New research published in the Lancet, on 24th May 2008, has found a worrying failure of both current and enhanced GP interventions to deal with the particularly challenging effects of Type 2 diabetes on the health of South Asian patients in the UK.
Type 2 Diabetes is a significantly greater problem for patients of South Asian ethnic background (which includes Indian, Pakistani, Bangladeshi, and other Asians) than it is for other ethnic groups. In the UK the prevalence of type 2 diabetes is four-fold to six-fold higher in people from south Asia than in white Europeans. Furthermore, the onset of the illness tends to start more than a decade earlier for such patients. The risk of cardiovascular and renal complications is also far greater in patients from south Asia, with 50% higher mortality.
Up till now health professionals and policy makers have thought that one of the key ways of addressing this particular health care problem in this patient group was to enhance healthcare resources to meet the challenging cultural, communication, and comprehension difficulties in meeting the needs of those communities who also suffer social deprivation,
The researchers (from Warwick Medical School in the University of Warwick, Heart of England NHS Foundation Trust, and the University of Birmingham) put together a culturally sensitive, enhanced care package for general practices aimed at improving cardiovascular risk factors in patients of South Asian origin with type 2 diabetes. The package included doubling the time with a practice nurse, using Asian link workers, and input from diabetes-specialist nurses. They then studied the impact of this over a three year period across 1486 patients in 21 GPs’ practices across the inner cities of Birmingham and Coventry.
An earlier pilot study by the researchers on South Asian patients facing particularly challenging health problems relating to their Type 2 diabetes had found that such targeted interventions improved the 40% higher risks of heart disease linked to diabetes in that community and hoped that this more extensive study across a wider variety of South Asian patients with type 2 diabetes would yield similar results.
Despite small but highly significant improvements in the levels of blood pressure and cholesterol across the patient group they found no improvements in the key indicator of haemoglobin A1c . They also only found very small improvements in general quality of life that were nowhere near any definition of cost effectiveness.
This should not be seen as simply a disappointing outcome for a small group of researchers – it is a challenging outcome for South Asian patients in the UK with type 2 diabetes. They are now left still suffering much greater health risks from type 2 diabetes than the rest of the UK population with no obvious way forward to address that problem.
One of the report’s two lead authors, Warwick Medical School researcher Dr Paul O’Hare, said: “Despite additional nursing resources, we only recorded small improvements for the patients in the study. This may have been due to reluctance of health professionals to intensify treatments and achieve tighter targets beyond those already set in national initiatives for this type of illness. These patient groups may require much more aggressive drug and insulin treatment and far tighter treatment targets for blood pressure and cholesterol than the norm. National guidelines and treatment targets for these patients may need to be aggressively tightened so GPs can begin to address the particularly adverse effects type 2 diabetes has on South Asian patients.”