AIMS To characterize ethnic differences in the severity and clinical management of type 2 diabetes at initial diagnosis. METHODS An observational cohort study of 179,886 people with incident type 2 diabetes between 2004 and 2017 in the Clinical Practice Research Datalink was undertaken; 63.4% of the cohort were of white ethnicity, 3.9% south Asian, and 1.6% black. Ethnic differences in clinical profile at diagnosis, consultation rates, and risk factor recording were derived from linear and logistic regression. Cox-proportional hazards regression was used to determine ethnic differences in time to initiation of therapeutic and non-therapeutic management following diagnosis. All analyses adjusted for age, sex, deprivation, and clustering by practice. RESULTS In the 12 months prior to diagnosis, non-white groups had fewer consultations compared to white groups, but risk factor recording was better than or equivalent to white groups for 9/10 risk factors for south Asian groups and 8/10 risk factors for black groups (p < 0.002). Blood pressure, BMI, cholesterol, eGFR, and CVD risk levels were more favourable in non-white groups, and prevalence of macrovascular disease was significantly lower (p < 0.003). Time to initiation of antidiabetic treatment and first risk assessment was faster in non-white groups relative to white groups, while time to risk factor measurement and diabetes review was slower. CONCLUSIONS We find limited evidence of systematic ethnic inequalities around the time of type 2 diabetes diagnosis. Ethnic disparities in downstream consequences may relate to genetic risk factors, or manifest later in the care pathway, potentially in relation to long-term risk factor control.

中文翻译：

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诊断时 2 型糖尿病严重程度和临床管理的种族差异：英国临床实践研究数据链中的一项队列研究。


目的 描述初次诊断时 2 型糖尿病的严重程度和临床管理方面的种族差异。方法 通过临床实践研究数据链对 2004 年至 2017 年间 179,886 名 2 型糖尿病患者进行了观察性队列研究；该群体中 63.4% 为白人，3.9% 为南亚裔，1.6% 为黑人。诊断时临床特征、咨询率和危险因素记录的种族差异来自线性和逻辑回归。 Cox比例风险回归用于确定诊断后开始治疗和非治疗管理的时间的种族差异。所有分析均根据年龄、性别、剥夺情况和实践聚类进行了调整。结果 在诊断前 12 个月内，非白人群体比白人群体就诊次数较少，但危险因素记录优于或相当于白人群体，其中南亚群体的 9/10 危险因素和 8/10 的南亚群体危险因素黑色组（p < 0.002）。非白人群体的血压、BMI、胆固醇、eGFR 和 CVD 风险水平更为有利，而且大血管疾病的患病率显着较低 (p < 0.003)。相对于白人群体，非白人群体开始抗糖尿病治疗和首次风险评估的时间更快，而危险因素测量和糖尿病审查的时间则较慢。结论 我们发现 2 型糖尿病诊断期间存在系统性种族不平等的证据有限。下游后果的种族差异可能与遗传风险因素有关，或者在护理途径的后期表现出来，可能与长期风险因素控制有关。