Ethnicity and Type 2 Diabetes
Type 2 diabetes (T2D) poses significant public health challenges and social consequences. T2D is the most common form of diabetes mellitus present, accounting for 90% of cases in the UK.1 T2D is a progressive and chronic condition, and is generally managed by diet and exercise advice/programmes; in the UK these are provided by the NHS in Primary Care settings.1 Medication can also be used to treat T2D; a commonly prescribed oral medication is metformin, progressing to use of insulin injections.2
In the UK, the prevalence of T2D has increased by three times over the past two decades from 2.4% to 6.5%.3,4 T2D affects around 3 million individuals in England.1 This is driven by the ageing population and the global burden of rising numbers of obesity.5 The most common complications of T2D include retinopathy, nephropathy and neuropathy, which can lead to serious consequences such as amputations of the lower body, stroke and cardiovascular disease, resulting in long-term disability and early death.1
In the UK, Black, Asian and Minority Ethnicities (BAMEs) are disproportionately affected by T2D and its associated complications. 1 Those at greater risk also include individuals from low socio-economic status, deprived areas, individuals over the age of 40 and individuals with disability, thus increasing health inequalities.1 Additional factors associated with T2D include: obesity, physical inactivity, sedentary behaviour, diets consisting of high sugar and carbohydrate and presence of family history.5-7
Current National Institute for Health and Care Excellence (NICE) guidelines for the management of long-term conditions focuses on promoting patient empowerment and self-management6 by attending a form of structured education.7-9 It is recommended that this form of management should be offered in the same year when a patient is diagnosed and delivered in a group format, face-to-face by a specially trained diabetes nurse or dietician with lay educators accompanying delivery in certain cases.6 Diabetes care aims to enable patients to improve their lifestyle and manage their diabetes through support and education.
The Department of Health in the UK has recognised the severe gap in healthcare and health outcomes in ethnic minorities, which led to the government creating the ‘Race Relations Amendment Act 2000’, which came into enforcement in April 2001.10 This act has been made a statutory duty to the NHS and public health providers “to have due regard to the need to eliminate unlawful discrimination and to ensure that every new action or policy considers the implications for racial equality.”10 National standards also view ethnic backgrounds as a critical component of diabetes self-management education.11
In response to this, a culturally specific diet and education self-management programme for individuals with T2D from South Asian communities has been developed.12 This programme is called ‘Diabetes Education and Self-Management for Ongoing and Newly Diagnosed for Black and Minority Ethnic groups (DESMOND BME). DESMOND BME is designed to support and empower individuals with T2D, making them the expert. This programme is also available for all individuals with T2D and is accessible online or by GP referral.
As Orthoptists we have a commitment to promote health and embed public health in our clinical practice, and as we see many adult patients with cranial nerve palsies due to diabetes or have some involvement in diabetic retinopathy screening, glaucoma care or intravitreal injections, we are ideally placed to do so. During our clinical assessments we can support diabetes patients by making every contact count by having a healthy conversation and signposting these patients to make healthy life choices, in order to improve health issues and health inequalities.
The current Type 2 Diabetes education programmes that meet NICE guidelines are:
- DESMOND: for people with Type 2 diabetes, both newly diagnosed and established
- DESMOND BME: culturally specific programme for people with Type 2 diabetes from South Asian communities, both newly diagnosed and established
- X-PERT Diabetes Programme: for people with Type 2 diabetes, both newly diagnosed and established
Links for Orthoptists and patients for further information:
- DESMOND Programme: https://www.desmond.nhs.uk/find-your-nearest-centre
- X-PERT Diabetes Programme: https://www.xperthealth.org.uk/programmes/
- Local support groups: https://www.diabetes.org.uk/how_we_help/local_support_groups
- Information and support for patients: https://www.diabetes.org.uk/professionals/information-support-for-your-patients
- Preventing Diabetes self-referral: https://preventing-diabetes.co.uk/self-referral/
Written by Sachi Sarna
