Ethnic Differences in Diabetes Management in Patients With and Without Comorbid Medical Conditions

Abstract

OBJECTIVETo examine ethnic disparities in diabetes management among patients with and without comorbid medical conditions after a period of sustained investment in quality improvement in the U.K.RESEARCH DESIGN AND METHODSThis cross-sectional study examined associations between ethnicity, comorbidity, and intermediate outcomes for mean A1C, total cholesterol, and blood pressure levels in 6,690 diabetes patients in South West London.RESULTSThe presence of ≥2 cardiovascular comorbidities was associated with similar blood pressure control among white and South Asian patients when compared with whites without comorbidity but with worse blood pressure control among black patients, with a mean difference in systolic blood pressure of +1.5, +1.4, and +6.2 mmHg, respectively.CONCLUSIONSDespite major reforms to improve quality, disparities in blood pressure management have persisted in the U.K., particularly among patients with cardiovascular comorbidities. Policy makers should consider the potential impacts of quality initiatives on high-risk groups.

Lifestyle advice, processes of care and glycaemic control amongst patients with type 2 diabetes in a South African primary care facility

“…Small gains in clinical effectiveness have great potential for improving clinical outcomes, considering that a 1% reduction in HbA1c levels results in a significant reduction in microvascular complications. 23,24 The increased odds of glycaemic control amongst participants with co-morbid CCF have been reported by previous studies 25,26 and confirm suggestions that healthcare providers tend to aim at tighter control in patients with multiple comorbidity than in those without. 27 Furthermore, concordant comorbidities often share similar pathophysiological pathways and treating one may result in the benefits of the other.…”

Differential associations of ankle and brachial blood pressures with diabetes and cardiovascular diseases: cross-sectional study

“…It is plausible that ankle systolic BP are highly related to insulin resistance than brachial BP in south Asians. In south Asians, insulin resistance has been observed to be mainly responsible for myocardial infarction and stroke 16 , 18 , 19 . It is well-documented that south Asians probably have predominately, micro-circulatory adverse perturbances compared to macro-circulatory changes, as evidenced by very low prevalence of both peripheral arterial disease (defined by ankle brachial index of < 0.9) and abdominal aortic aneurysms 20 , 21 .…”

Nationwide Study on Trends in Hospital Admissions for Major Cardiovascular Events and Procedures Among People With and Without Diabetes in England, 2004–2009

“…This is supported by a number of recent studies showing substantial improvement in diabetes management and cardiovascular risk factor control in U.K. primary care as a result of targeted interventions ( 14 , 27 , 28 ). Recent studies from the U.K. show that people with diabetes with a higher number of comorbid conditions receive more intensive treatment and are more likely to achieve established treatment targets compared with counterparts with less comorbidities, which indicate changes in previous patterns ( 24 , 26 , 28 , 29 ). These findings are further supported by our results showing increasing PCI rates and a parallel decline in CABG rates in people with diabetes, a similar manner to people without diabetes.…”