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Explanations for the lower rates of diabetic neuropathy in Indian Asians versus Europeans.

Abbott CA, Chaturvedi N, Malik RA, Salgami E, Yates AP, Pemberton PW, Boulton AJ - Diabetes Care (2010)

Bottom Line: We therefore compared signs, symptoms, and objective quantitative measures of diabetic neuropathy and their risk factors in Indian Asians and Europeans.Small fiber neuropathy was less prevalent in Indian Asians compared with Europeans (odds ratio 0.58 [95% CI 0.37-0.93]; P = 0.02) and was primarily accounted for by better TCpO(2) (0.70 [0.40-1.21]; P = 0.2).Independent from smoking, the lower risk of neuropathy in Asians is due to better skin microvascularization and may help explain the substantially reduced Asian foot ulcer risk.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Research Group, School of Biomedicine, University of Manchester, Manchester, UK. caroline.abbott@manchester.ac.uk

ABSTRACT

Objective: Risks of diabetes and cardiovascular disease are elevated worldwide in Indian Asians. However, risks of other diabetes-related complications, i.e., foot ulceration and amputation, also with a vascular basis, are substantially lower in Asians than in white Europeans in the U.K., possibly due to less neuropathy. We therefore compared signs, symptoms, and objective quantitative measures of diabetic neuropathy and their risk factors in Indian Asians and Europeans.

Research design and methods: This was a cross-sectional study of a population-based sample of age- and sex-matched adults with type 2 diabetes of European (95 male and 85 female) and Asian (96 male and 84 female) descent in the U.K. Patients were assessed for neuropathic symptoms, signs, nerve conduction, autonomic function, and quantitative sensory testing. Peripheral vascular function and other potential risk factors for neuropathy were measured. RESULTS Mean nerve conduction velocity Z scores were better in Asians (mean +/- SD 0.07 +/- 0.62) than in Europeans (-0.11 +/- 0.60; P = 0.007) and were explained by the shorter height, fewer pack-years smoked, and higher transcutaneous oxygen levels (TCpO(2)) in Indian Asians (P value for ethnic comparison attenuated to 0.2). Small fiber neuropathy was less prevalent in Indian Asians compared with Europeans (odds ratio 0.58 [95% CI 0.37-0.93]; P = 0.02) and was primarily accounted for by better TCpO(2) (0.70 [0.40-1.21]; P = 0.2).

Conclusions: Asians with diabetes have substantially less large and small fiber neuropathy than Europeans, despite comparable traditional risk factors. Independent from smoking, the lower risk of neuropathy in Asians is due to better skin microvascularization and may help explain the substantially reduced Asian foot ulcer risk.

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Indexes of neuropathy by ethnicity: Indian Asians and Europeans. A: Neuropathy prevalence (percent). B: Nerve conduction studies (Z scores) (mean ± SE). C: Autonomic nerve function (mean ± SD). *Significantly different between the two groups, P < 0.05. **Significantly different between the two groups, P < 0.01. SBP, systolic blood pressure.
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Figure 1: Indexes of neuropathy by ethnicity: Indian Asians and Europeans. A: Neuropathy prevalence (percent). B: Nerve conduction studies (Z scores) (mean ± SE). C: Autonomic nerve function (mean ± SD). *Significantly different between the two groups, P < 0.05. **Significantly different between the two groups, P < 0.01. SBP, systolic blood pressure.

Mentions: Neuropathy signs (NDS ≥6) were more prevalent in Europeans (36 of 180, 20%) than Indian Asians (27 of 178, 15%), although this was not statistically significant (P = 0.2) (Fig. 1A). Overall symptom reporting did not differ by ethnicity (total mean NSC score for Europeans 2.2 ± 2.2 and for Indian Asians 2.2 ± 2.1, P = 0.9); however, Europeans reported greater loss of peripheral sensation (0.29 ± 0.77 vs. 0.13 ± 0.45, P = 0.018).


