The UKs South Asian and African Caribbean populations experience far higher rates of type 2 diabetes and its cardiovascular disease complications, e.g. heart disease and strokes, than European-origin (white) groups. Ethnic minority populations without diabetes also experience an excess of most types of cardiovascular disease. Control of blood glucose, high blood pressure and high cholesterol helps to reduce cardiovascular disease complications from diabetes. Despite this, we know little about ethnic differences in the use of medications which do this. Limited existing research suggests that both choice and effective use of diabetes, blood pressure or cholesterol-lowering medication may differ by ethnicity.
This study aims to compare use of these medications for people with and without diabetes of European, South Asian and African Caribbean origin. Using computerised medical records, the commencement, type, dose, monitoring and adjustment of medication will be studied, and reasons for differences sought.
By identifying ethnic disparities in the use of medications to control diabetes, high blood pressure and high cholesterol, we may highlight reasons for the excess of diabetes complications and cardiovascular disease seen in UK South Asian or African Caribbean groups. These findings may influence prescribing policies, and thus ultimately reduce ethnic differences in cardiovascular disease and complications of type 2 diabetes.
UK South Asian and African Caribbean people with type 2 diabetes experience worse diabetic control and more cardiovascular complications than the European-origin population; ethnic minority populations without diabetes also experience an excess of most types of cardiovascular disease. Explanations are unclear. Blood pressure and lipid control, crucial to cardiovascular risk reduction for people with and without diabetes, also differ by ethnicity. However, ethnic differences in prescribing for diabetes, hypertension and hyperlipidaemia remain understudied.
Ethnic differences in prescribing anti-diabetic (in people with diabetes), antihypertensive and lipid-lowering medication (in people with and without type 2 diabetes) will be sought, including: i) time to commencement ii) choice of medication, iii) dosage, iv) monitoring and iv) time to intensification (either medication up-titration, addition or class switching) after detection of sub-optimal control.
Primary care electronic medical records will be used. Established algorithms and code lists will define ethnicity, diagnoses and medication use. Data will be analysed using Kaplan-Meier time-to-event methods and logistic, Poisson and Cox regression models (according to outcome), with South Asian or African Caribbean ethnicity as the exposure (baseline category=European). These methods will allow for differences in follow-up time. The potentially confounding or mediating influences of age, sex, smoking, BMI, deprivation, polypharmacy, multi-morbidity, drug adherence, patient engagement and diabetes duration/ HbA1c will be explored.
Time to first anti-diabetic prescription; Choice of anti-diabetic/ antihypertensive/ lipid-lowering medication; Dose of anti-diabetic/ antihypertensive/ lipid-lowering medication; Monitoring of anti-diabetic/ antihypertensive/ lipid-lowering medication; Time to anti-diabetic/ antihypertensive/ lipid-lowering treatment intensification.
Krishnan Bhaskaran - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sophie Eastwood - Corresponding Applicant - University College London ( UCL )
Andrew Hattersley - Collaborator - University of Exeter
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Naveed Sattar - Collaborator - University of Glasgow
Nishi Chaturvedi - Collaborator - University College London ( UCL )
Rohini Mathur - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Ruth Farmer - Collaborator - Boehringer-Ingelheim Pharmaceuticals, Inc
HES Admitted Patient Care;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation