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Dear Sirs, the clinical review on managing diabetic retinopathathy
draws much needed attention for the need to improve the frequency of, and
adherence to retinal examinations[1]. Given the increasing threat of
blindness, ethnicity is an additional consideration with respect to
diabetic retinopathy screening and treatment clinics.
Within the UK, rates
of diabetes are disconcerting amongst groups originating from the Indian
subcontinent [2]. A susceptibility to glucose intolerance is evident in
both resident and migrant populations of South Asians from at least 25
years [3], underpinning excessive rates of microvascular and macrovascular
complications that afflict this group [4]. Notably, two independent
studies have reported ethnic differences in rates of diabetic retinopathy
and retinal lesions, which occur earlier and at higher levels amongst
South Asian diabetics compared to Caucasian diabetics [5] [6]. Altogether,
the burden of diabetes is particularly concentrated amongst South Asians
in the UK, who get the disease earlier, with a greater chance of
developing its associated complications. The implementation of screening
strategies for the early identification of glucose intolerance and its
complications in young South Asian populations is an opportunity to
deliver equity in healthcare to such groups in the UK.
References
[1]Ockrim Z, Yorton D. Managing diabetic retinopathy. BMJ 2010;
341:c5400
[2] Cruickshank JK, Beevers DG, Osbourne VL, Haynes RA, Corlett JC,
Selby S. Heart attack, stroke, diabetes, and hypertension in West Indians,
Asians, and whites in Birmingham, England. BMJ. 1980; 25;281:1108
[3] Patel JV, Vyas A, Prabhakaran D, Bhatnagar D, Durrington PN,
Heald A, Hughes EA, Mackness MI, Reddy KS, Cruickshank JK. Nonesterified
fatty acids as mediators of glucose intolerance in Indian Asian
populations. Diabetes Care. 2005;28:1505-7
[4] Raleigh VS, Kiri V, Balarajan R. Variations in mortality from
diabetes mellitus, hypertension and renal disease in England and Wales by
country of birth. Health Trends 1997; 28: 122-127
[5] Stolk RP, van Schooneveld MJ, Cruickshank JK, Hughes AD, Stanton
A, Lu J, Patel A, Thom SA, Grobbee DE, Vingerling JR; AdRem Project Team
and ADVANCE Management Committee. Retinal vascular lesions in patients of
Caucasian and Asian origin with type 2 diabetes: baseline results from the
ADVANCE Retinal Measurements (AdRem) study. Diabetes Care. 2008;31:708-13.
[6] Raymond NT, Varadhan L, Reynold DR, Bush K, Sankaranarayanan S,
Bellary S, Barnett AH, Kumar S, O'Hare JP; UK Asian Diabetes Study
Retinopathy Study Group. Higher prevalence of retinopathy in diabetic
patients of South Asian ethnicity compared with white Europeans in the
community: a cross-sectional study. Diabetes Care. 2009;32:410-5
Is diabetes worse in South Asians?
Dear Sirs, the clinical review on managing diabetic retinopathathy
draws much needed attention for the need to improve the frequency of, and
adherence to retinal examinations[1]. Given the increasing threat of
blindness, ethnicity is an additional consideration with respect to
diabetic retinopathy screening and treatment clinics.
Within the UK, rates
of diabetes are disconcerting amongst groups originating from the Indian
subcontinent [2]. A susceptibility to glucose intolerance is evident in
both resident and migrant populations of South Asians from at least 25
years [3], underpinning excessive rates of microvascular and macrovascular
complications that afflict this group [4]. Notably, two independent
studies have reported ethnic differences in rates of diabetic retinopathy
and retinal lesions, which occur earlier and at higher levels amongst
South Asian diabetics compared to Caucasian diabetics [5] [6]. Altogether,
the burden of diabetes is particularly concentrated amongst South Asians
in the UK, who get the disease earlier, with a greater chance of
developing its associated complications. The implementation of screening
strategies for the early identification of glucose intolerance and its
complications in young South Asian populations is an opportunity to
deliver equity in healthcare to such groups in the UK.
References
[1]Ockrim Z, Yorton D. Managing diabetic retinopathy. BMJ 2010;
341:c5400
[2] Cruickshank JK, Beevers DG, Osbourne VL, Haynes RA, Corlett JC,
Selby S. Heart attack, stroke, diabetes, and hypertension in West Indians,
Asians, and whites in Birmingham, England. BMJ. 1980; 25;281:1108
[3] Patel JV, Vyas A, Prabhakaran D, Bhatnagar D, Durrington PN,
Heald A, Hughes EA, Mackness MI, Reddy KS, Cruickshank JK. Nonesterified
fatty acids as mediators of glucose intolerance in Indian Asian
populations. Diabetes Care. 2005;28:1505-7
[4] Raleigh VS, Kiri V, Balarajan R. Variations in mortality from
diabetes mellitus, hypertension and renal disease in England and Wales by
country of birth. Health Trends 1997; 28: 122-127
[5] Stolk RP, van Schooneveld MJ, Cruickshank JK, Hughes AD, Stanton
A, Lu J, Patel A, Thom SA, Grobbee DE, Vingerling JR; AdRem Project Team
and ADVANCE Management Committee. Retinal vascular lesions in patients of
Caucasian and Asian origin with type 2 diabetes: baseline results from the
ADVANCE Retinal Measurements (AdRem) study. Diabetes Care. 2008;31:708-13.
[6] Raymond NT, Varadhan L, Reynold DR, Bush K, Sankaranarayanan S,
Bellary S, Barnett AH, Kumar S, O'Hare JP; UK Asian Diabetes Study
Retinopathy Study Group. Higher prevalence of retinopathy in diabetic
patients of South Asian ethnicity compared with white Europeans in the
community: a cross-sectional study. Diabetes Care. 2009;32:410-5
Competing interests: No competing interests