Highly elevated diabetes prevalence in the Indian diaspora: Implications at the community level, Schenectady, New York

Purpose: Schenectady, New York is home to nearly 8000 Guyanese immigrants. They trace their ancestry to India. Because little intermarriage occurred, the Guyanese are genotypically and phenotypically Indian. Clinicians in Schenectady estimated that 30% of adult Guyanese had Type 2 diabetes mellitus (T2DM). To test this markedly elevated rate, we conducted a prevalence survey. Methods: The US Census does not recognize "Guyanese" and the Guyanese do not live in enclaves. Hence, we used a convenience sample focused at faith-based organizations and social gatherings, including Cricket matches. Using a paper instrument with 42 tested questions, at a sixth grade reading level, we collected surveys and entered data into SPSS. Age and sex adjustments used the New York State diabetes population estimates. Results: A total of 764 responses were returned, 324 from Guyanese and 440 from non-Guyanese. The crude T2DM prevalence rate in adult Guyanese was 30% vs. 19% for non-Guyanese (p<0.001). Standardized Morbidity Ratios (SMRs) for Guyanese males = 3.24, females = 2.72. Guyanese with diabetes had lower BMIs (28 vs. 33, p<0.001), more vision complications (44% vs. 26%, p<0.014) and were more often uninsured (22.1% vs. 6.3%, p<0.003). Extrapolating to the total adult Guyanese population, we estimate that nearly 50% either has T2DM or is at risk. Conclusion: This immigrant ethnic minority is disproportionately impacted by T2DM. The excess burden of morbidity and likely attendant cost for the Guyanese is striking. This disparity reflects the need for future primary, secondary and tertiary prevention programs.