title: Long-term diabetes outcomes in multi-ethnic Asians living in Singapore.
abstract: OBJECTIVE
  This study aims to assess ethnic and gender disparities on long-term complications among multi-ethnic Asians with Diabetes Mellitus (DM) living in Singapore.
  
  
  METHODS
  We conducted a retrospective cohort study involving 3006 patients who attended a diabetes centre in a hospital from 2003 to 2011. Demographics and clinical data were obtained from standardised questionnaire and patient's case records. Age at onset of diabetes was calculated as current age minus duration of DM in years. Outcomes on Acute Myocardial Infarction (AMI), End-Stage Renal Failure (ESRF) and all-cause death were ascertained by data linkage with national registries.
  
  
  RESULTS
  The mean duration of diabetes exposure was 15.6 ± 9.1 years for AMI, 15.4 ± 9.0 years for ESRF and 17.0 ± 9.0 years for death. After adjusting for traditional cardiovascular risk factors, Malay and Indian with diabetes remained significantly associated with AMI with HRs 2.81(95%CI, 1.81-4.37) and 2.03 (95%CI, 1.15-3.59), respectively. The effect of Malays on ESRF and death became attenuated post-adjustment. Besides mortality, there was preponderance for other adverse outcomes associated with male.
  
  
  CONCLUSIONS
  Ethnic (Malay worse) and gender (male worse) disparities were observed in DM-related outcomes. The results may inform allocation of finite resources and to organize care targeted at high-risk groups.
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore. Electronic address: low.serena.km@alexandrahealth.com.sg.
authors.forename: Serena
authors.initials: S
authors.lastname: Low
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore; Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Lim Su
authors.initials: LS
authors.lastname: Chi
authors.affiliation: Department of Medicine, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Lee Ying
authors.initials: LY
authors.lastname: Yeoh
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Jian Jun
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Sharon
authors.initials: S
authors.lastname: Fun
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Chang
authors.initials: C
authors.lastname: Su
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore; Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Tavintharan
authors.initials: T
authors.lastname: Subramaniam
authors.affiliation: Diabetes Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
authors.forename: Chee Fang
authors.initials: CF
authors.lastname: Sum
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D002423:Cause of Death; D048909:Diabetes Complications / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000401:mortality; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000208:ethnology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors
keywords: Complications; Diabetes mellitus; Ethnicity; Gender