Microvascular and macrovascular complications in type 2 diabetes Ghanaian residents in Ghana and Europe: The RODAM study

Charles Hayfron-Benjamin; Bert-Jan van den Born; Anke H Maitland-van der Zee; Albert G B Amoah; Karlijn A C Meeks; Kerstin Klipstein-Grobusch; Silver Bahendeka; Joachim Spranger; Ina Danquah; Frank Mockenhaupt; Erik Beune; Liam Smeeth; Charles Agyemang

doi:10.1016/j.jdiacomp.2019.04.016

Microvascular and macrovascular complications in type 2 diabetes Ghanaian residents in Ghana and Europe: The RODAM study

J Diabetes Complications. 2019 Aug;33(8):572-578. doi: 10.1016/j.jdiacomp.2019.04.016. Epub 2019 May 10.

Affiliations

¹ Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands; Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Physiology, University of Ghana Medical School, Accra, Ghana; Department of Anaesthesia, Korle-Bu Teaching Hospital, Accra, Ghana. Electronic address: charlesfhb1@gmail.com.
² Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, the Netherlands.
³ Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
⁴ Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana; National Diabetes Management & Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana.
⁵ Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands; Center for Research on Genomics and Global Health, National Human Genome Research Institute, Bethesda, MD, USA.
⁶ Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁷ MKPGMS-Uganda Martyrs University, Kampala, Uganda.
⁸ Department of Endocrinology and Metabolism, Charité Universitätsmedizin Berlin, Berlin, Germany; Center for Cardiovascular Research (CCR), Charite-Universitaetsmedizin Berlin, Berlin, Germany.
⁹ Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universitaet zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.
¹⁰ Institute of Tropical Medicine and International Health, Charité Universitätsmedizin Berlin, Berlin, Germany.
¹¹ Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands.
¹² Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.

PMID: 31167710
DOI: 10.1016/j.jdiacomp.2019.04.016

Abstract

Aims: To compare microvascular and macrovascular complication rates among Ghanaians with type 2 diabetes (T2D) living in Ghana and in three European cities (Amsterdam, London and Berlin).

Methods: Data from the multicenter Research on Obesity and Diabetes among African Migrants (RODAM) study were analyzed. 650 Ghanaian participants with T2D (206 non-migrant and 444 migrants) were included. Logistic regression analyses were used to determine the association between migrant status and microvascular (nephropathy and retinopathy) and macrovascular (coronary artery disease (CAD), peripheral artery disease (PAD) and stroke) complications with adjustment for age, gender, socioeconomic status, alcohol, smoking, physical activity, hypertension, BMI, total-cholesterol, and HbA1c.

Results: Microvascular and macrovascular complications rates were higher in non-migrant Ghanaians than in migrant Ghanaians (nephropathy 32.0% vs. 19.8%; PAD 11.2% vs. 3.4%; CAD 18.4% vs. 8.3%; and stroke 14.5% vs. 5.6%), except for self-reported retinopathy (11.0% vs. 21.6%). Except nephropathy and stroke, the differences persisted after adjustment for the above-mentioned covariates: PAD (OR 7.48; 95% CI, 2.16-25.90); CAD (2.32; 1.09-4.93); and retinopathy (0.23; 0.07-0.75).

Conclusions: Except retinopathy, the rates of microvascular and macrovascular complications were higher in non-migrant than in migrant Ghanaians with T2D. Conventional cardiovascular risk factors did not explain the differences except for nephropathy and stroke.

Keywords: Diabetes complications; Ethnic minority groups; Ghana; Macrovascular; Microvascular; RODAM study.

Publication types

Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Coronary Artery Disease / epidemiology
Diabetes Mellitus, Type 2 / complications*
Diabetes Mellitus, Type 2 / epidemiology*
Diabetic Angiopathies / epidemiology*
Diabetic Nephropathies / epidemiology
Diabetic Retinopathy / epidemiology
Europe / epidemiology
Female
Ghana / epidemiology
Ghana / ethnology
Humans
Male
Middle Aged
Obesity / epidemiology
Peripheral Arterial Disease / epidemiology
Risk Factors
Stroke / epidemiology
Transients and Migrants / statistics & numerical data*