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10-08-2019 | Primary care | News

Ethnic healthcare disparities in diabetes care uncovered

medwireNews: Researchers have revealed significant disparities in the monitoring and treatment of type 2 diabetes across England, with Black and Asian patients and those living in the most deprived areas at a particular disadvantage.

Routinely collected information from 49,380 patients at 164 primary care centers who were diagnosed with type 2 diabetes before 2012 and followed up over a 5-year period revealed ethnic and socioeconomic differences in glycemic control, healthcare monitoring, and the prescription of newer drugs such as sodium-glucose cotransporter (SGLT)2 inhibitors and glucagon-like peptide (GLP)-1 agonists.

Compared with White individuals, those who were Black (4.1%) were half as likely to be prescribed SGLT2 inhibitors and 55% less likely to receive GLP-1 agonists during the study period from 2012 to 2016, while for Asian patients (9.0%) these figures were a corresponding 32% and 63%.

Asian patients were also a significant 14% less likely than their White counterparts to be prescribed insulin, according to the data collected through the Royal College of General Practitioners Research and Surveillance Centre database. Overall, the mean age of the participants was 68.7 years at the end of the study, and mean BMI was 30.7 kg/m2.

Both Black and Asian patients had significantly worse glycemic control than White patients and their most recently measured glycated hemoglobin (HbA1c) levels were greater by 2.36 and 1.10 mmol/mol, respectively.

When patients were divided into fifths according to where they lived, those in the most deprived group had a significant 1.86 mmol/mol higher HbA1c level, on average, at the most recent measure than those in the highest socioeconomic group.

Those in the top socioeconomic fifth were additionally more likely than others to receive healthcare monitoring, in the form of annual testing for HbA1c, estimated glomerular filtration rate (eGFR), blood pressure, neuropathy, and retinopathy.

Black patients were significantly less likely than White individuals to have uninterrupted annual monitoring for HbA1c or retinopathy, at 11% and 18%, respectively.

Patients from an Asian background were significantly more likely than White participants to have unbroken annual HbA1c and eGFR monitoring, at 10% and 9%, respectively, but 12% less likely to have complete retinopathy or neuropathy screening.

“Our data support the ‘inverse equity’ hypothesis whereby preventative services are accessed first by the rich and well-informed, there is then an initial widening of the inequality gap before it later narrows,” write Martin Whyte (University of Surrey, Guildford, UK) and co-workers in PLOS Medicine.

They conclude that more research is needed to determine whether the disparities observed “represent inequality in care.”

By Anita Chakraverty

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

PLOS Med 2019; 16: e1002942

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