Epidemiology of Macrovascular Complications of Diabetes in South Asians and Comparison with Other Ethnicities

Ritesh Gupta, Anoop Misra


South Asians have been shown to have increased abdominal adiposity, visceral fat, low muscle mass and subclinical inflammation, all of which make them prone to diabetes and its macrovascular complications. Diabetes is the most important risk factor for coronary artery disease in South Asia and South Asians with diabetes have a higher prevalence of CAD than Caucasians. Similar trend has been seen with stroke and cerebrovascular disease.. Importantly peripheral vascular disease and diabetic foot occur less frequently in South Asians compared to Caucasians. In addition, erectile dysfunction is emerging as an important complication of diabetes in South Asians and its association with cardiovascular disease is being recognised increasingly.


Diabetes, complications, marcrovascular, cardiovascular, cerebrovascular, diabetic foot, erectile dysfunction, South Asians

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Mohan V, Shah S, Saboo B. Current glycemic status and diabetes related complications among type 2 diabetes patients in India: data from the A1chieve study. J Assoc Physicians India. 2013;61(1 Suppl):12-5.

Tharkar S, Devarajan A, Kumpatla S, Viswanathan V. The socioeconomics of diabetes from a developing country: a population based cost of illness study. Diabetes Res ClinPract. 2010;89(3):334-40. DOI: 10.1016/j.diabres.2010.05.009.

Kapur A. Economic analysis of diabetes care. Indian J Med Res. 2007;125(3):473-82.

Davis TM, Coleman RL, Holman RR; UKPDS Group. Ethnicity and long-term vascular outcomes in Type 2 diabetes: a prospective observational study (UKPDS 83). Diabet Med. 2014;31(2):200-7. DOI: 10.1111/dme.12353.

Bhardwaj S, Misra A, Misra R, et al. High prevalence of abdominal, intra-abdominal and subcutaneous adiposity and clustering of risk factors among urban Asian Indians in North India.PLoS One. 2011;6(9):e24362. DOI: 10.1371/journal.pone.0024362.

Misra A, Khurana L. Obesity-related non-communicable diseases: South Asians vs White Caucasians. Int J Obes (Lond). 2011;35(2):167-87. DOI: 10.1038/ijo.2010.135.

Misra A, Khurana L. Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S9-30. DOI: 10.1210/jc.2008-1595.

Nadeem M, Ahmed SS, Mansoor S, Farooq S. Risk factors for coronary heart disease in patients below 45 years of age. Pak J Med Sci. 2013;29(1):91-6. DOI: 10.12669/pjms.291.2828.

Selim S, Rahman R, Yasmin R, et al. Risk factors of acute coronary syndrome among Bangladeshi people. Mymensingh Med J. 2013;22(3):513-21.

Zahidullah M, Aasim M, Khan I, Muhammadzai HZ, Shah MA, Ali N, et al. Evaluation of patients with coronary artery disease for major modifiable risk factors for ischemic heart disease. J Ayub Med Coll Abbottabad. 2012;24(2):102-5.

Faisal AW, Ayub M, Waseem T, Khan RS, Hasnain SS. Risk factors in young patients of acute myocardial infarction. J Ayub Med Coll Abbottabad. 2011;23(3):10-3.

Khan SB, Hafiz-ur-Rehman, Noor L, Hameedullah, Hafeezullah M, Gul AM, et al. Prevalence of diabetes mellitus among obese and non-obese patients with coronary artery disease. J Ayub Med Coll Abbottabad. 2010;22(3):64-7.

Misiriya KJ, Sudhayakumar N, Khadar SA, George R, Jayaprakasht VL, Pappachan JM. The clinical spectrum of acute coronary syndromes: experience from a major center in Kerala. J Assoc Physicians India. 2009;57:377-83.

Kumar N, Sharma S, Mohan B, et al. Clinical and angiographic profile of patients presenting with first acute myocardial infarction in a tertiary care center in northern India. Indian Heart J. 2008;60(3):210-4.

Mardikar M, Deo D, Deshpande NV, et al. Indo Heart Survey on Latent Abnormal Glucose Regulation in patients with coronary artery disease without diabetes across India. IHJ 2008; 60:113–118.

Jafar TH, Qadri Z, Chaturvedi N. Coronary artery disease epidemic in Pakistan: more electrocardiographic evidence of ischaemia in women than in men. Heart. 2008;94(4):408-13.

