Hypoglycemia risks differ by ethnicity among adults prescribed insulin, sulfonylureas

Among adults with type 2 diabetes, those of black Caribbean ethnicity prescribed insulin are at increased risk for hypoglycemia as are those of black Caribbean, black African or Bangladeshi ethnicity prescribed a sulfonylurea, compared with adults of white British ethnicity, according to findings published in Diabetic Medicine.

Additionally, researchers found a lower risk for hypoglycemia among adults of Indian and Bangladeshi ethnicity with type 2 diabetes when taking insulin vs. sulfonylurea in comparison with other populations.

John Robson, MBBS MSc, MD, FRCGP, clinical reader in primary care research and development in the Centre for Primary Care and Public Health at Queen Mary University of London, and colleagues conducted an observational cohort study using data from electronic health records of 19,771 adults with type 2 diabetes who were patients at 128 general practices in east London. The patients were prescribed insulin or a sulfonylurea 6 months before January 2013 (mean age, 66.2 years; 46.5% women). The study spanned from 2013 to 2015. Study participants were divided into two cohorts based on whether they were prescribed insulin (n = 7,269) or sulfonylurea (n = 12,502). Nine ethnic groups were examined, with those of white British ethnicity (17.3%) used as reference for comparison: Bangladeshi (26%), Indian (10.8%), black Caribbean (9.7%), black African (8.5%), other white (7%), Pakistani (6.7%), other South Asian (3.8%), other black ethnicities (3.5%) and the rest “other” or not recorded.

Among the insulin cohort, hypoglycemic incident rates were highest for adults of black Caribbean ethnicity (adjusted incidence rate ratio [aIRR] = 1.56; 95% CI, 1.21-2.01) compared with adults with white British ethnicity. Adults of Bangladeshi ethnicity had the lowest incidence rate of any of the nine ethnicities in the study (aIRR = 0.49; 95% CI, 0.38-0.64).

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