Original research| Volume 8, ISSUE 3, P231-238, October 2014

Download started.


Ethnicity is an independent risk indicator when estimating diabetes risk with FINDRISC scores: A cross sectional study comparing immigrants from the Middle East and native Swedes

  • L. Bennet
    Corresponding author at: Family Medicine, Clinical Research Center, Entrance 72, Building 28, Floor 12, Jan Waldenströms gata 37, Skåne University Hospital, 205 02 Malmö, Sweden. Tel.: +46 40 391388; fax: +46 40 391370.
    Department of Clinical Sciences, Lund University, Malmö, Sweden

    Family Medicine, Lund University, Malmö, Sweden
    Search for articles by this author
  • L. Groop
    Department of Clinical Sciences, Lund University, Malmö, Sweden

    Department of Diabetes and Endocrinology/Lund Diabetes Centre, Skåne University Hospital, Malmö, Sweden
    Search for articles by this author
  • U. Lindblad
    Department of Primary Health Care, Institute of Medicine, University of Gothenburg, Sweden
    Search for articles by this author
  • Author Footnotes
    1 Deceased.
    C.-D. Agardh
    1 Deceased.
    Department of Clinical Sciences, Lund University, Malmö, Sweden
    Search for articles by this author
  • P.W. Franks
    Department of Clinical Sciences, Lund University, Malmö, Sweden

    Genetic & Molecular Epidemiology Unit, Lund University, Malmö, Sweden

    Department of Nutrition, Harvard School of Public Health, Boston Massachusetts, USA

    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
    Search for articles by this author
  • Author Footnotes
    1 Deceased.
Published:January 28, 2014DOI:



      This study sought to compare type 2 diabetes (T2D) risk indicators in Iraqi immigrants with those in ethnic Swedes living in southern Sweden.


      Population-based, cross-sectional cohort study of men and women, aged 30–75 years, born in Iraq or Sweden conducted in 2010–2012 in Malmö, Sweden. A 75 g oral glucose tolerance test was performed and sociodemographic and lifestyle data were collected. T2D risk was assessed by the Finnish Diabetes Risk Score (FINDRISC).


      In Iraqi versus Swedish participants, T2D was twice as prevalent (11.6 vs. 5.8%, p < 0.001). A large proportion of the excess T2D risk was attributable to larger waist circumference and first-degree family history of diabetes. However, Iraqi ethnicity was a risk factor for T2D independently of other FINDRISC factors (odds ratio (OR) 2.5, 95% CI 1.6–3.9).
      The FINDRISC algorithm predicted that more Iraqis than Swedes (16.2 vs. 12.3%, p < 0.001) will develop T2D within the next decade. The total annual costs for excess T2D risk in Iraqis are estimated to exceed 2.3 million euros in 2005, not accounting for worse quality of life.


      Our study suggests that Middle Eastern ethnicity should be considered an independent risk indicator for diabetes. Accordingly, the implementation of culturally tailored prevention programs may be warranted.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Unwin N.
        • Shaw J.
        • Zimmet P.
        • Alberti K.G.
        Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention.
        Diabetic Med. 2002; 19: 708-723
        • Zimmet P.
        • Magliano D.
        • Matsuzawa Y.
        • Alberti G.
        • Shaw J.
        The metabolic syndrome: a global public health problem and a new definition.
        J. Atheroscler. Thromb. 2005; 12: 295-300
        • Glans F.
        • Elgzyri T.
        • Shaat N.
        • Lindholm E.
        • Apelqvist J.
        • Groop L.
        Immigrants from the Middle-East have a different form of type 2 diabetes compared with Swedish patients.
        Diabetic Med. 2008; 25: 303-307
        • Mansour A.A.
        • Wanoose H.L.
        • Hani I.
        • Abed-Alzahrea A.
        Diabetes screening in Basrah, Iraq: a population-based cross-sectional study.
        Diabetes Res. Clin. Pract. 2008; 79: 147-150
        • Wandell P.E.
        • Carlsson A.
        • Steiner K.H.
        Prevalence of diabetes among immigrants in the Nordic countries.
        Curr. Diabetes Rev. 2010; 6: 126-133
        • Wandell P.E.
        • Wajngot A.
        • de Faire U.
        • Hellenius M.L.
        Increased prevalence of diabetes among immigrants from non-European countries in 60-year-old men and women in Sweden.
        Diabetes Metab. 2007; 33: 30-36
        • Wändell P.E.
        Quality of life of patients with diabetes mellitus. An overview of research in primary health care in the Nordic countries.
        Scand. J. Prim. Health Care. 2005; 23: 68-74
        • Bolin K.
        • Gip C.
        • Mörk A.C.
        • Lindgren B.
        Diabetes, healthcare cost and loss of productivity in Sweden 1987 and 2005 – a register-based approach.
        Diabetic Med. 2009; 26: 928-934
        • Noble D.
        • Mathur R.
        • Dent T.
        • Meads C.
        • Greenhalgh T.
        Risk models and scores for type 2 diabetes: systematic review.
        BMJ. 2011; 343: d7163
        • Lindström J.
        • Tuomilehto J.
        The diabetes risk score: a practical tool to predict type 2 diabetes risk.
        Diabetes Care. 2003; 26: 725-731
        • WMA
        Declaration of Helsinki – Ethical principles of medical research involving human subjects.
        • Bennet L.
        • Johansson S.E.
        • Agardh C.D.
        • Groop L.
        • Sundquist J.
        • Rastam L.
        • Sundquist K.
        High prevalence of type 2 diabetes in Iraqi and Swedish residents in a deprived Swedish neighbourhood – a population based study.
        BMC Public Health. 2011; 11: 303
        • World Health Organization
        Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO consultation. Part 1. Diagnosis and classification of diabetes mellitus.
        World Health Organization, Geneva1999
        • Shaw J.E.
        • Zimmet P.Z.
        • de Courten M.
        • Dowse G.K.
        • Chitson P.
        • Gareeboo H.
        • Hemraj F.
        • Fareed D.
        • Tuomilehto J.
        • Alberti K.G.
        Impaired fasting glucose or impaired glucose tolerance. What best predicts future diabetes in Mauritius?.
        Diabetes Care. 1999; 22: 399-402
        • Stern M.P.
        • Williams K.
        • Haffner S.M.
        Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test?.
        Ann. Intern. Med. 2002; 136: 575-581
      1. Nationella riktlinjer för sjukdomsförebyggande behandling.