Latheef S, Subramanyam G. Prevalence of Coronary Artery Disease and Coronary Risk Factors in an Urban Population of Tirupati. Indian Heart J. 2007;59(2):157-64.

Tewari S, Kumar S, Kapoor A, et al. Premature coronary artery disease in North India: an angiography study of 1971 patients.Indian Heart J. 2005;57(4):311-8.

Jones DA, Gallagher S, Rathod KS, et al; NICOR (National Institute for Cardiovascular Outcomes Research). Mortality in South Asians and Caucasians After Percutaneous Coronary Intervention in the United Kingdom: An Observational Cohort Study of 279,256 Patients From the BCIS (British Cardiovascular Intervention Society) National Database. JACC Cardiovasc Interv. 2014;7(4):362-71. DOI: 10.1016/j.jcin.2013.11.013.

Goel PK, Bharti BB, Pandey CM, et al. A tertiary care hospital-based study of conventional risk factors including lipid profile in proven coronary artery disease. Indian Heart J. 2003;55(3):234-40.

Joshi P, Islam S, Pais P, et al. Risk factors for early myocardial infarction in South Asians compared with individuals in other countries. JAMA. 2007;297(3):286-94.

Gunarathne A, Patel JV, Kausar S, Gammon B, Hughes EA, Lip GY.Glycemic Status Underlies Increased Arterial Stiffness and Impaired Endothelial Function in Migrant South Asian Stroke Survivors Compared to European Caucasians. Pathophysiological Insights From the West Birmingham Stroke Project. Stroke. 2009;40(7):2298-306. DOI: 10.1161/STROKEAHA.109.548388.

Das AK, Seshiah V, Sahay BK, et al. Improving management practices and clinical outcomes in type 2 diabetes study: Prevalence of complications in people with type 2 diabetes in India.Indian J Endocrinol Metab. 2012;16(Suppl 2):S430-1. DOI: 10.4103/2230-8210.104119.

Mohan V, Deepa R, Rani SS, Premalatha G; Chennai Urban Population Study (CUPS No.5)..Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5). J Am CollCardiol. 2001;38(3):682-7.

Vaz NC, Ferreira A, Kulkarni M, Vaz FS, Pinto N. Prevalence of diabetic complications in rural goa, India. Indian J Community Med. 2011;36(4):283-6. DOI: 10.4103/0970-0218.91330.

Umamahesh K, Vigneswari A, Surya Thejaswi G, Satyavani K, Viswanathan V. Incidence of cardiovascular diseases and associated risk factors among subjects with type 2 diabetes - An 11-year follow up study. Indian Heart J. 2014;66(1):5-10. DOI: 10.1016/j.ihj.2013.12.009.

Hashim R, Khan FA, Khan DA, Shaukat A. Prevalence of macrovascular complications in diabetics of WAH, District Rawalpindi. J Pak Med Assoc. 1999;49(1):8-11.

Zaman MJ, Philipson P, Chen R, et al. South Asians and coronary disease: is there discordance between effects on incidence and prognosis? Heart.2013;99(10):729-36. DOI: 10.1136/heartjnl-2012-302925

Yeo KK, Tai BC, Heng D, et al. Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore.Diabetologia. 2006;49(12):2866-73.

Silbiger JJ, Stein R, Roy M, et al. Coronary artery disease in South Asian immigrants living in New York City: angiographic findings and risk factor burdens. Ethn Dis. 2013;23(3):292-5.

Chow CK, McQuillan B, Raju PK, et al. Greater adverse effects of cholesterol and diabetes on carotid intima-media thickness in South Asian Indians: comparison of risk factor-IMT associations in two population-based surveys. Atherosclerosis.2008;199(1):116-22.

Roos CJ, Kharagjitsingh AV, Jukema JW, Bax JJ, Scholte AJ. Comparison by Computed Tomographic Angiography-The Presence and Extent of Coronary Arterial Atherosclerosis in South Asians Versus Caucasians With Diabetes Mellitus. Am J Cardiol. 2014;113(11):1782-7. DOI: 10.1016/j.amjcard.2014.03.005.

Zaman MJ, Crook AM, Junghans C, et al. Ethnic differences in long-term improvement of angina following revascularization or medical management: a comparison between south Asians and white Europeans. J Public Health. 2009;31(1):168–174. DOI: 10.1093/pubmed/fdn099.

