Vascular complications of black patients with type 2 diabetes mellitus in Southern Brazil

Abstract

Ethnicity has been shown to be associated with micro-and macrovascular complications of diabetes in European and North American populations. We analyzed the contribution of ethnicity to the prevalence of micro-and macrovascular complications in Brazilian subjects with type 2 diabetes attending the national public health system. Data from 1810 subjects with type 2 diabetes (1512 whites and 298 blacks) were analyzed cross-sectionally. The rates of ischemic heart disease, peripheral vascular disease, stroke, distal sensory neuropathy, and diabetic retinopathy were assessed according to self-reported ethnicity using multiple logistic regression models. Compared to whites, black subjects [odds ratio = 1.72 (95%CI = 1.14-2.6)] were more likely to have ischemic heart disease when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, smoking habit, and serum creatinine. Blacks were also more likely to have end-stage renal disease [3.2 (1.7-6.0)] and proliferative diabetic retinopathy [1.9 (1.1-3.2)] compared to whites when data were adjusted for age, sex, fasting plasma glucose, HDL cholesterol, hypertension, and smoking habit. The rates of peripheral vascular disease, stroke and distal sensory neuropathy did not differ between groups. The higher rates of ischemic heart disease, end-stage renal disease and proliferative diabetic retinopathy in black rather than in white Brazilians were not explained by differences in conventional risk factors. Identifying which aspects of ethnicity confer a higher risk for these complications in black patients is crucial in order to understand why such differences exist and to develop more effective strategies to reduce the onset and progression of these complications.

Prevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta‐analysis

“…Ten studies reported the incidence of ESRD in the three ethnicities relevant to this review; however, three of the studies where data were extracted were not included in the meta‐analysis as they did not report incidence rates; Chandie Shaw et al and Gerchman et al reported odds of having eGFR rather than incidence rates, and Ali et al reported different clinical outcomes relating to decline in kidney function.…”

Absence of diabetic retinopathy in a patient who has had diabetes mellitus for 69 years, and inadequate glycemic control: case presentation

“…In addition, a few ethnic groups have a higher frequency of DR. Hispanic and African-American patients present greater evidence of DR compared to Caucasian patients. We observed a higher proportion of sever DR among black Brazilian subjects compared to whites [ 25 ]. These observations suggest that genetically susceptible patients will develop DR more frequently.…”

Diabetic nephropathy

“…The prevalence of DN varies according to ethnicity: it is higher in African-Americans, Asians and Native-Americans than in Caucasians [ 1 , 12 ]. African-Brazilians are more susceptible to progress to end-stage renal disease (ESRD) than people of European ancestry, but there appears to be a similar prevalence of micro- or macroalbuminuria [ 13 ].…”

“…As previously stated, Brazilians of African descent have more aggressive renal disease than people of European ancestry [ 13 ]. This could be due to several reasons, such as the presence of different risk factors, different access to medical attention, and socioeconomic differences.…”

“…This could be due to several reasons, such as the presence of different risk factors, different access to medical attention, and socioeconomic differences. However, none of the assessed known risk factors were different between African and Europeans [ 13 , 92 ] make unclear an explanation for the different rates of DN between black and white subjects. Unfortunately, data on socioeconomic status were unavailable.…”