Ethnic inequalities in trajectories of cardio-metabolic risk factor control and outcomes of type two diabetes (360G-Wellcome-201375_Z_16_Z)

Type 2 diabetes increases the risk of vascular disease, with co-morbid hypertension and hyperlipidaemia increasing risk further. UK studies have identified substantial ethnic differences in the risk of vascular outcomes amongst individuals with type 2 diabetes. Whether these inequalities stem from differences in healthcare usage, quality of care, or differences in treatment efficacy remains unknown. The aim of this fellowship is to identify modifiable determinants of ethnic inequalities in vascular outcomes of type 2 diabetes in order to generate an evidence base for clinical management of diabetes tailored to the UK population. Objectives: 1. To identify determinants of ethnic differences in access to health services and quality of preventive care for patients with type 2 diabetes using electronic health databases. 2. To examine whether patients identified as having uncontrolled cardio-metabolic risk factors are treated appropriately and equitably across ethnic groups. 3. To identify ethnic differences in trajectories of risk factor control following initiation of treatment and achievement of control to recommended targets. 4. To explore whether pharmacological treatment reduces the risk of vascular events equally across ethnic groups. 5. To develop recommendations for treatment strategies based on real world evidence of ethnic differences in risk factor profile and pharmacological treatment.