Inequities in type 2 diabetes

Māori and Pacific peoples have a higher incidence of type 2 diabetes and have worse health outcomes associated with the disease, compared with Europeans. Although differences in genetic predisposition may be involved, this does not explain the extent of the disparity.^1,2

Many of the contributing factors are related and, in general, are likely to be due to inequities in standard of care, including access to medicines, medicines management, education and access to diabetes management services.²

• Type 2 diabetes presents earlier in Māori, Pacific and Indo-Asian people than in others and delayed management may lead to poorer long-term health outcomes.²
• Māori and Pacific people may be less likely to have their HbA1c checked at the recommended interval and rates of monitoring for renal failure (albumin creatinine ratio – ACR) may be lower in Maori compared with non-Maori.³
• Māori and Pacific adults are more than twice as likely not to have collected a prescription because of cost than non-Pacific and non-Māori adults, after adjusting for age and sex differences.⁴
• Māori are at increased risk of diabetic complications compared with non-Māori, including microvascular disease (nephropathy, retinopathy and neuropathy) and long-term macrovascular outcomes (coronary artery disease, stroke and peripheral vascular disease).^1,2,5
• Māori and Pacific people have a higher rate of progression to end-stage renal disease (ESRD) than European/other ethnicities.⁶
• Māori have higher rates of retinopathy, limb amputation and mortality, compared with non-Māori.^1,2,5
• Māori and Pacific patients have significantly higher hospital admission rates and development of complications such as hypoglycaemia, cellulitis, renal failure and CVD compared with Europeans.^1,2

The first step to addressing inequitable health outcomes is knowing that they exist.