(058) Migration Background and HbA1c Checks and Balances: A Large Routine Care Data Study in the Netherlands

Background: Type 2 diabetes (T2D) disproportionally affects persons with a migration background (MB) in Europe. Previous research also showed inequalities in T2D related monitoring between different ethnic groups in the United Kingdom (UK) and Denmark.

Objectives: The present study aims to investigate the association between MB and annual HbA1c checks and levels as measure of quality of T2D care in the Netherlands.

Methods: We performed a dynamic cohort study, including adults aged ≥35 years with T2D in primary care in the Netherlands, in the years 2015-2019. We used data from the DIAbetes, MANagement and Treatment (DIAMANT) cohort, a population-based, dynamic, prospective cohort of persons with T2D, derived from GP electronic medical records. DIAMANT data were linked to the National Statistics data-infrastructure to determine patients’ MB and income. MB was based on place of birth of the individual and both parents, and categorized into the largest groups: Surinam, Turkey, Morocco, European and other non-European MB. Outcome was defined as annually checked HbA1c blood levels (yes/no, per year measured), and whether these levels were on-target according to the Dutch GP guidelines (yes/no, lowest level per year). We used generalized estimating equations (GEE) analyses to estimate associations between MB and outcome measures, using Dutch native persons as reference category and adjusting for age, sex, T2D duration, polypharmacy and income.

Results: In 2017 (central year of study period), 165,670 persons with T2D were included (mean age 65.3, SD 12.0, 46.9% female): 83.7% with native Dutch, 2.1% Turkish, 3.0% Moroccan, 2.1% Surinamese, 3.3% European and 5.7% other non-European MB. Persons with MB had similar or higher odds of having an annual HbA1c measurement; only those with a European MB had lower odds (OR 0.92, 95%CI 0.88-0.97). Among persons with an annual HbA1c check the proportion with on-target HbA1c level ranged from 65.7% among persons with Surinamese MB to 83.1% among native Dutch persons. The GEE analyses showed that all migrant groups had significantly lower odds (OR 0.82 and lower) to have on-target HbA1c level compared to Dutch native persons, with the lowest odds for the group born in Turkey (OR 0.61, 95%-CI 0.57-0.64).

Conclusions: Differences in the proportion of annual checks and on-target HbA1c level according to migration background were observed in a large Dutch routine care data study.