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BMJ Open. 2012 Oct 18;2(5). pii: e001477. doi: 10.1136/bmjopen-2012-001477. Print 2012.

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

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1
Centre for Primary Care and Public Health, St Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

Abstract

OBJECTIVES:

To assess whether in people with poorly controlled type 2 diabetes (HbA1c>7.5%) improvement in HbA1c varies by ethnic and social group.

DESIGN:

Prospective 2-year cohort of type 2 diabetes treated in general practice.

SETTING AND PARTICIPANTS:

All 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 MEASURE:

Change 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.

RESULTS:

The 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.

CONCLUSIONS:

In 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.

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