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Obesity and intermediate clinical outcomes in diabetes: evidence of a differential relationship across ethnic groups


  • C.M., G.N. and K.K. conceived the study. C.M. and G.N. performed the statistical analyses. All authors contributed to the data interpretation. C.M. and K.K. wrote the first draft of the manuscript and all authors contributed to the revision and approved the final version. C.M. is the guarantor for the study.

: Christopher Millett, Consultant in Public Health, Department of Primary Care & Social Medicine, Imperial College Faculty of Medicine, 3rd Floor, Reynolds Building, St Dunstan's Road, London W6 8RP, UK. E-mail:


Aim  To examine associations between obesity, ethnicity and intermediate clinical outcomes in diabetes.

Methods  Population-based, cross-sectional study using electronic primary care medical records of 7300 people with diabetes from White, Black and south Asian ethnic groups.

Results  The pattern of obesity differed within ethnic groups, with rates significantly higher in younger when compared to older Black (women, 63% vs. 44%, P = 0.002; men, 37% vs. 20%, P = 0.005) and south Asian (women, 47% vs. 27%, P = 0.01; men, 21% vs. 13%, P = 0.05) people. Obese people with diabetes were significantly less likely to achieve an established target for blood pressure control (adjusted odds ratio 0.50, 95% confidence interval 0.42, 0.59). Differences in mean systolic blood pressure in obese and normal weight persons were significant in the White group but not in the Black groups or south Asian groups (6.9 mmHg, 1.9 mmHg and 2.7 mmHg, respectively). Differences in mean diastolic blood pressure between obese and normal weight persons were 4.8 mmHg, 3.6 mmHg and 3.4 mmHg in the White, Black and south Asian groups. Mean HbA1c and achievement of an established treatment target did not differ significantly with obesity in any ethnic group.

Conclusions  Obesity is more prevalent amongst younger people than older people with diabetes in ethnic minority groups. The relationship between obesity and blood pressure control in diabetes differs markedly across ethnic groups. Major efforts must be implemented, especially in young people, to reduce levels of obesity in diabetes and improve long-term outcomes.