Type 2 diabetes monitoring and control in migrants and non-migrants: A population-based cohort study in primary care in the Netherlands.

Abstract

Type 2 diabetes (T2D) disproportionally affects migrants. We compared T2D-care in primary care between migrants and non-migrants in the Netherlands. We performed a dynamic cohort study based on routine care data (2015-2019) from the DIAbetes MANagement and Treatment (DIAMANT) cohort linked to databases of Statistics Netherlands. Persons aged ≥ 35years with T2D treated in primary care were included. Outcomes included annual monitoring of HbA1c, systolic blood pressure and LDL; meeting of treatment targets; and medication prescription. Generalized estimating equations logistic regression models estimated the associations between having a migration background and outcomes. We included 165,670 persons: 83.7 % non-migrants, 2.1 % Turkish, 3.0 % Moroccan, 2.1 % Surinamese, 3.3 % European, and 5.7 % other non-European migrants. Most migrant groups had similar or higher odds of having annual monitoring compared to non-migrants, but lower odds of meeting the HbA1c and LDL treatment targets, with the lowest odds for Turkish migrants (OR 0.61, 95 %-CI 0.57-0.64; OR 0.86, 95 %-CI 0.81-0.91). Exploratory analyses demonstrated insulins to be less often prescribed to migrants. Most migrant groups were equally or better monitored for T2D-parameters compared to non-migrants, but were less likely to meet HbA1c targets. This might partly reflect the less frequent insulin prescriptions to migrants. Further research is needed on underlying mechanisms and the specific needs of migrant groups to optimize T2D-care for all.