Hadjinikolaou L, Klimatsidas M, Maria Iacona G, Spyt T, Samani NJ. Short- and medium-term survival following coronary artery bypass surgery in British Indo-Asian and white Caucasian individuals: impact of diabetes mellitus. Interact CardiovascThorac Surg. 2010;10(3):389-93. DOI: 10.1510/icvts.2009.210567.

Winkley K, Thomas SM, Sivaprasad S, et al. The clinical characteristics at diagnosis of type 2 diabetes in a multi-ethnic population: the South London Diabetes cohort (SOUL-D). Diabetologia. 2013;56(6):1272-81. DOI: 10.1007/s00125-013-2873-5.

Kanaya AM, Adler N, Moffet HH, et al. Heterogeneity of diabetes outcomes among asians and pacific islanders in the US: the diabetes study of northern california (DISTANCE). Diabetes Care. 2011;34(4):930-7. DOI: 10.2337/dc10-1964

Khan NA, Wang H, Anand S, et al. Ethnicity and sex affect diabetes incidence and outcomes. Diabetes Care. 2011;34(1):96-101. DOI: 10.2337/dc10-0865.

Shah BR, Victor JC, Chiu M, et al. Cardiovascular complications and mortality after diabetes diagnosis for South Asian and Chinese patients: a population-based cohort study.Diabetes Care. 2013;36(9):2670-6. DOI: 10.2337/dc12-2105.

Bellary S, O'Hare JP, Raymond NT, et al. Premature cardiovascular events and mortality in south Asians with type 2 diabetes in the United Kingdom Asian Diabetes Study - effect of ethnicity on risk. Curr Med Res Opin. 2010;26(8):1873-9. DOI: 10.1185/03007995

Tran AT, Straand J, Diep LM, Meyer HE, Birkeland KI, Jenum AK. Cardiovascular disease by diabetes status in five ethnic minority groups compared to ethnic Norwegians. BMC Public Health. 2011;11:554. DOI: 10.1186/1471-2458-11-554.

Air EL, Kissela BM. Diabetes, the metabolic syndrome, and ischemic stroke: epidemiology and possible mechanisms. Diabetes Care. 2007;30(12):3131-40.

Wasay M, Khatri IA, Kaul S. Stroke in South Asian countries. Nat Rev Neurol. 2014;10(3):135-43. DOI: 10.1038/nrneurol.2014.13.

Prasad K, Vibha D, Meenakshi. Cerebrovascular disease in South Asia - Part I: A burning problem. JRSM Cardiovasc Dis. 2012;1(7). DOI: 10.1258/cvd.2012.012025.

Das SK, Banerjee TK, Biswas A, et al. A prospective community-based study of stroke in Kolkata, India.Stroke. 2007;38(3):906-10.

Kaul S, Bandaru VC, Suvarna A, Boddu DB. Stroke burden and risk factors in developing countries with special reference to India. J Indian Med Assoc. 2009;107(6):358, 367-70.

Das S, Das SK. Knowledge, attitude and practice of stroke in India versus other developed and developing countries. Ann Indian Acad Neurol. 2013;16(4):488-93.

Kulshrestha M, Vidyanand. An analysis of the risk factors and the outcomes of cerebrovascular diseases in northern India. J Clin Diagn Res. 2013;7(1):127-31.

Baskar D, Revathy S. A study on stroke victims in Rajiv Gandhi Government General Hospital, Chennai. J Assoc Physicians India. 2013;61(10):696-700.

Shah SM, Shah SM, Khan S, et al. "Addressing the impact of stroke risk factors in a case control study in tertiary care hospitals": a case control study in Tertiary Care Hospitals of Peshawar, Khyber Phukhtoonkhwa (KPK) Pakistan. BMC Res Notes. 2013;6(1):268. DOI: 10.1186/1756-0500-6-268.

Basharat Z, Mumtaz S, Rashid F, et al. Prevalence of risk factors of ischemic stroke in a local Pakistani population. High-density lipoproteins, an emerging risk factor. Neurosciences (Riyadh). 2012;17(4):357-62.

Zahra F, Kidwai SS, Siddiqi SA, Khan RM. Frequency of newly diagnosed diabetes mellitus in acute ischaemic stroke patients. J Coll Physicians Surg Pak. 2012;22(4):226-9. DOI: 04.2012/JCPSP.226229.

Maskey A, Parajuli M, Kohli SC. A study of risk factors of stroke in patients admitted in Manipal Teaching Hospital, Pokhara. Kathmandu Univ Med J (KUMJ). 2011;9(36):244-7.

