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UK research reveals racial inequalities in diabetes care

Black and minority ethnic people less likely than white people to get newer diabetes drugs and be adequately monitored

Louise Prime

Tuesday, 08 October 2019

Black and minority ethnic people with type 2 diabetes are less likely than white people to be prescribed newer medication and less likely to be adequately monitored, as are people from lower socioeconomic groups, according to research* from UK general practice. The authors of the study, in PLOS Medicine, warned that disparities in glycaemic control and other areas of care might lead to higher rates of complications and adverse outcomes for some groups.

The research team, from the University of Surrey, identified a cohort of 49,380 people with type 2 diabetes from the Royal College of General Practitioners Research and Surveillance Centre dataset. They analysed both diabetes healthcare provision – including annual HbA1c, renal function (estimated glomerular filtration rate [eGFR]), blood pressure (BP), retinopathy, and neuropathy testing – and the use of different types of glucose-lowering medication over five years from between 1 January 2012 and 31 December 2016.

They compared care and medication use in different ethnic groups (using Office for National Statistics ethnicity categories: White, Mixed, Asian, Black, and Other) as well as by people’s socioeconomic status according to the index of multiple deprivation (IMD).

They found that people in the most deprived groups (IMD quintiles 1 and 2) showed poorer HbA1c than the least deprived (IMD quintile 5); and people of black ethnicity had worse HbA1c than those of white ethnicity.

Asian people were significantly less likely than white people to be prescribed insulin (odds ratio, OR 0.86), sodium-glucose cotransporter-2 (SGLT2) inhibitors (OR 0.68) and glucagon-like peptide-1 (GLP-1) agonists (OR 0.37). Black people were less likely than white people to be prescribed SGLT2 inhibitors (OR 0.50) and GLP-1 agonists (OR 0.45).

People in IMD quintile 5 were more likely than those in the other IMD quintiles to have annual testing for HbA1c, BP, eGFR, retinopathy, and neuropathy. Black people were less likely than white people to have annual testing for HbA1c (OR 0.89) and retinopathy (OR 0.82). Asian people were more likely than white people to have monitoring for HbA1c (OR 1.10) and eGFR (OR 1.09), but less likely for retinopathy (OR 0.88) and neuropathy (OR 0.88).

The study authors acknowledged that their study was limited by its observational nature, and using retrospectively collected data, and furthermore, they did not evaluate any possible regional variation in diabetes care. But they concluded: “Our findings suggest that disparity in glycaemic control, diabetes-related monitoring, and prescription of newer therapies remains a challenge in diabetes care. Both SES and ethnicity were important determinants of inequality. Disparities in glycaemic control and other areas of care may lead to higher rates of complications and adverse outcomes for some groups,” which they commented increases pressure on the NHS as well as being distressing for patients.

They said cost and accessibility might be limiting factors for screening, and that it is important for GPs to stress to patients how crucial monitoring is for their long-term health. They added: “The commissioning of diabetes services must continue with the ambition to reduce inequalities and thereby improve population health for individuals with type 2 diabetes.”


*Whyte MB, Hinton W, McGovern A, et al. Disparities in glycaemic control, monitoring, and treatment of type 2 diabetes in England: A retrospective cohort analysis. PLoS Med 2019; 16(10): e1002942. https://doi.org/10.1371/journal.pmed.1002942

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