Black, Ethnic Diabetics Less Likely to be Prescribed Newer Medications

A recent study regarding the healthcare disparities, specifically treatment of type 2 diabetes, is shedding new light on the uphill battle minority groups often face when trying to receive treatment.

Results of the study, which examined treatment of more than 80,000 patients in England, found Asian individuals were 15% less likely and black individuals were 50% less likely to be prescribed newer medications including SGLT2 inhibitors of GLP-1 agonists compared to white patients.

“Inequality in care persists. Diagnosis rates for Type 2 diabetes are on the rise and it is important that all patients receive the same high levels of care,” said lead investigator Martin Whyte, clinical senior lecturer in metabolic medicine at the University of Surrey, in a release.

In an effort to further evaluate the impact of treatment disparities in black and ethnic minority populations, investigators carried out a retrospective cohort analysis of patients treated at 164 primary care practices across England from 2012 through 2016. A total of 84,452 type 2 diabetics, which were identified through use of the Royal College of General Practitioners Research and Surveillance Centre dataset, were included in the current analysis.

For the current analysis, investigators examined data relating to patients’ use of glucose-lowering medication and annual measurements of HbA1c, renal function, blood pressure, and retinopathy and neuropathy testing. Multivariable analyses performed adjusted for age, sex, ethnicity, and socioeconomic status.

The mean age of the study cohort at the end of 2016 was 68.7 years, 43.9%(21,656) were female, and the mean BMI was 30.7. Investigators noted asian and black people were slightly over-represented in the study population compared to the general Royal College of General Practitioners Research and Surveillance Centre dataset population.

Upon analyses, investigators found Asian patients were less likely than their white counterparts to be prescribed insulin(OR 0.86, 95% CI 0.79-0.95; P<0.01), SGLT2 inhibitors(0.68, 0.58-0.79; P<0.001), and GLP-1 agonists (0.37, 0.31-0.44; P<0.001). Similarly, black patients were also less likely than white patients to be prescribed SGLT2 inhibitors(0.50, 0.39-0.65; P<0.001) and GLP-1 agonists (0.45, 0.35-0.57; P<0.001).

Additionally, investigators found black individuals were less likely than white patients to have HbA1c (0.89, 95% CI 0.79-0.99; P=0.04) and retinopathy(0.82, 0.70-0.96; P=0.011) testing. Conversely, Asian individuals were more likely to have monitoring for HbA1c(1.1, 1.01-1.20; P=0.023) and renal function, but less likely for retinopathy(0.88, 0.79-0.97; P=0.01) and neuropathy(0.88, 0.80-0.97; P=0.01). Investigators noted the study was limited due to observational design and using retrospectively collected data.

"Diabetes is a complex condition to manage, requiring each patient to be treated and supported in a variety of ways. It is concerning that such an inequality has been identified,” said study investigator Simon de Lusignan, BSc, MBBS, professor at the University of Surrey and University of Oxford. “Cost and accessibility may be limiting factors for screening and it is important that general practitioners stress to patients how crucial monitoring is for their long term health."

This study, “Disparities in glycaemic control, monitoring and treatment of type 2 diabetes in England: a retrospective cohort analysis,” was published online in PLOS MEDICINE.