Do ethnicity and coexisting health conditions impact high-risk diabetes?

About a third of people diagnosed with type 2 diabetes have very high blood sugar levels at the time of diagnosis. This is called severe hyperglycaemia. It means their HbA1c level is high. HbA1c is a person’s average blood glucose level over the past two to three months. It is measured using a blood test.

Being diagnosed with very high blood sugar levels seems to be especially common in people of African or African Caribbean ethnicity. However, we don’t know if this is because of:

• Inequalities being able to get an early diagnosis (including differences between when people access treatment)
• The impact of a patient’s other illnesses on their overall health
• A very aggressive form of type 2 diabetes

Project aims

During this project we will use national data from general practices and hospitals to identify a group of people with very high blood sugar levels at the time they were diagnosed with type 2 diabetes. We will then investigate whether a patient’s other health conditions and their demographic characteristics (such as ethnicity) can be used to explain differences in HbA1C levels at diagnosis.

We will compare the risk of developing coronary artery disease, stroke, heart failure, and cancer in patients presenting with very high blood sugar levels at diagnosis, compared to those with lower levels at diagnosis. We will also examine whether risk varies by ethnicity, the presence of other illnesses or type of treatment.

What we hope to achieve

Findings from the study will help us identify whether the type 2 diabetes associated with very high blood sugar is:

• A distinct, severe form of the disease
• A consequence of inequalities in early diagnosis and treatment
• The effect of the complex relationships with other long-term conditions

Evidence from this project could lead to the development of appropriate management and/or treatment guidelines for patients presenting with this form of type 2 diabetes.

This PhD project is being undertaken by Ewan Walker, as lead researcher, with Dr Rachel Denholm, Dr Sophie Eastwood, Professor Jonathan Sterne, Professor Nish Chaturvedi and Professor Kate Tilling providing supervision.