Explanations for the lower rates of diabetic neuropathy in Indian Asians versus Europeans.

Abbott CA, Chaturvedi N, Malik RA, Salgami E, Yates AP, Pemberton PW, Boulton AJ - Diabetes Care (2010)

Indexes of neuropathy by ethnicity: Indian Asians and Europeans. A: Neuropathy prevalence (percent). B: Nerve conduction studies (Z scores) (mean ± SE). C: Autonomic nerve function (mean ± SD). *Significantly different between the two groups, P < 0.05. **Significantly different between the two groups, P < 0.01. SBP, systolic blood pressure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875448&req=5

Figure 1: Indexes of neuropathy by ethnicity: Indian Asians and Europeans. A: Neuropathy prevalence (percent). B: Nerve conduction studies (Z scores) (mean ± SE). C: Autonomic nerve function (mean ± SD). *Significantly different between the two groups, P < 0.05. **Significantly different between the two groups, P < 0.01. SBP, systolic blood pressure.
Mentions: Neuropathy signs (NDS ≥6) were more prevalent in Europeans (36 of 180, 20%) than Indian Asians (27 of 178, 15%), although this was not statistically significant (P = 0.2) (Fig. 1A). Overall symptom reporting did not differ by ethnicity (total mean NSC score for Europeans 2.2 ± 2.2 and for Indian Asians 2.2 ± 2.1, P = 0.9); however, Europeans reported greater loss of peripheral sensation (0.29 ± 0.77 vs. 0.13 ± 0.45, P = 0.018).

Bottom Line: We therefore compared signs, symptoms, and objective quantitative measures of diabetic neuropathy and their risk factors in Indian Asians and Europeans.Small fiber neuropathy was less prevalent in Indian Asians compared with Europeans (odds ratio 0.58 [95% CI 0.37-0.93]; P = 0.02) and was primarily accounted for by better TCpO(2) (0.70 [0.40-1.21]; P = 0.2).Independent from smoking, the lower risk of neuropathy in Asians is due to better skin microvascularization and may help explain the substantially reduced Asian foot ulcer risk.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Research Group, School of Biomedicine, University of Manchester, Manchester, UK. caroline.abbott@manchester.ac.uk

ABSTRACT

Objective: Risks of diabetes and cardiovascular disease are elevated worldwide in Indian Asians. However, risks of other diabetes-related complications, i.e., foot ulceration and amputation, also with a vascular basis, are substantially lower in Asians than in white Europeans in the U.K., possibly due to less neuropathy. We therefore compared signs, symptoms, and objective quantitative measures of diabetic neuropathy and their risk factors in Indian Asians and Europeans.

Research design and methods: This was a cross-sectional study of a population-based sample of age- and sex-matched adults with type 2 diabetes of European (95 male and 85 female) and Asian (96 male and 84 female) descent in the U.K. Patients were assessed for neuropathic symptoms, signs, nerve conduction, autonomic function, and quantitative sensory testing. Peripheral vascular function and other potential risk factors for neuropathy were measured. RESULTS Mean nerve conduction velocity Z scores were better in Asians (mean +/- SD 0.07 +/- 0.62) than in Europeans (-0.11 +/- 0.60; P = 0.007) and were explained by the shorter height, fewer pack-years smoked, and higher transcutaneous oxygen levels (TCpO(2)) in Indian Asians (P value for ethnic comparison attenuated to 0.2). Small fiber neuropathy was less prevalent in Indian Asians compared with Europeans (odds ratio 0.58 [95% CI 0.37-0.93]; P = 0.02) and was primarily accounted for by better TCpO(2) (0.70 [0.40-1.21]; P = 0.2).

Conclusions: Asians with diabetes have substantially less large and small fiber neuropathy than Europeans, despite comparable traditional risk factors. Independent from smoking, the lower risk of neuropathy in Asians is due to better skin microvascularization and may help explain the substantially reduced Asian foot ulcer risk.

Show MeSH
Related in: MedlinePlus