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21st Mar 2022

Type 2 Diabetes: A Discriminatory Disease

4.7 million people are estimated to have diabetes in the UK, and as obesity rises, so too does the number of diabetes sufferers. While the risk of developing diabetes is significantly linked to your weight, physical activity and diet; it’s also important to recognise that race and ethnicity also play a part. The proportion of people with type 2 diabetes in the UK is significantly higher within certain ethnic minority groups.(Whicher et al., Diabetic Medicine, 2020) (Oldroyd et al., BMJ, 2005)

It’s not clear why people from certain races and ethnic backgrounds are at increased risk of developing type 2 diabetes, but amongst South Asian, and Black African or Caribbean ethnic groups living in the UK, that risk is substantially higher. South Asian people are five times more likely and Black African or Caribbean people are three times more likely to develop type 2 diabetes than white Europeans.(Ntuk et al., Diabetes Care, 2014) This increased risk is even starker in children: with South Asian children 14 times more likely to develop type 2 diabetes than white European children. Ethnic minority groups with type 2 diabetes are also more likely to develop cardiovascular disease. (Goff, Diabetic Medicine, 2019)

It’s a concerning reality that makes for depressing reading, but as diabetes impacts on physical and mental health, increasing the risk of heart attacks, strokes, amputations, and depression, it’s crucial to understand why this increased prevalence of diabetes arises and how we can improve prevention and treatment solutions for higher risk ethnic groups living in the UK.(Oldroyd et al., BMJ, 2005)

 

What is Type 2 diabetes?

Type 2 diabetes makes up around 90% of all diabetes cases. (Whicher et al., Diabetic Medicine, 2020)(Nagar et al., eClinical Medicine, 2021)

Type 2 diabetes occurs when the body lacks or completely loses the ability to use and regulate blood sugar (glucose) levels. Glucose can be thought of as a fuel or energy source for a cell. The blood supplies cells with glucose, where channels in the cell membranes move glucose from the blood to the inside of the cell. Blood glucose levels are strictly regulated so the body has adequate energy supplies to work properly.

While regulating blood glucose levels is a complex process, two hormones play a key role: insulin and glucagon. Both hormones are released by cells in the pancreas, with alpha-cells releasing glucagon and beta-cells releasing insulin. Insulin triggers cells to take up glucose from the blood, lowering blood glucose levels, whereas glucagon triggers the release of glucose into the blood, raising blood glucose levels. Diabetes is a result of faulty processes linked to insulin, either from:

  1. Impaired beta-cells no longer releasing sufficient levels of insulin, or
  2. Insulin no longer effectively triggering cells to take up glucose. (Röder et al., Exp Mol Med, 2016)

 

Potential Factors Linked to Increased Prevalence

General risk factors for type 2 diabetes include obesity, high waist size, inactive lifestyle, family history of type 2 diabetes, and being over 40 years old—although this number is lower (25 years old) for some ethnic minority groups.(NICE Review) More work needs to be done to understand the reasons behind the increased prevalence of type 2 diabetes in South Asian and black African or Caribbean ethnic groups in the UK but there are a multitude of factors likely playing a part.(Nagar et al., eClinical Medicine, 2021)

Environmental, diet and lifestyle factors are likely to play a role in type 2 diabetes prevalence rates as rates of type 2 diabetes amongst ethnicities can differ depending upon location. For example, Asian Indians living in the UK have a higher prevalence of type 2 diabetes than people of the same ethnicity living in India.(Goff, Diabetic Medicine, 2019)

Obesity is a major risk factor for type 2 diabetes, accounting for 80–85% of a person’s risk. Measuring the body mass index (BMI) and waist size can indicate whether a person is overweight or obese; an overweight person’s BMI is typically 25 kg/m2 or more.(NHS)(Ganz, Diabetology & Metabolic Syndrome, 2014) Yet while obesity is a risk factor for type 2 diabetes for all of us, this risk is higher at normal and overweight BMI values in ethnic minority groups than white European people living in the UK.

