Type 2 diabetes: a cohort study of treatment, ethnic and social group influences on glycated haemoglobin

Abstract

ObjectivesTo assess whether in people with poorly controlled type 2 diabetes (HbA1c>7.5%) improvement in HbA1c varies by ethnic and social group.DesignProspective 2-year cohort of type 2 diabetes treated in general practice.Setting and participantsAll patients with type 2 diabetes in 100 of the 101 general practices in two London boroughs. The sample consisted of an ethnically diverse group with uncontrolled type 2 diabetes aged 37–71 years in 2007 and with HbA1c recording in 2008–2009.Outcome measureChange from baseline HbA1c in 2007 and achievement of HbA1c control in 2008 and 2009 were estimated for each ethnic, social and treatment group using multilevel modelling.ResultsThe sample consisted of 6104 people; 18% were white, 63% south Asian, 16% black African/Caribbean and 3% other ethnic groups. HbA1c was lower after 1 and 2 years in all ethnic groups but south Asian people received significantly less benefit from each diabetes treatment. After adjustment, south Asian people were found to have 0.14% less reduction in HbA1c compared to white people (95% CI 0.04% to 0.24%) and white people were 1.6 (95% CI 1.2 to 2.0) times more likely to achieve HbA1c controlled to 7.5% or less relative to south Asian people. HbA1c reduction and control in black African/Caribbean and white people did not differ significantly. There was no evidence that social deprivation influenced HbA1c reduction or control in this cohort.ConclusionsIn all treatment groups, south Asian people with poorly controlled diabetes are less likely to achieve controlled HbA1c, with less reduction in mean HbA1c than white or black African/Caribbean people.

Socio‐economic status and HbA1c in type 2 diabetes: A systematic review and meta‐analysis

“…After screening the titles and abstracts of all references, 262 potentially eligible articles were read full text. Fifty‐five studies met the inclusion criteria of this review . As 2 studies examined identical associations within the same sample, we only included 1 paper in our study .…”

An alternative approach to modelling HbA1c trajectories in patients with type 2 diabetes mellitus

“…Despite the heterogeneous nature of HbA1c progression in T2DM, trajectories tended to vary according to baseline HbA1c, treatment group and patient age. The systematic literature review additionally identified a small number of studies that examined ethnic differences and gender differences in HbA1c progression in T2DM patients.…”

“…7 Initial monotherapy took place at a mean HbA1c of 8% (−0.9% reduction), mean time to dual therapy was 2.6 years (HbA1c at 8.5%; −1.1% reduction observed), and mean time to insulin initiation was 7 years (HbA1c at 9.8%; −1.5% reduction observed). Figure 3 10 Price et al 11 Sun et al 12 Virdi et al 13 Year 2010 a small number of studies that examined ethnic differences [14][15][16][17][18][19] and gender differences 14,[19][20][21] in HbA1c progression in T2DM patients.…”

Prevalence of dysglycaemic events among inpatients with diabetes mellitus: a Singaporean perspective

“…(19) In addition, a more recent prospective cohort study showed that South Asians with poorly controlled DM are less likely to achieve controlled HbA1c and respond less favourably to treatment in terms of HbA1c levels. (20) While it is unclear whether these findings can be extrapolated to inpatients in an acute care setting, it suggests that HbA1c alone is not a good indicator of the intensity of treatment required and that clinicians should utilise other indicators (e.g. BG levels) to guide glycaemic management.…”