Key result
Ethnic minority background in European T2D patients is linked to ~30% lower all-cause mortality.
Why the study?
Differences in type 2 diabetes complications between ethnic minority populations and European host populations had not been comprehensively quantified across cross-sectional and prospective studies.
Does ethnic minority status compared with the European host population alter the risk of mortality, macrovascular, microvascular, and mental complications in adults with type 2 diabetes living in Europe?
Meta-Analysis (n=1,230,410)
Yes
Does ethnic minority status compared with the European host population alter the risk of mortality, macrovascular, microvascular, and mental complications in adults with type 2 diabetes living in Europe?
In Europe, ethnic minority patients with type 2 diabetes generally experience lower all-cause mortality and macrovascular complication risks than European host populations—except South Asians who face comparable macrovascular and slightly higher MACE risks—while facing significantly higher risks of microvascular complications like nephropathy and retinopathy.
Answers are grounded in this paper and cite their sources.
These mortality differences should not yet alter T2D risk stratification; leaves open prospective validation of microvascular complication patterns.
This systematic review and meta-analysis aimed to quantify differences in type 2 diabetes (T2D) complications between ethnic minority populations and European host populations, in both cross-sectional and prospective studies. Following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, we searched multiple databases for studies (until July 1, 2024) with T2D complications as outcome. Studies were included if they compared ethnic minority populations to the host population and were conducted in Europe. T2D complications included mortality, macrovascular and microvascular complications and mental disorders. Risk of bias was assessed with the assessment tool for observational cohort and cross-sectional studies. Risk estimates were pooled using random effects models. From a total of 2901 references, 58 studies were included, comprising 805 to 1 230 410 individuals for the meta-analyzed complications. Compared with the host population, ethnic minority populations generally had a lower risk of all-cause mortality (RR 0.70 (95% CI 0.63; 0.77); I 2 =87%)) and macrovascular complications (RR 0.72 (95% CI 0.58; 0.88); I 2 =88%). South Asians, however, showed comparable risks for most macrovascular complications and a slighthly higher risk of major adverse cardiovascular events. Increased risks for microvascular complications, nephropathy and retinopathy were observed (eg, in prospective studies RR 1.50 (95% CI 1.14; 1.96); I 2 =86% for nephropathy). No ethnic differences were observed for mental disorders. Ethnic minority populations with T2D in Europe are generally at reduced risk of all-cause mortality and macrovascular complications, but at higher risk of nephropathy and retinopathy. Our findings may help to further identify high-risk populations and to develop guidelines and future interventions. PROSPERO registration number:PROSPERO 2022 CRD42022366854 .
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Reichelt et al. (2024) conducted a meta-analysis in Type 2 diabetes mellitus (T2D) (n=1,230,410). Ethnic minority status in Europe (including South Asian, Sub-Saharan African, Middle Eastern/North African, South/Central American, and Western Pacific) vs. European host population was evaluated on All-cause mortality (RR 0.70, 95% CI 0.63-0.77). Ethnic minority populations with T2D in Europe had a lower risk of all-cause mortality and macrovascular complications compared with European host populations.
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