Taj F, Zahid R, Syeda UE, Murtaza M, Ahmed S, Kamal AK. Risk factors of stroke in Pakistan: a dedicated stroke clinic experience. Can J Neurol Sci. 2010;37(2):252-7.

Sridharan SE, Unnikrishnan JP, Sukumaran S, et al. Incidence, types, risk factors, and outcome of stroke in a developing country: the Trivandrum Stroke Registry. Stroke. 2009;40(4):1212-8. DOI: 10.1161/STROKEAHA.108.531293.

Nagaraja D, Gururaj G, Girish N, et al. Feasibility study of stroke surveillance: data from Bangalore, India. Indian J Med Res. 2009;130(4):396-403.

Kalita J, Kumar G, Bansal V, Misra UK. Relationship of homocysteine with other risk factors and outcome of ischemic stroke. Clin Neurol Neurosurg. 2009; 111(4): 364-7. DOI: 10.1016/j.clineuro.2008.12.010.

Kamal AK, Itrat A, Murtaza M, et al. The burden of stroke and transient ischemic attack in Pakistan: a community-based prevalence study. BMC Neurol. 2009;9:58. DOI: 10.1186/1471-2377-9-58.

Khan NI, Naz L, Mushtaq S, Rukh L, Ali S, Hussain Z. Ischemic stroke: prevalence of modifiable risk factors in male and female patients in Pakistan. Pak J Pharm Sci. 2009;22(1):62-7.

De Silva R, Gamage R, Wewelwala C, et al.Young strokes in Sri Lanka: an unsolved problem. J Stroke Cerebrovasc Dis. 2009;18(4):304-8. DOI: 10.1016/j.jstrokecerebrovasdis.2008.11.004.

Devkota KC, Thapamagar SB, Malla S. Retrospective analysis of stroke and its risk factors at Nepal Medical College Teaching Hospital. Nepal Med Coll J. 2006;8(4):269-75.

Jafar TH. Blood pressure, diabetes, and increased dietary salt associated with stroke--results from a community-based study in Pakistan. J Hum Hypertens. 2006;20(1):83-5.

Pathak V, Kanth R, Pant H. Stroke: a case series study in Nepal Medical College Teaching Hospital. Nepal Med Coll J. 2006;8(3):180-1.

Sridharan SE, Unnikrishnan JP, Sukumaran S, et al. Incidence, types, risk factors, and outcome of stroke in a developing country: the Trivandrum Stroke Registry. Stroke. 2009;40(4):1212-8. DOI: 10.1161/STROKEAHA.108.531293.

Deoke A, Deoke S, Saoji A, Hajare S. Profile of modifiable and non-modifiable risk factors in stroke in a rural based tertiary care hospital - a case control study. Glob J Health Sci. 2012;4(3):158-63. DOI: 10.5539/gjhs.v4n3p158

Masood CT, Afzal W. Long-term complications of diabetes and co-morbidities contributing to atherosclerosis in diabetic population of Mirpur, Azad Kashmir. J Pak Med Assoc. 2013;63(11):1383-6.

Khuwaja AK, Rafique G, White F, Azam SI. Macrovascular complications and their associated factors among persons with type 2 diabetes in Karachi, Pakistan--a multi-center study. J Pak Med Assoc. 2004;54(2):60-6.

Hashim R, Khan FA, Khan DA, Shaukat A. Prevalence of macrovascular complications in diabetics of WAH, District Rawalpindi. J Pak Med Assoc. 1999;49(1):8-11.

Tillin T, Hughes AD, Mayet J, et al.The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians and African Caribbeans. SABRE (Southall and Brent revisited) - a prospective population based study. J Am Coll Cardiol. 2013;61(17):1777-86. DOI: 10.1016/j.jacc.2012.12.046

Connor M, Rheeder P, Bryer A, et al. The South African stroke risk in general practice study. S Afr Med J. 2005;95(5):334-9.

Sharma VK, Tsivgoulis G, Teoh HL, Ong BK, Chan BP.Stroke risk factors and outcomes among various Asian ethnic groups in Singapore. J Stroke Cerebrovasc Dis. 2012;21(4):299-304. DOI: 10.1016/j.jstrokecerebrovasdis.2010.08.010.

