The global challenge of type 2 diabetes and the strategies for response in ethnic minority groups

Abstract

Ethnic minorities living in high-income countries usually exhibit a greater risk of developing diabetes along with higher morbidity and mortality rates. We evaluated the effectiveness of interventions to improve glycaemic control in ethnic minority groups. Results of major controlled trials, systematic reviews and meta-analyses were included in the review. Only 1/47 studies addressing diet and exercise interventions reported details on the ethnicity of the studied population. Self-management education was successful if associated with increased self-efficacy; delivered over a longer period; of high intensity; culturally tailored; and when using community educators. Strategies adopted in community-gathering places, family-based, multifaceted, and those tackling the social context were likely to be more effective. A positive relationship was found between social support and self-management behaviour as well as quality of life, but there is little evidence about the impact of organizational changes within health-care services on diabetes control. More research is needed to strengthen the evidence on effective strategies for response to diabetes in ethnic minorities. Also, there is a need to take into account diabetes beliefs and communication difficulties, as well as potential protective factors. Globally, many health-care systems are inadequately equipped to improve diabetes prevention and disease outcomes in these communities.

TLR4 gene polymorphisms: evidence for protection against type 2 diabetes but not for diabetes-associated ischaemic heart disease

“…When considering the aforementioned data on the protective potential of TLR4 mutations, an obvious paradox seems to emerge. Despite the relatively high frequency of protective TLR4 alleles, in the western populations, an increasing DM2 incidence is being recorded (1,2). This phenomenon may be due to the impact of lifestyle/environmental factors (fat and calorie-rich, nutrient-poor diet, low levels of exercise and so on), on the development of DM2 (1-3), the contribution of other genetic loci on the diversity of DM2 susceptibility, among ethnicities (4,34,35) and the currently 'fixed' mutant TLR4 genetic background primarily influenced by neutral genetic drift (7,8), because traditional selective pressures (infections) have been relieved as a result of aggressive antimicrobial practices, i.e.…”

“…Among the various endocrine disorders, the biggest challenge is without doubt diabetes mellitus (DM), especially type 2 (DM2; Mendelian Inheritance in Man/MIM ID #125853), a disease of global dissemination and steadily increasing incidence throughout the western societies (1,2). Several risk factors have been associated with the onset of DM2, including family history of DM, ethnicity, obesity and polycystic ovary disease (2)(3)(4)(5).…”

“…Several risk factors have been associated with the onset of DM2, including family history of DM, ethnicity, obesity and polycystic ovary disease (2)(3)(4)(5). However, only few factors have been found to induce protection against DM and its complications, i.e.…”

“…However, only few factors have been found to induce protection against DM and its complications, i.e. nephropathy, retinopathy, and ischaemic heart disease (IHD) (2)(3)(4)(5)(6). Among these, specific polymorphisms of toll-like receptor 4 (TLR4) were quite recently proposed as being protective against DM2 (6).…”

Changes in dietary intake following a culturally adapted lifestyle intervention among Iraqi immigrants to Sweden at high risk of type 2 diabetes: a randomised trial

“…It is estimated that by the year 2025 more than 300 million individuals will be affected by the disease (1) . The increasing prevalence has occurred in parallel with the worldwide rise in obesity and environmental and lifestyle changes related to migration and urbanisation; issues which are often linked to high prevalence of T2D (2,3) . Migration of non-Western immigrants to Western countries is often associated with changes in dietary habits.…”