Ethnic differences in the severity and clinical management of type 2 diabetes at time of diagnosis: A cohort study in the UK Clinical Practice Research Datalink

• Published in: Diabetes research and clinical practice Vol. 160; p. 108006
• Main Authors: Mathur, R., Palla, L., Farmer, R.E., Chaturvedi, N., Smeeth, L.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-02-2020; Elsevier Scientific Publishers
• Subjects: Asian People; Cohort Studies; Diabetes Mellitus, Type 2 - ethnology; Epidemiology; Ethnicity; Ethnicity - statistics & numerical data; Female; Humans; Hypoglycemic Agents - pharmacology; Hypoglycemic Agents - therapeutic use; Inequalities; Male; Middle Aged; Prevalence; Primary care; Risk Assessment; Risk Factors; Treatment; Type 2 diabetes; United Kingdom; United Kingdom; Type 2 diabetes; Ethnicity; Treatment; Epidemiology; Primary care; Inequalities
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2020.108006

•Non-white groups had better or equivalent capture of risk factors prior to diagnosis compared to white groups.•Risk factor levels at diagnosis were more favourable for south Asian and Black groups.•Initiation of diabetes therapy was faster for non-white groups relative to white groups.•Downstream inequalities in type 2 diabetes do not appear to stem from inequalities in initial diagnosis.
To characterize ethnic differences in the severity and clinical management of type 2 diabetes at initial diagnosis.
An observational cohort study of 179,886 people with incident type 2 diabetes between 2004 and 2017 in the Clinical Practice Research Datalink was undertaken; 63.4% of the cohort were of white ethnicity, 3.9% south Asian, and 1.6% black. Ethnic differences in clinical profile at diagnosis, consultation rates, and risk factor recording were derived from linear and logistic regression. Cox-proportional hazards regression was used to determine ethnic differences in time to initiation of therapeutic and non-therapeutic management following diagnosis. All analyses adjusted for age, sex, deprivation, and clustering by practice.
In the 12 months prior to diagnosis, non-white groups had fewer consultations compared to white groups, but risk factor recording was better than or equivalent to white groups for 9/10 risk factors for south Asian groups and 8/10 risk factors for black groups (p < 0.002). Blood pressure, BMI, cholesterol, eGFR, and CVD risk levels were more favourable in non-white groups, and prevalence of macrovascular disease was significantly lower (p < 0.003). Time to initiation of antidiabetic treatment and first risk assessment was faster in non-white groups relative to white groups, while time to risk factor measurement and diabetes review was slower.
We find limited evidence of systematic ethnic inequalities around the time of type 2 diabetes diagnosis. Ethnic disparities in downstream consequences may relate to genetic risk factors, or manifest later in the care pathway, potentially in relation to long-term risk factor control.