Gunarathne A, Patel JV, Gammon B, Gill PS, Hughes EA, Lip GY. Ishemic Stroke in South Asians.A Review of the Epidemiology, Pathophysiology,and Ethnicity-Related Clinical Features. Stroke. 2009;40:e415-e423. DOI: 10.1161/STROKEAHA.108.535724.

Gunarathne A, Patel JV, Potluri R, et al. Increased 5-year mortality in the migrant South Asian stroke patients with diabetes mellitus in the United Kingdom: the West Birmingham Stroke Project. Int J ClinPract. 2008;62(2):197-201.

Sen I, Stephen E, Agarwal S. Clinical profile of aortoiliac occlusive disease and outcomes of aortobifemoral bypass in India. J Vasc Surg. 2013;57(2 Suppl):20S-5S. DOI: 10.1016/j.jvs.2012.06.113.

Pradeepa R, Chella S, Surendar J, Indulekha K, Anjana RM, Mohan V. Prevalence of peripheral vascular disease and its association with carotid intima-media thickness and arterial stiffness in type 2 diabetes: The Chennai Urban Rural Epidemiology Study (CURES 111). Diab Vasc Dis Res. 2014; 11(3):190-200. DOI: 10.1177/1479164114524584

Ali Z, Ahmed SM, Bhutto AR, Chaudhry A, Munir SM. Peripheral artery disease in type II diabetes. J Coll Physicians Surg Pak. 2012;22(11):686-9. DOI: 11.2012/JCPSP.686689.

Akram J, Aamir AU, Basit A, et al. Prevalence of peripheral arterial disease in type 2 diabetics in Pakistan. J Pak Med Assoc. 2011;61(7):644-8.

Viswanathan V, Madhavan S, Rajasekar S, Chamukuttan S, Ambady R. Urban-rural differences in the prevalence of foot complications in South-Indian diabetic patients. Diabetes Care. 2006;29(3):701-3.

Viswanathan V, Thomas T, Tandon N, et al. Profile of Diabetic Foot Complications and its Associated Complications - A Multicentric Study from India. J Assoc Physicians India. 2005;53:933-36.

Morbach S, Lutale JK, Viswanathan V, et al. Regional differences in risk factors and clinical presentation of diabetic foot lesions. Diabet Med. 2004;21(1):91-5.

Premalatha G, Shanthirani S, Deepa R, Markovitz J, Mohan V. Prevalence and risk factors of peripheral vascular disease in a selected South Indian population: the Chennai Urban Population Study. Diabetes Care. 2000;23(9):1295-300.

Mohan V, Vijayaprabha R, Rema M. Vascular complications in long-term south Indian NIDDM of over 25 years’duration.Diabetes Res ClinPract. 1996;31(1-3):133-40.

Weerasuriya N, Siribaddana S, Dissanayake A, Subasinghe Z, Wariyapola D, Fernando DJ. Long-term complications in newly diagnosed Sri Lankan patients with type 2 diabetes mellitus. QJM. 1998;91(6):439-43.

Rabia K, Khoo EM. Prevalence of peripheral arterial disease in patients with diabetes mellitus in a primary care setting. Med J Malaysia. 2007;62(2):130-3.

Chaturvedi N, Coady E, Mayet J, et al. Indian Asian men have less peripheral arterial disease than European men for equivalent levels of coronary disease. Atherosclerosis 2007; 193:204–12.

Ahmad N, Thomas GN, Chan C, Gill P. Ethnic differences in lower limb revascularisation and amputation rates. Implications for the aetiopathology of atherosclerosis? Atherosclerosis. 2014;233(2):503-7. DOI: 10.1016/j.atherosclerosis.2013.12.039.

Mohanty SA, Woolhandler S, Himmelstein DU, Bor DH. Diabetes and cardiovascular disease among Asian Indians in the United States. J Gen Intern Med 2005; 20:474–8.

Kumpatla S, Kothandan H, Tharkar S, Viswanathan V. The costs of treating long-term diabetic complications in a developing country: a study from India. J Assoc Physicians India. 2013;61(2):102-9

George H, Rakesh P, Krishna M, et al. Foot care knowledge and practices and the prevalence of peripheral neuropathy among people with diabetes attending a secondary care rural hospital in southern India. J Family Med Prim Care. 2013;2(1):27-32. DOI: 10.4103/2249-4863.109938.

Jayasinghe SA, Atukorala I, Gunethilleke B, Siriwardena V, Herath SC, De Abrew K. Is walking barefoot a risk factor for diabetic foot disease in developing countries? Rural Remote Health. 2007;7(2):692.

