Diabetes mellitus and obesity among South Asians with ischaemic stroke across three countries

BACKGROUND: Diabetes mellitus and central obesity are more common among South Asian populations than among white British people. This study explores the differences in diabetes and obesity in South Asians with stroke living in the UK, India and Qatar compared with white British stroke patients.

METHODS: The study included the UK, Indian and Qatari arms of the ongoing large Bio-Repository of DNA in Stroke (BRAINS) international prospective hospital-based study for South Asian stroke. BRAINS includes 4580 South Asian and white British recruits from UK, Indian and Qatar sites with first-ever ischemic stroke.

RESULTS: The study population comprises 1751 white British (WB) UK residents, 1165 British South Asians (BSA), 1096 South Asians in India (ISA), and 568 South Asians in Qatar (QSA). ISA, BSA and QSA South Asians suffered from higher prevalence of diabetes compared to WB by 14.5% (ISA 95%CI: 18.6-33.0, P<0.001), 31.7% (BSA 95%CI: 35.1-50.2, P<0.001) and 32.7% (QSA 95%CI: 28.1-37.3, P<0.001), respectively. Although WB had the highest prevalence of BMI above 27 kg/m2 compared to South Asians patients (37% vs. 21%, P<0.001), South Asians patients had a higher waist circumference than WB (94.8cm vs. 90.8cm, P<0.001). Adjusting for traditional stroke risk factors, ISA, BSA and QSA continued to display an increased risk of diabetes compared to WB by 3.28 (95%CI: 2.53-4.25, P<0.001), 3.61 (95%CI: 2.90-4.51, P<0.001), and 5.24 (95%CI: 3.93-7.00, P<0.001), respectively.

CONCLUSION: South Asian ischaemic stroke patients living in Britain and Qatar have a near 3.5-fold risk of diabetes compared to white British stroke patients. Their body composition may partly help explain that increased risk. These findings have important implications for public health policymakers in nations with large South Asian populations.