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Ethnic variation in the susceptibility to diabetes
Published on April 29, 2020 42 min
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Hello, I'm Professor Jonathan Shaw. I'm from the Baker Heart and Diabetes Institute in Melbourne, Australia, and I'm going to talk today about the variation due to ethnicity in the susceptibility to diabetes.
So there is significant ethnic variation, in the manifestations of diabetes, and we see marked differences across the world in the susceptibility to diabetes. Interestingly, the pattern of this is quite different for type 1 diabetes than it is for type 2. In other words, those ethnicities in those parts of the world that are at high risk for type 1, are on the lower end of the risk spectrum for type 2 diabetes. As we'll see, there are a number of factors that may underlie ethnic variation. Although the reality is that this is not adequately understood, the various factors include genes, include variations in diet, in the physical environments, and also recognized in recent years, the impact of gestational exposure, particularly to hyperglycemia during pregnancy.
So if we start by just comparing the top 10 ranked countries for type 1 and type 2 diabetes, you see on the left the countries with the highest incidence of type 1 diabetes in children and adolescents, and incidence, in other words, the rate at which new cases occur is the most commonly used metric for type 1 diabetes, and on the right we have the top 10 ranked countries for the prevalence of type 2 diabetes. In other words, the proportion of the population in this case are adults who have type 2 diabetes, because that is the most commonly used metric of burden of type 2 diabetes. Just running your eye down the countries, you see that for type 1 diabetes, this is mainly dominated by European countries. We see Finland at the top, we then see Sweden and Norway, United Kingdom, Ireland, and Denmark towards the bottom end. Not only are these European countries but they are countries predominantly from Northern and Western Europe. That is quite different to the profile of the countries where the prevalence of type 2 diabetes is the highest. We see several small Pacific Islands at the top there, Marshall Islands, Kiribati, followed by Mauritius in the Indian Ocean and Solomon Islands again in the Pacific. So what do we have here is we have predominantly Northern and Northwestern European countries for type 1 diabetes and predominantly Pacific Islands for type 2 diabetes, but somewhat surprisingly from a number of studies in the last 10 or 20 years, we are also now starting to see Middle Eastern countries showing high risk for type 1 diabetes.