Chandalia HB, Singh D, Kapoor V, Chandalia SH, Lamba PS. Footwear and foot care knowledge as risk factors for foot problems in Indian diabetics. Int J Diabetes Dev Ctries. 2008;28(4):109-13. DOI: 10.4103/0973-3930.45269.

Sriyani KA, Wasalathanthri S, Hettiarachchi P, Prathapan S. Predictors of diabetic foot and leg ulcers in a developing country with a rapid increase in the prevalence of diabetes mellitus. PLoS One. 2013;8(11):e80856. DOI: 10.1371/journal.pone.0080856.

Dixit S, Maiya A, Khetrapal H, Agrawal B, Vidyasagar S, Umakanth S. A questionnaire based survey on awareness of diabetic foot care in Indian population with diabetes: a cross-sectional multicentre study. Indian J Med Sci. 2011;65(10):411-23. DOI: 10.4103/0019-5359.109224.

Saeed N, Zafar J, Atta A. Frequency of patients with diabetes taking proper foot care according to international guidelines and its impact on their foot health. J Pak Med Assoc. 2010;60(9):732-5.

Chellan G, Srikumar S, Varma AK, et al. Foot care practice - the key to prevent diabetic foot ulcers in India. Foot (Edinb). 2012;22(4):298-302. DOI: 10.1016/j.foot.2012.08.007.

Nagpal J, Bhartia A. Quality of diabetes care in the middle- and high-income group populace: the Delhi Diabetes Community (DEDICOM) survey. Diabetes Care. 2006;29(11):2341-8.

Viswanathan V, Madhavan S, Rajasekar S, Chamukuttan S, Ambady R. Amputation prevention initiative in South India: positive impact of foot care education. Diabetes Care. 2005;28(5):1019-21.

Zubair M, Malik A, Ahmad J. Incidence, risk factors for amputation among patients with diabetic foot ulcer in a North Indian tertiary care hospital. Foot (Edinb). 2012;22(1):24-30. DOI: 10.1016/j.foot.2011.09.003.

Ashraf MN, Khalil-ur-Rehman, Malik KI, Iqbal GS. Epidemiology and outcome in patients of diabetic foot. J Ayub Med Coll Abbottabad. 2011;23(1):122-4.

Aamir AH, Nasir A, Jadoon MZ, Mehmood K, Ali SS. Diabetic foot infections and their management in a tertiary care hospital. J Ayub Med Coll Abbottabad. 2011;23(1):58-62.

Jayaprakash P, Bhansali S, Bhansali A, Dutta P, Anantharaman R.Magnitude of foot problems in diabetes in the developing world: a study of 1044 patients. Diabet Med. 2009 Sep;26(9):939-42. DOI: 10.1111/j.1464-5491.2009.02781.x..

Mehra BR, Thawait AP, Karandikar SS, Gupta DO, Narang RR. Evaluation of foot problems among diabetics in rural population. Indian J Surg. 2008;70(4):175-80. DOI: 10.1007/s12262-008-0048-2.

Viswanathan V, Madhavan S, Rajasekar S, Chamukuttan S, Ambady R. Urban-rural differences in the prevalence of foot complications in South-Indian diabetic patients.Diabetes Care. 2006;29(3):701-3.

Viswanathan V, Thomas N, Tandon N, et al. Profile of diabetic foot complications and its associated complications--a multicentric study from India.JAssoc Physicians India.2005 ;53:933.

Khuwaja AK, Rafique G, White F, Azam SI. Macrovascular complications and their associated factors among persons with type 2 diabetes in Karachi, Pakistan--a multi-center study. J Pak Med Assoc. 2004;54(2):60-6.

Ali SM, Basit A, Sheikh T, Mumtaz S, Hydrie MZ. Diabetic foot ulcer--a prospective study. J Pak Med Assoc. 2001;51(2):78-81.

Vijay V, Narasimham DV, Seena R, Snehalatha C, Ramachandran A. Clinical profile of diabetic foot infections in South India--a retrospective study. Diabet Med. 2000;17(3):215-8.

Viswanathan V, Wadud JR, Madhavan S, et al.Comparison of post amputation outcome in patients with type 2 diabetes from specialized foot care centres in three developing countries.Diabetes Res ClinPract. 2010;88(2):146-50. DOI: 10.1016/j.diabres.2010.02.015

Yang Y, Østbye T, Tan SB, Abdul Salam ZH, Ong BC, Yang KS. Risk factors for lower extremity amputation among patients with diabetes in Singapore. J Diabetes Complications. 2011;25(6):382-6. DOI: 10.1016/j.jdiacomp.2011.08.002.

