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Health disparities in diabetes and its complications and co-morbidities exist globally.

A recent Endocrine Society Scientific Statement described the Health Disparities in several endocrine disorders, including type 2 diabetes. Finally we discuss biological, behavioral, social, environmental, and health system contributors to diabetes disparities in order to identify areas for future preventive interventions. Health disparities in diabetes and its complications and co-morbidities exist worldwide. There are multiple factors that contribute to these disparities, including biological and clinical factors, as well as health system and social factors [ 1 ]. This review will also include more global and international data on the prevalence of diabetes and its complications outside of the United States U.

IndianEast Asian e. Japanese, Chinese, KoreanSoutheast Asian e. We recognize that these are arbitrary and sometimes contain heterogeneous groups, particularly among Asian and Hispanic populations. When studies use more specific terms in defining ethnic subgroups, we will use them accordingly. Diabetes is an important global public health burden.

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In the U. Among them 7 million are estimated to be undiagnosed [ 15 ]. NHWs and Asian Americans have similar prevalence rates of 7. Table 1 is reproduced from Centers for Disease Control and Prevention National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States.

Atlanta: U. S Department of Health and Human Services. Latino subpopulations. Importantly, the prevalence of diabetes varied among Hispanic American populations based on their countries of origin.

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South Americans had one of the lowest prevalence rates Similarly low rates were found among Cuban men and women The prevalence of diabetes was the highest in those of Mexican, Puerto Rican, Central American, and Dominican descent, with rates of Diabetes prevalence rates among Asian Americans also differ by countries of origin, Table 3 [ 7 ]. Asian Indians have the highest diabetes prevalence rate Similar prevalence rates have been found among other Asian American subgroups, including Vietnamese 6.

Globally the prevalence of diabetes mellitus has increased at alarming epidemic rates [ 8 ]. In the summary statistics presented here, we report the comparative prevalence of diabetes in various regions, which adjusts for differences in the age distributions of various countries and allows regional comparisons [ 9 ]. Inmillion people worldwide had a diagnosis of diabetes [ 9 ].

The West Pacific region had the highest of individuals The two countries in this region that had the highest prevalence rates were the Kiribati and Marshall Islands, with rates of Middle East and North Africa regions had the highest comparative prevalence rates of diabetes at Six countries in this region are among the world's top ten countries for highest diabetes prevalence rates--Kuwait Africa had the lowest comparative prevalence rate of diabetes 4.

Globally, the highest comparative prevalence rate of prediabetes based on impaired glucose tolerance [IGT] values was reported in the North American and Caribbean region and was Although incidence rates of newly diagnosed diabetes have been reported for both type 1 and type 2 diabetes, there are limited global prevalence data regarding children with these conditions. The prevalence of type 1 diabetes was highest in NHWs in the U. NHB children between the ages of and years have prevalence rates of 0. Children of Asian and Pacific Island and Navajo origin had the lowest prevalence rates of type 1 diabetes Table 5 [ 13 ] [ 14 ].

The highest prevalence has been reported in Native Americans with prevalence rates, of 0. In NHB children the prevalence in those ages years 1. Asian and Pacific Island children ages years have similar prevalence rates of 0.

Finally, one of the lowest prevalence rates of type 2 diabetes among children years has been reported in NHWs at 0. To our knowledge, there are no data available on the prevalence of prediabetes in children and adolescents. In diabetes was listed as an underlying cause of death in 71, death certificates and it was listed also as a contributing factor in anotherdeath certificates in the U. Globally 4. The International Diabetes Federation estimated diabetes mortality rates in various regions using two data sources—the World Health Organization estimates of the total of deaths in each country and published regional estimates of the relative risk of death in individuals with diabetes compared to those without diabetes [ 9 ].

It should be noted that mortality rates need always to be interpreted with caution as the diagnosis of diabetes is oftentimes omitted from death certificates [ 9 ]. A systematic review of the literature concluded that NHBs, Hispanic Americans and Asian Americans had a lower risk for developing cardiovascular complications of diabetes compared to NHWs [ 16 ].

Data from the Centers for Disease Control and Prevention showed that Hispanic Americans with diabetes had a lower percentage of stokes or heart disease among those ages 35 years and older Men from Puerto Rico had the highest self-reported stroke prevalence rate 3. Women from Puerto Rico and Mexico had the highest and lowest self-reported stroke prevalence rate, of 2.

