Explanations for the Lower Rates of Diabetic Neuropathy in Indian Asians Versus Europeans

Abbott, Caroline A.; Chaturvedi, Nishi; Malik, Rayaz A.; Salgami, Eleanna V.; Yates, Allen P.; Pemberton, Philip W.; Boulton, Andrew J.M.

doi:10.2337/dc09-2067

Cited by 62 publications

(65 citation statements)

References 24 publications

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“…There was a negative correlation between the incidences of both total and major amputation and estimates of the PCT prevalence of both black and Asian racial groups, and this remained significant for Asians after regression analysis. The potential contribution of race reinforces earlier data suggesting that the incidence of amputation is lower in both Asian [12,13] and black [14] minorities in UK. Documentation of wide geographical variation in amputation incidence within a single nationalised healthcare system is of great potential importance.…”

Section: Discussionsupporting

confidence: 85%

Variation in the recorded incidence of amputation of the lower limb in England

Holman¹,

2012

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Aims/hypothesis The study aimed to explore the variation in recorded incidence of lower limb amputation in England. Methods The incidences of amputations in adults with and without diabetes were determined from hospital episode statistics over 3 years to 31 March 2010 and compared between the 151 Primary Care Trusts (PCTs) in England. Results There were 34,109 amputations, including 16,693 (48.9%) in people with diabetes. The incidence was 2.51 per 1,000 person-years in people with diabetes and 0.11 per 1,000 person-years in people without (relative diabetes risk 23.3). Incidence varied eightfold across PCTs in people both with diabetes (range 0.64-5.25 per 1,000 person-years) and without (0.03-0.24 per 1,000 person-years). Amputations in people with diabetes varied tenfold-both major (range 0.22-2.20 per 1,000 person-years) and minor (range 0.30-3.25 per 1,000 person-years). The incidences of minor and major amputations were positively correlated both in those with (r00.537, p<0.0005) and without (r00.611, p<0.0005) diabetes. Incidences of amputations were also correlated between people with and without diabetes (total amputations r00.433, p<0.0005; major amputations r00.528, p<0.0005). There was a negative correlation between the incidence of amputation and estimated prevalence of ethnic Asians. No association was found between the PCT incidence of either total amputations and general population prevalence of social deprivation (r 0−0.138, p 00.092) or smoking (r00.137, p00.096). Conclusions/interpretation Variation in amputation incidence occurs across England. Because of the similarity in amputation variation between people with and without diabetes the variation may reflect generic differences in local healthcare delivery, although racial factors may also contribute.

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Section: Discussionsupporting

confidence: 85%

Variation in the recorded incidence of amputation of the lower limb in England

Holman¹,

2012

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“…Many of the subjects already exhibited established diabetes complications (e.g., albuminuria, as indicated in Table 2). The participant characteristics are similar to those reported previously in a different region of the United Kingdom (24), suggesting that the present study sample was representative of the wider T2D population in secondary care. However, whether our findings are applicable to patients typically managed in primary care and those with a shorter duration of diabetes remains to be examined.…”

Section: Discussionsupporting

confidence: 83%

Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

Altaf

Dodson

Ali

et al. 2017

Am J Respir Crit Care Med

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Rationale: Obstructive sleep apnea (OSA) is associated with several pathophysiological deficits found in diabetic retinopathy (DR). Hence, it's plausible that OSA could play a role in the pathogenesis of sight-threatening DR (STDR).Objectives: To assess the relationship between OSA and DR in patients with type 2 diabetes and to assess whether OSA is associated with its progression.Methods: A longitudinal study was conducted in diabetes clinics within two U.K. hospitals. Patients known to have any respiratory disorder (including OSA) were excluded. DR was assessed using twofield 45-degree retinal images for each eye. OSA was assessed using a home-based multichannel cardiorespiratory device. Measurements and Main Results:A total of 230 patients were included. STDR and OSA prevalence rates were 36.1% and 63.9%, respectively. STDR prevalence was higher in patients with OSA than in those without OSA (42.9% vs. 24.1%; P = 0.004). After adjustment for confounders, OSA remained independently associated with STDR (odds ratio, 2.3; 95% confidence interval, 1.1-4.9; P = 0.04). After a median (interquartile range) follow-up of 43.0 (37.0-51.0) months, patients with OSA were more likely than patients without OSA to develop preproliferative/proliferative DR (18.4% vs. 6.1%; P = 0.02). After adjustment for confounders, OSA remained an independent predictor of progression to preproliferative/proliferative DR (odds ratio, 5.2; 95% CI confidence interval, 1.2-23.0; P = 0.03). Patients who received continuous positive airway pressure treatment were significantly less likely to develop preproliferative/proliferative DR.Conclusions: OSA is associated with STDR in patients with type 2 diabetes. OSA is an independent predictor for the progression to preproliferative/proliferative DR. Continuous positive airway pressure treatment was associated with reduction in preproliferative/proliferative DR. Interventional studies are needed to assess the impact of OSA treatment on STDR.

