Proactive primary care minimizes ethnic disparities at type 2 diabetes diagnosis
medwireNews: A reassuring UK study has found limited evidence to suggest non-White patients are at a disadvantage for being diagnosed with type 2 diabetes in primary care and having their cardiometabolic risk managed around the time of initial diagnosis.
The researchers state: “Overall, our findings suggest that downstream inequalities in diabetes outcomes do not appear to stem wholly from inequalities around the time of initial diagnosis, and in fact, highlight several positive aspects of primary care-based diabetes management.”
The team reports that “despite a lower consultation rate and higher burden of pre-diabetic states, south Asian and Black groups had better capture of risk factors, a lower age at diagnosis, and better or equivalent cardio-metabolic profile[s] at diagnosis” than White patients.
In addition, antidiabetic therapy was initiated significantly faster in Black and South Asian patients than White patients after adjusting for potential confounders (hazard ratio [HR]s=1.10 and 1.18, respectively).
Both Black and South Asian patients were also more likely to receive their first health service health check (corresponding HRs=1.30 and 1.33) and the offer of structured diabetes education (HR=1.17 and 1.44) sooner than White patients.
By contrast, the time to first consultation, risk-factor measurement and diabetes review was longer for Black and South Asian patients than for White patients.
The 179,886 study participants from 714 primary care practices had incident type 2 diabetes between 2004 and 2017 and were identified on a clinical research database.
Rohini Mathur (London School of Hygiene and Tropical Medicine, UK) and colleagues report that the average age at diabetes diagnosis was 63.2 years for the 113,988 White patients versus 52.6 years for the 6970 South Asian patients and 55.1 years for the 2944 Black patients.
After accounting for the age at diagnosis, mean glycated hemoglobin levels were lower in the South Asian group but higher in the Black group compared with White patients.
BMI, total cholesterol, and estimated glomerular filtration rate were significantly more favorable in non-White than White participants, but only South Asian patients had significantly better fasting blood glucose, blood pressure, and creatinine levels.
Mathur and team note that the odds of having comorbid macrovascular disease at diagnosis were reduced by 12% among South Asian patients and by 50% for Black patients, compared with White patients.
They add: “[T]he similarity of microvascular disease between ethnic groups at time of diagnosis suggests that non-white groups are not being diagnosed at a more severe stage of diabetes progression, and that the latency between true onset of diabetes and clinical diagnosis does not disadvantage ethnic minority groups.”
Non-White patients also had “markedly fewer” prescriptions for antihypertensive and lipid-lowering drugs in the 12 months before diagnosis than White patients, and a significantly reduced odds of having a cardiovascular disease risk score over 10%.
Median consultation frequency in the 12 months prior to diagnosis was 10 for White patients versus nine and eight for South Asian and Black patients, respectively.
However, risk factor recording was better than or equivalent to that for White patients for nine out of 10 risk factors of interest among South Asian patients and eight out of 10 among Black patients.
The researchers conclude in Diabetes Research and Clinical Practice: “Combined with the findings of pro-active treatment initiation and timely risk assessments, our findings suggest that the elevated burden of cardio-metabolic risk in non-white groups is being appropriately recognized by health care professionals.
“Delays in risk factor measurement and diabetes review may reflect lower burden of cardio-metabolic risk at time of diagnosis or may be indicative of growing ethnic disparities with respect to longer-term diabetes management.”
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