Ethnic and social disparity in glycaemic control in type 2 diabetes; cohort study in general practice 2004–9

Gareth D James, Peter Baker, Ellena Badrick, Rohini Mathur, Sally Hull, John Robson
Journal of the Royal Society of Medicine, , -

Objective: To determine whether ethnic group differences in glycated haemoglobin (HbA1c) changed over a 5-year period in people on medication for type 2 diabetes.

Design: Open cohort in 2004–9.

Setting: Electronic records of 100 of the 101 general practices in two inner London boroughs.

Participants: People aged 35 to 74 years on medication for type 2 diabetes.

Main outcome measures: Mean HbA1c and proportion with HbA1c controlled to ≤7.5%.

Results: In this cohort of 24,111 people, 22% were White, 58% South Asian and 17% Black African/Caribbean. From 2004 to 2009 mean HbA1c improved from 8.2% to 7.8% for White, from 8.5% to 8.0% for Black African/Caribbean and from 8.5% to 8.0% for South Asian people. The proportion with HbA1c controlled to 7.5% or less, increased from 44% to 56% in White, 38% to 53% in Black African/Caribbean and 34% to 48% in South Asian people. Ethnic group and social deprivation were independently associated with HbA1c. South Asian and Black African/Caribbean people were treated more intensively than White people.

Conclusion: HbA1c control improved for all ethnic groups between 2004–9. However, South Asian and Black African/Caribbean people had persistently worse control despite more intensive treatment and significantly more improvement than White people. Higher social deprivation was independently associated with worse control.

Number of levels
Model data structure
Response types
Multivariate response model?
Longitudinal data?
Substantive discipline
Paper submitted by
James Gareth, Primary Care & Population Health, University College London,
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