The Association of Ethnicity and Social Deprivation and Choice of Second-line Antidiabetic Treatment in People with Type 2 Diabetes: A Cross-sectional Study

Sunday, August 28, 2022

9:30 AM – 9:45 AM CEST

Location: Congress Hall D2

Publication Number: 216

Background: Ethnic and socioeconomic inequities in health services and outcomes persist in England despite efforts to standardise and reduce inequities in health services. Inequities in type 2 diabetes mellitus (T2DM), such as disease burden and treatment inertia, are well-described. While placebo-controlled clinical trials report that newer treatment options offer cardiovascular (CVD) and kidney-protective effects, there is little evidence on whether there are disparities in prescribing second-line oral antidiabetic treatments according to patients' socioeconomic characteristics.

Objectives: To assess any differences in second-line antidiabetic treatment prescribed for patients with T2DM according to ethnicity and social deprivation.

Methods: Design/setting: Cross-sectional study in primary and secondary care in England using the Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES), and the Index of Multiple Deprivation (IMD).
Participants: People ≥18 years with T2DM who intensified to second-line oral antidiabetic treatment (2014-2020).
Main outcome measures: Prescription for one of (1) sulfonylurea (SU), (2) dipeptidyl peptidase 4 inhibitor (DPP4i), or (3) sodium-glucose co-transporter 2 inhibitor (SGLT2i - recommended for people with underlying CVD and kidney disease) in combination with metformin.
Analyses: We calculated predicted percentages for second-line treatment prescribed according to ethnicity and deprivation using multivariable multinomial logistic regression models. These models were mutually adjusted for ethnicity and deprivation, as well as potential confounders, and clustering at the Clinical Commissioning Group (CCG) level. We also investigated interactions with time and stratified results by prevalent CVD status.

Results: Among 36,023 people, 85% were white, 10% South Asian, 4% black, and 1% mixed/other. After adjustment, we did not find substantial differences in the predicted percentages prescribed SGLT2i according to ethnicity (white: 21%, 95% CI 19-23%; South Asian: 20%, 95% CI 18-22%; Black: 19%, 95% CI 16-22%; Mixed/other: 17%, 95% CI 14-21%) or deprivation (least deprived quintile: 22%, 95% CI 20-25%; most deprived quintile: 19%, 95% CI 17-21%). Similarly, there were no differences in predicted percentages prescribed DPP4i and SU according to ethnicity or deprivation. There was no evidence of interaction effects over time, nor differences between those with and without prevalent CVD.

Conclusions: Amongst people with T2DM, there were no substantive differences in the percent prescribed SGLT2i, DPP4i, or SU as second-line antidiabetic treatment according to ethnicity or deprivation after adjusting for measured confounders.

Presenting Author(s)

Patrick Bidulka, MSc, BSc

Research Fellow
London School of Hygiene and Tropical Medicine
London, United Kingdom

Slides

Co-Author(s)

Rohini Mathur, PhD, MSc

Associate Professor of Epidemiology
LSHTM
London, United Kingdom
DL

David Lugo-Palacios

London School of Hygiene and Tropical Medicine, United Kingdom
SO

Stephen O'Neill

London School of Hygiene and Tropical Medicine, United Kingdom
AB

Anirban Basu

University of Washington School of Pharmacy, United States
RS

Richard Silverwood

Associate Professor of Statistics
University College London, United Kingdom
PC

Paul Charlton

National Institute for Health Research, United Kingdom
AB

Andrew Briggs

London School of Hygiene and Tropical Medicine, United Kingdom
LS

Liam Smeeth

London School of Hygiene and Tropical Medicine, United Kingdom
AA

Amanda Adler

University of Oxford, United Kingdom
ID

Ian Douglas, PhD

Professor
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
KK

Kamlesh Khunti

University of Leicester, United Kingdom
RG

Richard Grieve

London School of Hygiene and Tropical Medicine, United Kingdom