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Ethnicity and social deprivation and its influence on diabetes

The International Diabetes Federation has posted an update for 2012 on its Diabetes Atlas (http://www.idf.org/diabetesatlas/5e/Update2012). We are reminded that there are more than 371 million people who have diabetes and half of those are undiagnosed. The number of people with diabetes is increasing in every country; four out five people live in lowand middle-income countries; 4.8 million people died because of diabetes, with half being under the age of 60 years; $US 471 billion were spent as a result of diabetes in 2012. They comment that the new figures ‘add urgency to the need for effective prevention, treatment and an end to silence and discrimination’. This message is extended by a number of papers published in this month’s issue of Diabetic Medicine and disturbingly includes the care of children with diabetes. Ruta and colleagues (page 387) present a detailed literature search on the prevalence of diabetic retinopathy in Type 2 diabetes, and find the prevalence was highest in developing countries. They conclude there were significant gaps in the literature that demanded more research with standardization of methodologies. Leese and colleagues (page 484) address an equally important issue, namely social deprivation, and highlight its importance as a determinant of diabetes-related foot disease. Both retinopathy and foot disease have disastrous consequences for people in developing countries and the socially deprived, especially if it affects the main wage earner of the household, as the consequences of this impacts not only on the person with diabetes, but those who he/she financially supports. Equally disturbing are papers from two groups who look after children and young adults living in London (UK) from Dias and colleagues (page 495) and Thompson and colleagues (page 491); both are made free for download. In the first paper from the Royal London Hospital, the investigators observed differences over the course of their study in glycaemia control between white children and young persons compared with South Asians and black children and young persons; with the best achieved target HbA1c being in the South Asian group and worst in the black group. Additionally, South Asian ethnicity was associated with an atherogenic profile independent of HbA1c. In the second paper, from University College London Hospitals, their data suggest that deprivation and ethnicity influence diabetes control adversely, and how insulin pump therapy is utilized. Although clinic attendance did not differ between ethnic groups, it indicates that, even at this young age, and in socalled ‘developed countries’, there is much work to be carried out to ensure equitable care to all people living with diabetes.