Abbott CA, Garrow AP, Carrington AL, Morris J, Van Ross ER, Boulton AJ. North-West diabetes foot care study.Foot ulcer risk is lower in South-Asian and african-Caribbean compared with European diabetic patients in the U.K.: the North-West diabetes foot care study. Diabetes Care 2005; 28:1869-1875.

Chaturvedi N, Abbott CA, Whalley A, Widdows P, Leggetter SY, Boulton AJ. Risk ofdiabetes-related amputation in South Asians vs. Europeans in the UK. Diabet Med 2002;19:99-104.

Shah BR, Victor JC, Chiu M, et al. Cardiovascular complications and mortality after diabetes diagnosis for South Asian and Chinese patients: a population-based cohort study.Diabetes Care. 2013;36(9):2670-6. DOI: 10.2337/dc12-2105.

Hyman I, Patychuk D, Zaidi Q, et al. Self-management, health service use and information seeking for diabetes care among recent immigrants in Toronto. Chronic Dis Inj Can. 2012;33(1):12-8.

Tseng CH. Prevalence of lower-extremity amputation among patients with diabetes mellitus: is height a factor? CMAJ. 2006;174(3):319-23.

Avasthi A, Grover S, Bhansali A, et al. Erectile dysfunction in diabetes mellitus contributes to poor quality of life. Int Rev Psychiatry. 2011;23(1):93-9. DOI: 10.3109/09540261.2010.545987

Dan A, Chakraborty K, Mondal M, Neogi R, Chatterjee S, Makhal M. Erectile dysfunction in patients with diabetes mellitus: Its magnitude, predictors and their bio-psycho-social interaction: A study from a developing country.Asian J Psychiatr. 2014;7(1):58-65. DOI: 10.1016/j.ajp.2013.10.012.

Goyal A, Singh P, Ahuja A. Prevalence and Severity of Erectile Dysfunction as Assessed by IIEF-5 in North Indian Type 2 Diabetic Males and Its Correlation with Variables. J Clin Diagn Res. 2013;7(12):2936-8. DOI: 10.7860/JCDR/2013/7718.3777

Ahmed I, Aamir Au, Anwar E, Ali SS, Ali A, Ali A. Erectile dysfunction and type 2 diabetes mellitus in northern Pakistan. J Pak Med Assoc. 2013;63(12):1486-90.

Kumar KV, Radhakrishnan AP, Nair V, Kumar H. Erectile dysfunction in diabetic men. Int J Diabetes Dev Ctries. 2004; 24:23-26.

Viswanathan V, Agarwal S, Kumpatla S. Severity of erectile dysfunction and prevalence of premature ejaculation among type 2 diabetic men referred to an ED clinic of a tertiary care centre. J Assoc Physicians India. 2009;57:604.

Meena BL, Kochar DK, Agarwal TD, Choudhary R, Kochar A. Association between erectile dysfunction and cardiovascular risk in individuals with type-2 diabetes without overt cardiovascular disease. Int J Diabetes Dev Ctries. 2009;29(4):150-4. DOI: 10.4103/0973-3930.57345.

Malavige LS, Jayaratne SD, Kathriarachchi ST, Sivayogan S, Fernando DJ, Levy JC. Erectile dysfunction among men with diabetes is strongly associated with premature ejaculation and reduced libido. J Sex Med. 2008;5(9):2125-34. DOI: 10.1111/j.1743-6109.2008.00907.x.

Smith JF, Caan BJ, Sternfeld B. Racial disparities in erectile dysfunction among participants in the California Men’s Health Study.J Sex Med. 2009;6(12):3433-9. DOI: 10.1111/j.1743-6109.2009.01519.x

Malavige LS, Wijesekara P, SeneviratneEpa D, Ranasinghe P, Levy JC. Ethnic differences in sexual dysfunction among diabetic and nondiabetic males: The Oxford Sexual Dysfunction Study. J Sex Med. 2013;10(2):500-508. DOI: 10.1111/j.1743-6109.2012.02911.x

Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2 DOI: 10.17987/icfj.v2i1.4.

DOI: https://doi.org/10.17987/icfj.v8i0.285

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