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“…In several European studies, large-fiber neuropathy (LFN) and small-fiber neuropathy (SFN) seem to be less prevalent in Asian than in European patients with diabetes and this is attributed to their lower height, less smoking, and better skin microvascularization (3,4). Vitamin D deficiency has also been recently implicated in the pathogenesis of diabetic neuropathy (DN) (5)(6)(7).…”

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confidence: 99%

Lack of Definite Association of Vitamin D Deficiency with Diabetic Neuropathy. Investigation in Greek and in Bangladeshi Patients

Papadakis

Kokotis

Villiotou

et al. 2017

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Abstract. Aim: Determination of the 25(OH) vitamin D levels in Greek-born Diabetic distal sensorimotor neuropathy (DSPN) is the most frequent type of polyneuropathy and the most frequent complication of diabetes affecting up to 50% of patients (1, 2). In several European studies, large-fiber neuropathy (LFN) and small-fiber neuropathy (SFN) seem to be less prevalent in Asian than in European patients with diabetes and this is attributed to their lower height, less smoking, and better skin microvascularization (3, 4). Vitamin D deficiency has also been recently implicated in the pathogenesis of diabetic neuropathy (DN) (5-7).In a previous study, we showed that vitamin D levels were lower in Bangladeshi immigrants with diabetes in Greece compared to indigenous Greek patients with diabetes (8). In this study, we investigated the 25 (OH) vitamin D level in patients with diabetes with and without polyneuropathy in both ethnic groups. Materials and MethodsThe study sample consisted of Greek and Bangladeshi patients recruited from the outpatient diabetic clinic of a general hospital and were matched as to age, sex and diabetes duration. This sample is part of that previously described (8). The following clinical and diabetes related factors were taken into consideration: Age, sex, type of diabetes, age at diabetes diagnosis, duration of diabetes, diabetes treatment, episodes of hypoglycemia, body mass index (BMI), glycated hemoglobin (HbA1c) and 25(OH) vitamin D levels. Patients treated for vitamin D deficiency, those taking vitamin D supplements and those treated with medicines known to affect bone metabolism were excluded from this study. The patients were recruited between January 2012 and December 2014, over a period of time that included all seasons. Serum 25(OH) vitamin D levels were measured using an assay kit from Roche Diagnostics GmbH (Mannheim, Germany) and the measurement was performed once, at the first appointment.All patients gave their written consent and the study was approved by our local Ethics Committee (approval number 445/30-11-2011).The electrophysiological study for the detection and staging of polyneuropathy has been described elsewhere (9): The diagnosis of polyneuropathy required the combination of abnormal findings from the Neuropathy Symptoms Score (NSS), Neuropathy Disability Score (NDS), nerve conduction velocities (NCV) and Quantitative Sensory Tests (QST). The classification proposed by Dyck for patients with diabetes was used (10).Student's t-test analysis was used to assess the statistical significance of the differences between groups. A value of p<0.05 was considered significant. 259This article is freely accessible online.

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Explanations for the Lower Rates of Diabetic Neuropathy in Indian Asians Versus Europeans

Cited by 62 publications

References 24 publications

Variation in the recorded incidence of amputation of the lower limb in England

Variation in the recorded incidence of amputation of the lower limb in England

Obstructive Sleep Apnea and Retinopathy in Patients with Type 2 Diabetes. A Longitudinal Study

Lack of Definite Association of Vitamin D Deficiency with Diabetic Neuropathy. Investigation in Greek and in Bangladeshi Patients

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