News Release

Special diabetes care package for UK Asian population delivers some benefits

Peer-Reviewed Publication

The Lancet_DELETED

A special diabetes care package for UK residents of south Asian ethnic origin has delivered some benefits -- but stricter targets in general practice and further measures to motivate patients are needed to reduce the impact of diabetes in this population. These are the conclusions of authors of an Article in this week's Diabetes Special Issue of The Lancet.

Patients of south Asian ethnic background include Indians, Pakistanis, Bangladeshis and other Asians, and patients of this background with type 2 diabetes present special management challenges. Prevalence of type 2 diabetes in these patients is four-fold to six-fold higher than in white Europeans. Also, onset can occur more than a decade earlier and risk of cardiovascular and renal complications is greater in patients from south Asia, with 50% higher mortality. Cultural, communication and social deprivation issues further complicate treatment management in these patients. Professor Anthony Barnett and Dr Srikanth Bellary, Heart of England NHS Foundation Trust, Birmingham, UK, and colleagues investigated the effectiveness of care package in UK general practices specially tailored for improvement of cardiovascular risk factors in patients from south Asia with type 2 diabetes.

The randomised controlled trial included 21 UK inner-city practices, and each practice was assigned either to intervention (enhanced care including additional time with a nurse and support form a link worker and diabetes specialist nurse -- 9 practices, 868 patients), or to control (12 practices, 618 patients). Outcomes measured were changes in blood pressure, total cholesterol, and glycaemic control after two years.

The researchers found that across the whole study population over the two years of the trial, systolic blood pressure, diastolic blood pressure, and cholesterol decreased significantly by 4.9mm Hg, 3.8mm Hg, and 0.45mmol/l, respectively. However there was no statistically significant change in glycaemic control.

Whilst acknowledging the health benefits delivered by the small but sustained reductions in blood pressure achieved by the enhanced care package, the authors conclude: "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."

In an accompanying Comment, Dr Tahseen Chowdhury and Professor Graham Hitman, Barts and The London NHS Trust and School of Medicine and Dentistry, London, UK, say: "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."

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Professor Anthony Barnett, Heart of England NHS Foundation Trust, Birmingham, UK T) +44 (0) 7788 801064 / +44 (0)121 424 3587 E) anthony.barnett@heartofengland.nhs.uk

Dr Tahseen Chowdhury, Barts and The London NHS Trust and School of Medicine and Dentistry, London, UK T) + 44 (0) 20 8223 8384 E) tahseen.chowdhury@bartsandthelondon.nhs.uk

http://multimedia.thelancet.com/pdf/press/ukasiandiabetes.pdf


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