The prevalence of type 2 diabetes in South Asian individuals in the UK with a BMI of 22kg/m2 is the same as that for Black African or Caribbean’s with a BMI of 26kg/m2 and white Europeans with a BMI of 30kg/m2.(Nakagami, Diabetologia, 2003) (Goff, Diabetic Medicine, 2019)

It’s thought this may be due to differences in the level of fat around the organs (visceral fat) individuals carry; South Asian individuals tend to carry higher levels of visceral fat compared to white Europeans(Goff, Diabetic Medicine, 2019) Consequently, a different BMI scale for monitoring type 2 diabetes risk has been suggested for ethnic minority populations in the UK.(Ntuk et al., Diabetes Care, 2014).

 

Managing Type 2 Diabetes

Despite South Asian and Black African or Caribbean communities having a greater risk of developing type 2 diabetes than white Europeans in the UK, these communities face further issues surrounding the treatment and management of their disease. Second and third-line therapies, including additional medications to lower blood sugar levels, can take longer to be obtained by these groups in comparison to white Europeans, impacting their potential outcomes.(Mathur et al., Plos Medicine, 2020)

As a complex disease, type 2 diabetes can be challenging to manage for affected individuals. This is made harder by barriers and the lack of access to care, with type 2 diabetes sufferers only spending an average of three hours per year with a healthcare professional.(Whicher et al., Diabetic Medicine, 2020

Taking an inclusive and patient-centred approach, the dedicated team of Doctors, Dietitians and Health Coaches at Diabetes Lifestyle Doctors provide support and information to all people suffering with type 2 diabetes, helping individuals to understand their condition and therefore empowering them to self-manage the condition, where possible.

You can find out more about the programmes currently available from Diabetes Lifestyle Doctors by clicking here.

 

 

References

 

Ntuk, U. E., Gill, J. M. R., Mackay, D. F., Sattar, N., & Pell, J. P. (2014). Ethnic-specific obesity cutoffs for diabetes risk: Cross-sectional study of 490,288 UK biobank participants. Diabetes Care37(9). https://doi.org/10.2337/dc13-2966

 

Oldroyd, J., Banerjee, M., Heald, A., & Cruickshank, K. (2005). Diabetes and ethnic minorities. In Postgraduate Medical Journal (Vol. 81, Issue 958). https://doi.org/10.1136/pgmj.2004.029124

 

Goff, L. M. (2019). Ethnicity and Type 2 diabetes in the UK. In Diabetic Medicine (Vol. 36, Issue 8). https://doi.org/10.1111/dme.13895

 

Whicher, C. A., O’neill, S., & Holt, R. I. G. (2020). Diabetes UK Position Statements Diabetes in the UK: 2019. Diabetes UK37(2).

 

Nagar, S. D., Nápoles, A. M., Jordan, I. K., & Mariño-Ramírez, L. (2021). Socioeconomic deprivation and genetic ancestry interact to modify type 2 diabetes ethnic disparities in the United Kingdom. EClinicalMedicine37. https://doi.org/10.1016/j.eclinm.2021.100960

 

Ganz, M. L., Wintfeld, N., Li, Q., Alas, V., Langer, J., & Hammer, M. (2014). The association of body mass index with the risk of type 2 diabetes: A case-control study nested in an electronic health records system in the United States. Diabetology and Metabolic Syndrome6(1). https://doi.org/10.1186/1758-5996-6-50

 

Nakagami, T., Borch-Johnsen, K., Carstensen, B., Qiao, Q., Nøhr-Hansen, C., Hu, G., Tuomilehto, J., & Balkau, B. (2003). Age, body mass index and Type 2 diabetes – Associations modified by ethnicity. Diabetologia46(8). https://doi.org/10.1007/s00125-003-1158-9

 

Röder, P. v., Wu, B., Liu, Y., & Han, W. (2016). Pancreatic regulation of glucose homeostasis. In Experimental & molecular medicine (Vol. 48). https://doi.org/10.1038/emm.2016.6

 

Mathur, R., Farmer, R. E., Eastwood, S. v., Chaturvedi, N., Douglas, I., & Smeeth, L. (2020). Ethnic disparities in initiation and intensification of diabetes treatment in adults with type 2 diabetes in the UK, 1990–2017: A cohort study. PLOS Medicine17(5), e1003106. https://doi.org/10.1371/journal.pmed.1003106