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.
AIMS: To characterize ethnic differences in the severity and clinical management of type 2 diabetes at initial diagnosis.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
|ジャーナル名||Diabetes research and clinical practice|
|投稿者||Mathur, R; Palla, L; Farmer, R E; Chaturvedi, N; Smeeth, L|
|組織名||London School of Hygiene & Tropical Medicine, Department of Non-Communicable;Disease Epidemiology, Keppel Street, London WC1E 7HT, UK. Electronic address:;Rohini.firstname.lastname@example.org.;Luigi.email@example.com.;firstname.lastname@example.org.;University College London, Institute of Cardiovascular Sciences, Gower Street,;London WC1E 6BT, UK. Electronic address: email@example.com.;Liam.firstname.lastname@example.org.|