Ethnic and socioeconomic disparities in initiation of second-line antidiabetic treatment in people with type 2 diabetes in England: a cross-sectional study

AIMS: To assess any disparities in the initiation of second-line antidiabetic treatments prescribed among people with type 2 diabetes mellitus (T2DM) in England according to ethnicity and social deprivation. MATERIAL AND METHODS: This cross-sectional study used linked primary (Clinical Practice Research Datalink) and secondary care data (Hospital Episode Statistics), and the Index of Multiple Deprivation (IMD). We included people aged 18 years or older with T2DM who intensified to second-line oral antidiabetic medication between 2014-2020 to investigate disparities in second-line antidiabetic treatment prescribing (one of sulfonylureas (SU), dipeptidyl peptidase 4 inhibitors (DPP4i), or sodium-glucose co-transporter 2 inhibitors (SGLT2i), in combination with metformin) by ethnicity (white, South Asian, black, mixed/other) and deprivation (IMD quintiles). We reported prescriptions of the alternative treatments by ethnicity and deprivation according to predicted percentages derived from multivariable, multinomial logistic regression. RESULTS: Among 36,023 people, 85% were white, 10% South Asian, 4% black, and 1% mixed/other. After adjustment, the predicted percentages for SGLT2i prescribing by ethnicity were 21% [95% CI 19-23%], 20% [95% CI 18-22%], 19% [95% CI 16-22%], and 17% [95% CI 14-21%) among people with white, South Asian, black, and mixed/other ethnicity, respectively. After adjustment, the predicted percentages for SGLT2i prescribing by deprivation were 22% [95% CI 20-25%] and 19% [95% CI 17-21%] for the least deprived and the most deprived quintiles, respectively. When stratifying by prevalent cardiovascular disease (CVD) status, we found lower predicted percentages of people with prevalent CVD prescribed SGLT2i compared with people without prevalent CVD across all ethnicity groups and all levels of social deprivation. CONCLUSIONS: Among people with T2DM, there were no substantial differences by ethnicity or deprivation in the percentage prescribed either SGLT2i, DPP4i, or SU as second-line antidiabetic treatment. This article is protected by copyright. All rights reserved