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.

Retinopathy and risk factors in diabetic patients from Al-Madinah Al-Munawarah in the Kingdom of Saudi Arabia

“…In Saudi Arabia, women had significantly higher rates of diabetic retinopathy than men, which is in agreement with a study in Sweden where women had higher rates than men49 and in other studies 13,19. Two further studies have suggested nonsignificant differences in diabetic retinopathy according to gender 50,51.…”

“…However, their analysis revealed that diabetic retinopathy in the study sample was only marginally associated with hypertension, which is widely regarded as a significant risk factor for diabetic retinopathy in most studies 10,19. Improved monitoring and control of hypertension among diabetic patients in the United Arab Emirates, which has been shown to slow the progression of retinopathy, particularly among those with poorly controlled diabetes, is strongly recommended 20…”

“…The main risk factors involved in the development of microvascular and macrovascular complications of diabetes include a long disease duration,11,12 inadequate control of serum glucose levels,12–16 hypertension,11,12 dyslipidemia, smoking,17,18 gender,13,19 and pregnancy 20,21. Genetic factors also seem to play a role in predisposition to microvascular and macrovascular disease 22,23.…”

Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis

“…Brazil had the most scientific production with fourteen studies [ 53 , 55 – 58 , 60 , 61 , 64 – 66 , 71 , 72 ], Mexico with seven [ 52 , 54 , 67 , 68 , 70 , 73 , 74 ], Peru with four [ 59 , 69 , 74 , 77 ], and Cuba [ 51 ], Uruguay [ 63 ], and Ecuador with one study [ 62 ] ( Fig 2 ) . Regarding DM type, 22 studies included type 2 DM [ 52 – 57 , 59 – 62 , 66 , 68 – 78 ], three type 1 DM [ 58 , 65 , 67 ] and three in both types of DM [ 51 , 63 , 64 ], presenting combined prevalence. In twenty-one studies, patients were recruited from reference hospitals [ 51 , 54 – 59 , 61 , 63 – 67 , 69 , 70 , 72 – 74 ], four from primary care [ 52 , 53 , 60 ,…”

“…In twenty-one studies, patients were recruited from reference hospitals [ 51 , 54 – 59 , 61 , 63 – 67 , 69 , 70 , 72 – 74 ], four from primary care [ 52 , 53 , 60 , 68 ], and three from the general population [ 62 , 71 , 75 ]. According to the onset of DM, one study was made with newly detected DM (debut) [ 61 ], nine with DM patients with more than 5 years of illness [ 51 , 56 , 65 , 68 – 70 , 72 , 77 , 78 ], six with more than 10 years of disease [ 53 , 57 , 64 , 66 , 73 , 74 ], and eleven did not specify any time [ 52 , 54 , 55 , 58 – 60 , 62 , 63 , 71 , 75 , 76 ].…”