      2. Statistics Sweden.

        • Wandell P.E.
        • Johansson S.E.
        • Gafvels C.
        • Hellenius M.L.
        • de Faire U.
        • Sundquist J.
        Estimation of diabetes prevalence among immigrants from the Middle East in Sweden by using three different data sources.
        Diabetes Metab. 2008; 34: 328-333
        • Shaw J.E.
        • Sicree R.A.
        • Zimmet P.Z.
        Global estimates of the prevalence of diabetes for 2010 and 2030.
        Diabetes Res. Clin. Pract. 2010; 87: 4-14
        • Falkenberg M.G.
        Diabetes mellitus: prevalence and local risk factors in a primary health care district.
        Scand. J. Soc. Med. 1987; 15: 139-144
        • Rhodes E.T.
        • Prosser L.A.
        • Hoerger T.J.
        • Lieu T.
        • Ludwig D.S.
        • Laffel L.M.
        Estimated morbidity and mortality in adolescents and young adults diagnosed with type 2 diabetes mellitus.
        Diabetic Med. 2012; 29: 453-463
        • Sundquist K.
        • Chaikiat A.
        • León V.R.
        • Johansson S.E.
        • Sundquist J.
        Country of birth, socioeconomic factors, and risk factor control in patients with type 2 diabetes: a Swedish study from 25 primary health-care centres.
        Diabetes/Metab. Res. Rev. 2011; 27: 244-254
        • Saadi H.
        • Carruthers S.G.
        • Nagelkerke N.
        • Al-Maskari F.
        • Afandi B.
        • Reed R.
        • Lukic M.
        • Nicholls M.G.
        • Kazam E.
        • Algawi K.
        et al: Prevalence of diabetes mellitus and its complications in a population-based sample in Al Ain, United Arab Emirates.
        Diabetes Res. Clin. Pract. 2007; 78: 369-377
        • Eriksson T.
        Empirical Essays of Health and Human Capital.
        Lund University, 2013
        • Hoerger T.J.
        • Hicks K.A.
        • Sorensen S.W.
        • Herman W.H.
        • Ratner R.E.
        • Ackermann R.T.
        • Zhang P.
        • Engelgau M.M.
        Cost-effectiveness of screening for pre-diabetes among overweight and obese U.S. adults.
        Diabetes Care. 2007; 30: 2874-2879
        • IDF Diabetes Atlas
        Undiagnosed diabetes.
        • Tuomilehto J.
        • Lindstrom J.
        • Eriksson J.G.
        • Valle T.T.
        • Hamalainen H.
        • Ilanne-Parikka P.
        • Keinanen-Kiukaanniemi S.
        • Laakso M.
        • Louheranta A.
        • Rastas M.
        • et al.
        Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
        N. Engl. J. Med. 2001; 344: 1343-1350
        • Lirussi F.
        The global challenge of type 2 diabetes and the strategies for response in ethnic minority groups.
        Diabetes/Metab. Res. Rev. 2010; 26: 421-432
        • Saha S.
        • Leijon M.
        • Gerdtham U.
        • Sundquist K.
        • Sundquist J.
        • Arvidsson D.
        • Bennet L.
        A culturally adapted lifestyle intervention addressing a Middle Eastern immigrant population at risk of diabetes, the MEDIM (impact of Migration and Ethnicity on Diabetes In Malmo): study protocol for a randomized controlled trial.
        Trials. 2013; 14: 279