Background: People from South East Asia and East Asia develop T2DM at a younger age and with a lower BMI. (1)  It has been reported that retinopathy and nephropathy occurs earlier and disease progression tends to be more aggressive in these populations. (2-4)

Australia, as a multicultural nation, has had a significant migration from both East and South East Asia.  Understanding the ethnic variation in Asians with diabetes by clinicians is therefore crucial for better management of this chronic condition. 

Aim: To compare the differences in T2DM presentations and outcomes between Asian and Caucasian populations in 2 major health care regions in Melbourne.    

Methods: At Royal Melbourne Hospital, T2DM patients, who attended outpatient clinics from 2011-2015, were selected via the Biogrid clinic diabetes database. In Eastern Health, information was collected prospectively from February 2015 by treating clinicians. The Asian population included in this study is limited to only SE Asian and East Asian as self-defined.

Results: In total, 659 patients with T2DM were reviewed. Mean BMI at disease onset was 25.8 in Asians compared to 31.7 in Caucasians. Diabetes developed 7 years earlier in the Asian group.

The prevalence of cataracts and diabetic retinopathy was 4 times higher in Asians and the end stage renal failure rate was double in Asians.  However, diabetes foot ulcers, peripheral neuropathy and macro-vascular complications were more common in Caucasians.    

Using the latest recorded blood test results, average HbA1c (7.6% vs 7.7%) was similar between 2 groups. The albumin:creatinine ratio was higher in the Asian group (233.7 vs 212.8).  Meformin was more commonly prescribed in Asian (69%) compared to Caucasian patients (51%).  In addition, insulin was commenced on average 8 years earlier in the Asian population.  

Conclusion: Asians with T2DM living in Australia developed diabetes at an earlier age than Caucasians and had lower BMI at the time of diagnosis.  The BMI difference was maintained over years.   They required insulin therapy at younger age.  The diabetes complication rate is overall similar to that seen with Asians living in their homeland with retinopathy and nephropathy been more common than foot ulcers and macro-vascular disease.