Racial and ethnic differences in cardiovascular disease and outcome in type 1 diabetes patients

ABSTRACT

Introduction: Type 1 diabetes mellitus (T1DM) has increased dramatically over the last two decades with global variation greater than 350-fold difference reflecting the ethnic, racial, and geographical variation. Diabetic patients remain at a higher risk of cardiovascular mortality than those without diabetes. Therefore, it is vital for clinicians to have in-depth knowledge of T1DM statistics and their impact on people health and health resources.

Areas covered: This review will cover the epidemiologic characteristics of T1DM and the influence of race, ethnicity, and geographical variation on the incidence and the outcome. The minority populations health disparities in the clinical presentation and outcomes among youth with T1DM, the long-term glycemic control patterns in racially and ethnically diverse youth, and the long-term influence of these factors on cardiovascular outcomes will be elucidated. The PubMed database was searched using the terms: T1DM ± incidence, Race, ethnicity, and Genetic.

Expert opinion: Understanding the epidemiological characteristics of T1DM including race, ethnicity and the genetic predisposition will help to develop guidelines target these higher risk patients of an unfavorable outcome. Further research and interventional strategies to identify infants at genetic risk of T1DM may help to prevent, stop or retard the destructive autoimmune process leading to T1DM.

KEYWORDS:

• Cardiovascular disease
• diabetes
• ethnicity and racial differences
• epidemiology of type 1 diabetes mellitus

Article highlights

• T1DM is rising at an alarming rate especially in children less than 5 years old.

• T1DM develops as a consequence of a combination of genetic predisposition and largely unknown environmental factors.

• There is a global variation in the incidence of childhood T1DM with a greater than 350-fold difference among the worldwide populations.

• The highest incidence rates for juvenile diabetes have been reported from northern European countries, which are characterized by ethnically stable and nonmigrating Caucasian populations.

• A statistically significant male-to-female excess in incidence was reported.

• Individuals with a first-degree relative with T1DM have a 1 in 20-lifetime risk of developing T1DM, compared to a 1 in 300-lifetime risk for the general population.

• Children withT1DM before the age of 5 years are more likely to be genetically predisposed, their siblings at 3 times higher risk than other ages.

• The offspring of T1DM mothers have one-third the risk of developing T1DM in comparison to the offspring of T1DM fathers.

• Cardiovascular disease is responsible for 30% of all deaths worldwide with most of the burden occurring in developing countries.

• Race and ethnicity significantly influence the risk of CVD, and it accounts for about one-third of the disparity in the potential life-years lost between blacks and whites.

• The overall mortality from acute myocardial infarction in the diabetic population was 4 times higher among men and 7 times higher among women compared to the non-diabetic population.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.