Ethnic variations in the risk of hypoglycaemia among people with Type 2 diabetes prescribed insulins and/or sulfonylureas: a historical cohort study using general practice‐recorded data. Issue 12 (17th October 2018)

• Record Type: Journal Article
• Authors: Malawana, M.; Hutchings, A.; Mathur, R.; Robson, J.
• Is Part Of: Diabetic medicine. Volume 35:Issue 12(2018)
• Page Start: 1707
• Page End: 1715
• Publication Date: 2018-10-17
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13828
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: To identify ethnic differences in hypoglycaemic risk among people with Type 2 diabetes prescribed insulins and/or sulfonylureas in community settings. Methods: Using routine general practice‐recorded data, two cohorts of adults with Type 2 diabetes from east London were studied between January 2013 and December 2015: (1) adults prescribed insulins ± other antidiabetes medications (n=7269) and (2) adults prescribed sulfonylureas ± other antidiabetes medications excluding insulins (n=12 502). Incidence rate ratios of hypoglycaemia by ethnicity, adjusting for age, sex, socio‐economic status and clustering within Clinical Commissioning Groups, were estimated using random effects Poisson regression. Results: Compared with white British people prescribed insulins, those of black Caribbean ethnicity were at increased hypoglycaemic risk [adjusted incidence rate ratio 1.56 (95% CI 1.21, 2.01)], while Bangladeshi people had a lower risk [adjusted incidence rate ratio 0.49 (95% CI, 0.38, 0.64)]. In the sulfonylurea cohort, black Caribbean, black African and Indian people all had increased risks of hypoglycaemia compared with white British people [adjusted incidence rate ratios 1.63 (95% CI 1.15, 2.29), 1.90 (95% CI 1.32, 2.75) and 1.93 (95% CI 1.39, 2.69), respectively]. Conclusion: The differences in hypoglycaemic risk among people with Type 2 diabetes prescribed insulin and/or sulfonylureas warrant further investigation of any differing biological responses and/or cultural attitudes to antidiabetes therapy among ethnic groups, and should be considered by clinicians evaluating the treatment goals of people with Type 2 diabetes using insulins or sulfonylureas. What's new?: This study explored ethnic group differences in the risk of hypoglycaemia among people with Type 2 diabetes prescribed insulins and/or sulfonylureas using primary care‐recorded data, with near‐complete ethnicity recording. Individuals of black Caribbean ethnicity prescribed either insulins and/or sulfonylureas, as well as black Africans and Indians prescribed sulfonylureas, were at increased hypoglycaemic risk compared with white British groups. Bangladeshi people prescribed insulins were at lower risk of hypoglycaemia than other South Asian groups. Such differences in hypoglycaemic risk warrant further investigation to determine the appropriateness of universal treatment targets across all ethnicities.