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dc.contributor.authorMathur, Ren_US
dc.contributor.authorPalla, Len_US
dc.contributor.authorFarmer, REen_US
dc.contributor.authorChaturvedi, Nen_US
dc.contributor.authorSmeeth, Len_US
dc.date.accessioned2020-05-26T11:14:12Z
dc.date.available2020-01-02en_US
dc.date.issued2020-02en_US
dc.identifier.urihttps://qmro.qmul.ac.uk/xmlui/handle/123456789/64335
dc.description.abstractAIMS: 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.en_US
dc.description.sponsorshipRM is supported by a Sir Henry Wellcome Postdoctoral Fellowship from the Wellcome Trust (201375/Z/16/Z).en_US
dc.format.extent108006 - ?en_US
dc.languageengen_US
dc.language.isoenen_US
dc.relation.ispartofDiabetes Res Clin Practen_US
dc.rightsCC-BY
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.subjectEpidemiologyen_US
dc.subjectEthnicityen_US
dc.subjectInequalitiesen_US
dc.subjectPrimary careen_US
dc.subjectTreatmenten_US
dc.subjectType 2 diabetesen_US
dc.subjectAsian Continental Ancestry Groupen_US
dc.subjectCohort Studiesen_US
dc.subjectDiabetes Mellitus, Type 2en_US
dc.subjectEthnic Groupsen_US
dc.subjectFemaleen_US
dc.subjectHumansen_US
dc.subjectHypoglycemic Agentsen_US
dc.subjectMaleen_US
dc.subjectMiddle Ageden_US
dc.subjectPrevalenceen_US
dc.subjectRisk Assessmenten_US
dc.subjectRisk Factorsen_US
dc.subjectUnited Kingdomen_US
dc.titleEthnic differences in the severity and clinical management of type 2 diabetes at time of diagnosis: A cohort study in the UK Clinical Practice Research Datalink.en_US
dc.typeArticle
dc.rights.holder2020. The authors
dc.identifier.doi10.1016/j.diabres.2020.108006en_US
pubs.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/31923438en_US
pubs.notesNot knownen_US
pubs.publication-statusPublisheden_US
pubs.volume160en_US
dcterms.dateAccepted2020-01-02en_US
rioxxterms.funderDefault funderen_US
rioxxterms.identifier.projectDefault projecten_US
qmul.funderSir Henry Wellcome Postdoctoral Fellowship::Wellcome Trusten_US
rioxxterms.funder.project483cf8e1-88a1-4b8b-aecb-8402672d45f8en_US


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