Epidemiology and epigenetics of type 2 diabetes among African migrants in Europe

The global burden of type 2 diabetes (T2D) is high and rising and affects high income countries as well as low- and middle income countries such as countries in the sub-Saharan African region. Sub-Saharan African migrants in Europe seem disproportionally affected by T2D compared to European host populations and compared to compatriots resident in the sub-Saharan African region. So far, however, the extent of the burden of T2D among sub-Saharan Africans has not been systematically quantified. Furthermore, the reasons for the disproportionate burden are unclear. This thesis aims to gain insight into the burden and underlying factors of T2D among sub-Saharan African migrants.
The results show that sub-Saharan African migrants are nearly three times more likely to suffer from T2D compared to Europeans as well as compared to their compatriots in rural Africa. Body fat and body fat distribution accounted only partly their increased risk. Insulin resistance rather than beta-cell dysfunction contributed to disparities in impaired fasting glucose (prediabetes) between sub-Saharan African migrants in Europe and their compatriots in rural Africa. Novel epigenetic loci were identified associated with T2D and its main determinant, adiposity, in sub-Saharan Africans.
The studies in this thesis stress the need to address the high burden of T2D among African migrants. Further studies are needed to improve the understanding of the underlying pathophysiological factors of T2D in sub-Saharan Africans. Further studies related to epigenetic loci involved should include replication as well as functional studies.