Characterization of Type 2 Diabetes Mellitus in First Generation Italian Migrants to Belgium

Abstract

Type 2 diabetes mellitus is a major metabolic disease in developed countries, and preferentially affects low-income groups and/or people from Southern extraction. Migrants are especially at risk. In Belgium, a large population of workers emigrated in the 50s and 60s, especially from rural areas of Southern Italy and Sicily. We tested the hypothesis that type 2 diabetes mellitus' phenotype in these Italian migrants could differ from that observed in autochthonous Belgian subjects. We retrospectively compared the clinical files of 485 patients with type 2 diabetes either of Belgian (n=445) or Italian origin (n=40). Italians were younger at diagnosis (46 +/- 14 vs. 52 +/- 13 years, P < 0.01), shorter, had a lower education and a stronger family record of diabetes (89 vs. 47%, P < 0.01). They had similar BMIs (31 +/- 6) and similar or slightly worse degree of sedentarity (>75%). We further compared this Italian group to 115 Belgians subjects matched for age, sex, and education. Known duration of diabetes (16 years), smoking and drinking habits, use of oral hypoglycaemic, antihypertensive and hypolipaemic drugs, complications, CRP, estimated glomerular filtration rate, micro-albuminuria prevalence, blood pressure, insulin sensitivity/ beta-cell function estimated by HOMA modelling, as well as fat mass indirectly estimated by impedancemetry were not significantly different between the two populations. There was a non significant trend toward higher HbAlc (8.7 +/- 2 vs. 8.2 +/- 2%, NS) in Italian subjects whose LDL-cholesterol was however significantly lower (105 +/- 31 vs. 120 +/- 33 mg.dL-1, P< 0.01) as well as folic acid (5 + 1.7 vs. 6.7 +/- 4, P < 0.001). Insulin dose was higher (0.77 +/- 0.4 vs. 0.48 +/- 0.3 IU.day-1, P < 0.001) and abdominal obesity less prevalent in males (33 vs. 58%, P < 0.01) of this group. Thus, Italian diabetic subjects in Belgium exhibit higher insulin requirements despite similar/better BMI, known duration of diabetes, HOMA indices, use of oral antidiabetic drugs, abdominal obesity and slightly higher HbA1c. This points towards different dietary habits, as do the differences in folic acid and LDL-cholesterol; different patterns of exercise may also play a role. Higher family record of diabetes may be genetic, but may also be biased by tighter family structure in subjects of Italian extraction.

The Experiences of Older Italian Migrants With Type 2 Diabetes: A Qualitative Study

“…Higher rates of T2D have been found among older Italian migrants (Hodge, English, O'Dea, & Giles, 2004;Selvais & Hermans, 2005) at approximately three times the rate of the Australian-born population (Hodge et al, 2004). Internationally, Selvais and Hermans (2005) found higher rates of T2D among older Italian migrants, living in Belgium and suggested that disadvantage contributed to increased incidence. Nonetheless, although higher rates of T2D are found among older Italian migrants, research exploring the impact of diabetes among this group is limited.…”

“…Factors affecting this dramatic increase, include population obesity, low-socioeconomic status, and migration from world areas of high T2D risk (Abouzeid, Philpot, Janus, Coates, & Dunbar, 2013). There is additionally considerable evidence to suggest that migrants are more likely to develop T2D compared with locally born populations (Abouzeid et al, 2013; AIHW, 2005; Selvais & Hermans, 2005). This is especially the case for migrants from South Asia, South East Asia, and Southern Europe (AIHW, 2005).…”

“…Older migrants from these world areas are particularly vulnerable groups and research suggests that low-socioeconomic circumstance intensifies the risk of T2D (Abouzeid et al, 2013; Selvais & Hermans, 2005). A number of studies have also indicated that older migrants are more likely to experience difficulty accessing health services, based on cultural and language differences (Jowsey, Gillespie, & Aspin, 2011).…”

Migrant adults with diabetes in France: Influence of family migration

“…Other European studies described similar differences in Africans in France (Hba1c at 8.6% vs. 8.1% in the host population (71 vs. 65 mmol/mol) p < 0.001 [11] , 10.5% vs. 9.3% (91 vs. 78 mmol/mol) p < 0.01 in 1986 [10] ), or Turks in Holland [9] . Although no significant difference was seen in terms of HbA1c between Italian and Belgium patients with diabetes in Belgium, the migrant patients had a diagnosis of diabetes at younger age and required higher doses of insulin [20] . In a larger cohort (ENTRED, n = 3894), patients with diabetes who were born in north Africa had a poorer diabetes control (Hba1c >8% or 64 mmol/mol in 30% vs. 15% for patients born in France) and performed less frequently a test for HbA1c (tested 3 times/year in 39% vs. 44%, p < 0,05) [5] .…”