Diabetic neuropathies in Greenland: the role of Inuit ancestry and modernization in disease prevalence

Aims: The global prevalence of diabetic neuropathies varies, with a higher prevalence often observed among indigenous populations. This study aimed to estimate the prevalence of diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) among Greenlanders with diabetes and prediabetes, and to explore whether Inuit ancestry contributes to increased susceptibility to these conditions.

Methods: Participants from the Greenland Population Survey 2018 with diabetes or prediabetes were assessed for DPN using the Vibration Perception Threshold (VPT) and light pressure tests, and for CAN using Cardiovascular Reflex Tests and Heart Rate Variability. Inuit genetic admixture was included as a variable in regression models adjusted for age, sex, genetics, diabetes status, and residency.

Results: Among 160 individuals with diabetes and 287 individuals with prediabetes the prevalence of DPN was 28% and 25%, while the prevalence of CAN was 24% and 15%, respectively. A 20-percentage point increase in Inuit ancestry was associated with a 4% higher VPT (coefficient: 1.04, 95% CI: 1.003–1.08) and a 51% increase in the odds of CAN (OR: 1.51, 95% CI: 1.09–2.08).

Conclusions: DPN and CAN are prevalent among Greenlanders with diabetes and prediabetes, underscoring the need for improved diagnostic and preventive strategies. The association between Inuit ancestry and increased neuropathy risk suggests a genetic predisposition, which may be influenced by both genetic and lifestyle factors.

Comments. Within the past half century, Greenlanders have experienced rapid lifestyle changes due to modernization, leading to longer life expectancy but also lifestyle-related diseases such as diabetes. This study highlights a notably high prevalence of DPN and CAN among Greenlanders. The reported figures are significantly higher than those observed in comparable Danish studies, where the DPN prevalence is typically reported to be around 18-23% (Røikjer J et al Prim Care Diabetes. 2024;18:606-611; Gylfadottir SS et al Pain. 2020;161:574-583). This disparity suggests that Greenlanders may face unique risk factors, possibly influenced by both genetic and environmental factors, including Inuit ancestry.

Additionally, the study’s finding of high rates of DPN and CAN in individuals with prediabetes is concerning and highlights the possible need for earlier screening and intervention even in Greenlanders with prediabetes.

The study excels with its unique aim and provides valuable insights, but has several limitations including its cross-sectional design, potential selection bias, the relatively simplistic definition of DPN, and lack of peripheral small fiber measurements.

Johan Røikjer

Reference. Christensen MMB, Hansen CS, Fleischer J, Senftleber N, Stæger FF, Hansen T, Witte DR, Jørgensen ME. The prevalence of diabetic neuropathy in Greenland and its association with Inuit genetic ancestry - a cross-sectional study. J Diabetes Complications. 2025 Nov;39(11):109179. doi: 10.1016/j.jdiacomp.2025.109179. Epub 2025 Oct 2. PMID: 41056699.

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