Data on macrovascular complications among Native Americans are generally limited [ 1 ]; however, available data indicate that the overall prevalence of CHD was 2. Many of these studies were limited by lack of adjustment for potentially confounding factors that might explain the increased risk for lower extremity amputations in these populations [ 16 ].

After a more comprehensive adjustment for confounders, two studies showed an increased risk and four studies showed no difference in risk for developing lower extremity amputations among NHBs compared with NHWs [ 16 ].

In one study, Native Americans also had an increased risk for lower extremity amputations compared to NHWs [ 16 ]. Among Hispanic Americans, two studies found an increased risk and two studies found no risk difference in lower extremity amputations compared to NHWs following multivariable adjustment for confounders. In contrast, Asian Americans had a decreased risk for lower extremity amputations compared to NHWs [ 16 ]. Overall, minority populations are more likely to develop retinopathy than NHWs [ 116 ]. Native Americans have one of the highest prevalence rates of diabetic retinopathy, with a rate of Although Hispanic Americans and NHBs appeared to have similar prevalence rates of clinically ificant macular edema and diabetic retinopathy, Hispanic Americans were more likely to have intraretinal hemorrhages involving a greater area of retina [ 24 ].

In contrast, international data show that in the United Kingdom, NHBs had a similar risk and Asians had a lower risk of retinopathy compared to NHWs after adjusting for retinopathy risk factors [ 16 ].

Algerian immigrants to France had similar adjusted retinopathy risk compared to the native French population [ 16 ]. Thus, minorities with diabetes in non-U. Ethnic and racial minorities have higher prevalence rates of end-stage renal disease ESRD ; however, interestingly, they have a lowest mortality rate on dialysis compared with NHWs [ 19 ]. The rate among Hispanic Americans was 2, per million population inalso higher compared to NHWs and 1.

A comprehensive review of the available studies found no difference among them [ 16 ], however, these should be interpreted with caution, as there was variability in the definition of diabetic neuropathy, methodology of each study that was performed and also cultural and language barriers that all can affect the.

A French study found neuropathy rates to be higher among Algerian immigrants to France compared to the native French. It should be noted, however, that one study showed no difference in insulin secretion between Hispanic Americans of Mexican origin and NHWs [ 29 ].

are mixed in the small of studies in Cuban Americans, with one study showing increased insulin resistance [ 30 ] and one study showing no difference in insulin resistance compared to NHWs [ 31 ]. In Asian Americans most studies showed a higher degree of insulin resistance [ 3132 ] and lower insulin secretion compared to NHWs [ 13133 ]. Very few studies have been conducted in Native American populations. Similar were reported in another study where Pima Indians had reduced insulin sensitivity compared to NHWs [ 35 ].

Race/ethnic difference in diabetes and diabetic complications

Obesity represents one of the strongest contributors for the development of type 2 diabetes. InWHO estimated that million individuals worldwide were obese [ 36 ]. In the WHO reported that the highest obesity prevalence rates for men and women 15 years of age and older were found in Nauru, Tonga and Micronesia, all located in the South Pacific [ 37 ]. Among adults in the U. NHBs had the highest prevalence rate of age-adjusted obesity of Among Asian Americans there is important variation in age adjusted obesity prevalence rates among Asian subgroups [ 139 ].

The lowest obesity prevalence rates are reported among Korean 2. Vietnamese and Japanese have obesity prevalence rates of 5.

The highest obesity prevalence rates are reported to be Among Hispanic Americans, a recent study found that the overall prevalence of obesity was The obesity highest prevalence rate was reported among Puerto Ricans Similar prevalence rates of obesity were reported in Cubans Obesity is also an important contributor to type 2 diabetes in children and adolescents.

NHB girls had the highest prevalence rate of obesity between ages years Over 40 confirmed loci are associated with an increased risk for type 2 diabetes regardless of race or ethnicity [ 141 ].

As there are few large-scale genetic studies in minority populations, these groups deserve focused attention for novel discovery in ongoing and future genome wide association studies of type 2 diabetes [ 140 ]. Hyperglycemia is an important risk factor for the development of diabetic microvascular complications [ 42 ].

It should be noted, however, that non-glycemic factors may contribute to the higher HbA 1c seen in minority populations [ 146 ].