Positive Results Found In Trial Of Special Diabetes Care Package For UK Asians

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Main Category: Diabetes
Also Included In: Cardiovascular / Cardiology;  Public Health;  Endocrinology
Article Date: 23 May 2008 - 15:00 PDT

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In the UK, some residents of South Asian ethnic origin have received a special diabetes care package that has resulted in some benefits. However, in a Diabetes Special Issue of The Lancet, researchers suggest stricter targets in general practice and additional measures to keep patients motivated in order to lessen the impact of diabetes on this segment of the population.

Patients with type 2 diabetes (commonly known as adult-onset diabetes) of Indian, Pakistani, Bangladeshi, and other South Asian backgrounds present certain management challenges for doctors in the UK. First, compared to white Europeans, patients with South Asian backgrounds are 4 to 6 times as likely to have type 2 diabetes. In addition, onset of the disease for patients from South Asia often occurs over 10 years earlier than for whites, and the risks of cardiovascular and renal complications is greater in this segment the population (including a 50% higher mortality rate). Further complications in management are due to cultural, communication, and social deprivation issues.

To evaluate the effectiveness of specialized care packages designed to improve cardiovascular risk factors for South Asian patients with type 2 diabetes, Professor Anthony Barnett and Dr Srikanth Bellary (Heart of England NHS Foundation Trust, Birmingham, UK) and colleagues conducted a randomized controlled trial.

The data were drawn from 21 UK inner-city practices, each assigned either to a control group or an intervention group. The control group consisted of 12 practices with 618 patients; the intervention group - enhanced care with additional nurse time, support from link workers, and a diabetes specialist nurse - consisted of 9 practices with 868 patients. The researchers analyzed the outcomes of blood pressure changes, total blood pressure, total cholesterol, and glycemic control at two years.

Over the two year trial, the researchers found that in the intervention group, systolic blood pressure decreased by about 4.9 mm Hg, diastolic blood pressure decreased by about 3.8 mm Hg, and cholesterol decreased by about 0.45 mmol/l, all with statistical significance. There was no notable change, however, in glycemic control.

Even though the enhanced care package resulted in small, sustained reductions in blood pressure, which have associated health benefits, the authors conclude that, "Improvement in glycaemic control remains a major challenge, and further work to enhance effectiveness of health-care delivery in general practice and to improve motivation is clearly needed for this group if health-care inequalities are to be reduced."

Dr Tahseen Chowdhury and Professor Graham Hitman (Barts and The London NHS Trust and School of Medicine and Dentistry, London, UK) write in a Comment that accompanies this research: "These findings should equate to substantial reductions in cardiovascular disease in this population over time. However, similar reductions in glycaemic control have not been achieved, emphasising that this challenge in diabetes care remains, particularly for South Asian patients."

Enhanced diabetes care to patients of south Asian ethnic origin (the United Kingdom Asian Diabetes Study): a cluster randomised controlled trial
S Bellary et al.
The Lancet (2008). 371[9626]: pp. 1769 - 1776.
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Written by: Peter M Crosta
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