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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.
Diabetes Res Clin Pract. 2020 Feb; 160:108006.DR

Abstract

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.

Authors+Show Affiliations

London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK. Electronic address: Rohini.mathur@lshtm.ac.uk.London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK. Electronic address: Luigi.palla@lshtm.ac.uk.London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK. Electronic address: ruth.farmer@lshtm.ac.uk.University College London, Institute of Cardiovascular Sciences, Gower Street, London WC1E 6BT, UK. Electronic address: n.chaturvedi@ucl.ac.uk.London School of Hygiene & Tropical Medicine, Department of Non-Communicable Disease Epidemiology, Keppel Street, London WC1E 7HT, UK. Electronic address: Liam.smeeth@lshtm.ac.uk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31923438

Citation

Mathur, R, et al. "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." Diabetes Research and Clinical Practice, vol. 160, 2020, p. 108006.
Mathur R, Palla L, Farmer RE, et al. 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. Diabetes Res Clin Pract. 2020;160:108006.
Mathur, R., Palla, L., Farmer, R. E., Chaturvedi, N., & Smeeth, L. (2020). 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. Diabetes Research and Clinical Practice, 160, 108006. https://doi.org/10.1016/j.diabres.2020.108006
Mathur R, et al. 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. Diabetes Res Clin Pract. 2020;160:108006. PubMed PMID: 31923438.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Mathur,R, AU - Palla,L, AU - Farmer,R E, AU - Chaturvedi,N, AU - Smeeth,L, Y1 - 2020/01/07/ PY - 2019/08/02/received PY - 2019/12/15/revised PY - 2020/01/02/accepted PY - 2020/1/11/pubmed PY - 2020/5/16/medline PY - 2020/1/11/entrez KW - Epidemiology KW - Ethnicity KW - Inequalities KW - Primary care KW - Treatment KW - Type 2 diabetes SP - 108006 EP - 108006 JF - Diabetes research and clinical practice JO - Diabetes Res Clin Pract VL - 160 N2 - 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. SN - 1872-8227 UR - https://www.unboundmedicine.com/medline/citation/31923438/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0168-8227(19)31109-X DB - PRIME DP - Unbound Medicine ER -