Heterogeneity in the development of diabetes-related complications: narrative review of the roles of ancestry and geographical determinants

作者：Andrea O. Y. Luk, Yingnan Fan, Baoqi Fan, Edith W. K. Chow, C K O Tony · 发表于：Diabetologia · 年份：2025 · DOI：10.1007/s00125-025-06482-8 · 被引用次数：10 · 研究领域：Diabetes, Cardiovascular Risks, and Lipoproteins、Diabetes Management and Education、Alcohol Consumption and Health Effects

The risk of developing diabetes-related complications is influenced by a combination of biological factors, clinical factors and social determinants of health that vary across countries and ethnic groups. Available evidence indicates that the incidence of diabetes-related complications is lower in high-income countries in Europe and North America, while other world regions have higher or variable incidence rates. By ethnicity, White individuals tend to have lower risks of most diabetes-related complications with the exception of coronary artery disease. In contrast, Black, East Asian and South Asian individuals have a greater propensity for most complications, notably chronic kidney disease and stroke. In general, ethnic groups that report a higher incidence of diabetes-related complications also exhibit a higher incidence of type 2 diabetes, particularly among younger age groups. Unique clinical phenotypes characterised by more severe insulin resistance and related comorbidities that drive both an earlier age of diabetes onset and manifestation of end-organ damage have been documented in several high-risk ethnic populations, but the genetic and epigenetic contributors have not been fully elucidated. Non-biological determinants, such as disparities in access to preventive care and the adoption of health-promoting behaviour, shaped by a combination of socioeconomic position, education and culture, are equally as significant as biological factors in influencing disease outcomes...