High prevalence of type 2 diabetes in all ethnic groups, including Europeans, in a British inner city - Relative poverty, history, inactivity, or 21st century Europe?

OBJECTIVE - To compare the prevalence of type 2 diabetes in white Europeans and individuals of African-Caribbean and Pakistani descent. RESEARCH DESIGN AND METHODS - Random sampling of population-based registers in inner-city Manchester, Britain's third most impoverished area. A total of 1,318 people (25-79 years of age) were screened (minimum response 67%) 5 33 individuals without known diabetes underwent 2-h glucose tolerance testi ng, classified by 1999 World Health Organization criteria. RESULTS - More than 60% of individuals reported household annual income < p ound 10,000 ($15,000) per year. Energetic physical activity was rare and ob esity was common. Age-standardized (35-79 years) prevalence (mean 95% Cl) o f known and newly detected diabetes was 20% (17-24%) in Europeans, 22% (18- 26%) in African-Caribbeans, and 33% (25-41%) in Pakistanis. Minimum prevale nce (assuming all individuals not tested were normoglycemic) was 11% (8-14% ), 19% (15-23%), and 32% (24-40%), respectively. Marked changes in prevalen ce represent only small shifts in glucose distributions. Regression models showed that greater waist girth, lower height, and older age were independe ntly related to plasma glucose levels, as was physical activity. Substituti ng BMI and waist-to-hip ratio revealed their powerful contribution. CONCLUSIONS - A surprisingly high prevalence of diabetes, despite expected increases with new lower criteria, was found in Europeans, as previously es tablished in Caribbeans and Pakistanis. Lower height eliminated ethnic diff erences in regression models. History and relative poverty, which cosegrega te with obesity and physical inactivity, are likely contributors. Whatever the causes, the implications for health services are alarming, although sub stantial preventive opportunities through small reversals of glucose distri butions are the challenge.