RESUMO
Over the past twenty years a computerized record sytem `Diabeta' has been used to collect and collate clinical information on all patients attending the Diabetes Centre. In this time over 8000 patients have been registered, of these 42 percent have been grouped `caucasian' and 32 percent `afro-caribbean' by their own description. These large groups allow us to look at ethnic differences in disease pattern and outcomes, in order to better plan future diabetes health care requirement of different ethnic groups. Specific and significant differences between caucasians and afro-caribbeans are seen in many aspects of disease process and outcome. Age of onset of diabetes in European populations charateristically follows a bi-modal distribution, with peaks around the age of 10 and 60 years, this is mirrored in our own caucasian population in Lambeth. By contrast incidence of diabetes in our afro-Caribbean population is extremely low under the age of 20, but peaks at 50 years. True insulin-dependent diabetes (IDDM) is thus uncommon in afro-Caribbeans whilst non-insulin dependent diabetes (NIDDM) is somewhat more common. Patients with NIDDM have increased risks for cardio-vascular disease and peripheral vascular disease in addition to the specific diabetes-related complications, thus attention is given in the clinic to blood pressure, cholesterol, smoking habits and weight in addition to measures of glycaemic control. Risk factors differ significantly between the two groups, afro-caribbeans having higher blood pressure (despite treatment) but lower rates of smoking. Glycaemic control (percentage of HbALc) is not significantly different between the groups as a mean, but 2/3 of the worst 5 percent of glycaemic control are afro-caribbean. Despite these differences, stroke rates are similar in the two groups, cardiovascular disease higher in caucasians, and almost all specific diabetes complications higher in caucasians. The only major significant outcome that shows higher in afro-caribbeans is the onset of persistent proteinuria (heralding renal failure). Diabetes complications create a large health and financial burden on patients, knowledge of ethnic differences in relative risks of complications will allow us to better tailor the care and health-screening offered in the clinic to the individual needs of our patients. (AU)