Type 2 diabetes management in Hong Kong ethnic minorities: what primary care physicians need to know.

ABSTRACT

OBJECTIVES: To identify the demographics and compare diabetes control in ethnic minority group diabetes patients with Chinese diabetes patients who are managed in primary care settings and to explore strategies to improve their care. DESIGN: Retrospective case series. SETTING: General Outpatient Clinic of a Hong Kong Hospital Authority hospital. PATIENTS Chinese type 2 diabetes patients and ethnic minority groups who had been regularly followed up with annual assessments carried out between 1 March 2012 to 28 February 2013 were recruited. Their serum levels of fasting glucose, creatinine, estimated glomerular filtration rate, haemoglobin A1c levels, lipid profile, blood pressure, and co-morbidities were retrieved from the Clinical Management System. Student's t test and analysis of variance were used to evaluate continuous variables and the Chi squared test for categorical data. All statistical tests were two-sided, and a P value of <0.05 was considered significant. RESULTS: Among 4346 type 2 diabetes patients fulfilling the inclusion criteria, 3966 (91.3%) patients were Chinese and 380 (8.7%) were from the ethnic minority groups. Compared with Chinese diabetes patients, the latter were much younger and more obese (both P<0.001). Their glycaemic control was poorer than age- and sex-matched Chinese diabetes patients (P=0.006). Control of systolic blood pressure was similar in the two groups, but the mean diastolic blood pressure was higher in the ethnic minority groups than in the controls (78 ± 11 mm Hg vs 73 ± 11 mm Hg; P<0.001). With regard to lipid control, their total cholesterol, low-density lipoprotein, and triglyceride levels were similar, but high-density lipoprotein levels were much lower in the ethnic minority groups than their Chinese counterparts (1.19 ± 0.33 mmol/L vs 1.28 ± 0.36 mmol/L; P=0.001). Among the five major ethnic minority groups with diabetes, Pakistani patients had particularly poor glycaemic control and the Nepalese had the poorest diastolic blood pressure control. CONCLUSIONS: Ethnic minority groups are an integral part of the Hong Kong population. Compared with Chinese diabetes patients, those from the ethnic minorities were much younger and more obese. Deficiencies exist in the comprehensive management of diabetes in these ethnic minorities, particularly with respect to glycaemic control. Culturally tailored health care interventions are therefore warranted to promote patient education and clinical effectiveness and to improve their long-term health status.