Diabetes care and cardiovascular prevention in migrant population in Lombardia
A new study by “Mario Negri” IRCCS show the importance of ethnicity and duration of stay in prevalence of the disease and access to treatments, and highlights the need of more migrant-friendly care.
The burden of diabetes is forecast to increase. Worldwide 8.8% of adults aged 20–79 are estimated to have diabetes. About 75% live in low-to-middle income countries, such as Middle East, Africa and South-East Asia.
A recent study on Italian administrative databases indicated that in the migrant population in Lombardia Region from North or Sub-Saharan regions of Africa the prevalence of diabetes is double than that of Italian citizens; and among South Asians the prevalence is five times higher.
A new population-based study, – by the IRCCS Istituto di Ricerche Farmacologiche "Mario Negri", with the collaboration of the Regional Health Ministry of Lombardy Region, – using linkable administrative health databases, describes the prevalence and management of diabetes among migrants according to their ethnic groups and the duration of stay, in relation to Italian citizens. Centro Cardiologico Monzino also contributed to the study with a consultation of Dr. Stefano Genovese, Head of Diabetes, Endocrine and Metabolic Disease Unit.
In the Lombardia Region, the total number of diabetic patients aged 20–69 years was 215,041 (3.3%) in 2010, 195,049 Italians (91.8%) and 19,992 (9.2%) of foreign origin.
Data from the study confirm that the prevalence of diabetes among migrants is generally higher than among Italians, with great variability in specific ethnic groups, with a higher percentage among southern Asian (4.6%) and North African (3.9%) migrants, having a more than double-adjusted prevalence compared to Italians, with higher trend in long-term resident migrants than in short-term residents.
Pharmacological treatment of diabetes seemed different in migrants and Italians with migrants less likely than Italians to be treated with insulin and more likely to be treated with oral antidiabetic drugs (OAD) or with the combination of insulin and OADs.
The prescription of cardiovascular preventive treatments and the indicators of diabetes care were far from optimal in people with diabetes (including Italians), but all the short-term foreign-born diabetic people, with few exceptions, received significantly less recommended treatments than the Italians, and were less likely than Italians to be seen by a diabetologist and to have at least one HbA1c test per year. In particular, the proportion of Italian diabetic patients not tested for HbA1c in a year was 25% while long-term resident immigrants had around 30% and short-term residents almost 50%.
The numbers of migrants in European countries will increase in the coming years. Legal healthcare entitlements need therefore to be expanded, but our study also highlights that health systems need to become more migrant-friendly: overcoming language and cultural barriers, improving the competencies of health workers and organizations, and increasing the health literacy of the immigrants themselves.
- Marzona I, Avanzini F, Tettamanti M, Vannini T, Fortino I, Bortolotti A, Merlino L, Genovese S, Roncaglioni MC. Prevalence and management of diabetes in immigrants resident in the Lombardy Region: the importance of ethnicity and duration of stay. Acta Diabetol. 2018 Jan 22. doi: 10.1007/s00592-018-1102-6. [Epub ahead of print]