient observed in the Black ethnic population
Previous studies have explored the risks of T2DM incidence among different ethnic populations [3, 4, 24], this study uniquely explored the risk of T2DM associated with ethnicity in a population of individuals who were overweight or obesity
Summary
The global prevalence of type 2 diabetes mellitus (T2DM) has been increasing steadily for the past 3 decades [1], with 80–85 percent of this burden resulting from obesity and overweight [2]. While it is known that T2DM increases the risk of death [5, 6], there is conflicting evidence on how increased mortality risk associated with T2DM varies among ethnic populations [7, 8]. Recent work suggests previously observed excess mortality in South Asians with T2DM, may have been reversed [9]. It is not known whether the risk of mortality in overweight or obese individuals with T2DM differs by ethnicity
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