Migrants in Denmark with type 2 diabetes receive suboptimal treatment

Disease and treatment 19. dec 2023 3 min Clinical Researcher Anders Isaksen Written by Kristian Sjøgren

Migrants in Denmark with type 2 diabetes are monitored less than native Danes for damage to the kidneys, feet and eyes. They also had higher cholesterol and blood glucose levels. A researcher says that treatment is poorest for migrants originally from Somalia.

More than 250,000 people in Denmark have type 2 diabetes, including increasingly many migrants.

A major study shows that the treatment of specific groups of migrants with type 2 diabetes lags behind and that these people are examined less for complications related to the kidneys, eyes and feet and that they do not receive the same general treatment as people born in Denmark.

According to a researcher behind the study, the reasons for these differences cannot be determined. Nevertheless, quantifying the differences is highly relevant because they may strongly affect the pressure on Denmark’s healthcare system in the future.

“The problem is that people with type 2 diabetes who are not well regulated will be more likely to develop various complications in the future. This may be the big concern, and we have to assess the possible problem that these people are not getting optimal treatment now, which could mean they instead need considerable help from the healthcare system later on,” explains Anders Isaksen, Clinical Researcher, Steno Diabetes Center Aarhus and Aarhus University.

The research has been published in PLOS Global Public Health.

Data from more than 250,000 people

Migrants living in high-income countries have a higher prevalence of type 2 diabetes. They also often have higher blood glucose, which indicates that their diabetes is more poorly controlled.

Anders Isaksen works as a general practitioner in Gellerupparken in Aarhus, home to relatively many migrants from middle- and low-income countries. He has found that achieving the targets of treatment can be difficult for these people with type 2 diabetes even if doctors follow the guidelines on diabetes.

To learn more about how the treatment of people with type 2 diabetes in Denmark differs based on ethnic origin, the researchers examined data from 254,097 people with type 2 diabetes in Denmark.

The researchers grouped migrants by country of origin and combined some groups to get enough data to analyse the individual groups. The groups were: native Danes; and first-generation migrants from the Middle East, Europe, Turkey, the former Yugoslavia, Pakistan, Sri Lanka, Somalia and Vietnam.

The researchers investigated whether the groups differed on 11 indicators for treatment in relation to the clinical guidelines on diabetes.

The researchers divided the 11 indicators into three groups:

  • monitoring, which includes recommended measurements of blood glucose and cholesterol and examining how diabetes affects the kidneys, eyes and feet;
  • biomarkers: whether blood glucose, cholesterol levels and blood pressure are within the recommended limit values; and
  • medication: whether the people receive the recommended medication to reduce blood glucose and lower cholesterol and blood pressure.

The researchers obtained the data through Statistics Denmark and the Danish Health Data Authority.

Treatment for migrants much worse

The results show that migrants generally do not receive the same level of treatment as native Danes.

Fewer migrants than native Danes with type 2 diabetes were examined for blood glucose, cholesterol levels, kidney damage, eye damage and foot damage within the recommended time in Denmark’s guidelines.

For example, 44% of native Danes with type 2 diabetes were not examined for kidney damage within the recommended time versus 48% among people born in the Middle East and 56% among people born in Somalia.

The proportion of people with type 2 diabetes with cholesterol above 2.6 mmol/L was 28% for native Danes, 33% for people born in the Middle East and 50% for people born in Somalia.

The proportion of people with type 2 diabetes not taking the recommended cholesterol-lowering medication was 35% among native Danes and people born in the Middle East, and 57% for people born in Somalia. Similarly, the proportion not taking the recommended blood pressure-lowering medication was also higher among migrants: 28% for native Danes, 36% for people born in the Middle East and 43% for people born in Somalia.

“All the indicators we examined show a clear pattern: worst among people from Somalia in the vast majority of cases. Twice as many people with type 2 diabetes born in Somalia have elevated cholesterol levels versus native Danes, and many fewer are being treated with cholesterol-lowering medication. I did not expect these numbers to be so high for this group,” says Anders Isaksen.

He elaborates that the treatment of people born in Somalia was worse on all 11 indicators of good diabetes treatment versus native Danes and the worst of all groups on nine indicators.

In accordance with previous research, a higher percentage of migrants have type 2 diabetes than native Danes.

Identifying reasons for the differences

According to Anders Isaksen, the results may have several explanations.

Having high cholesterol is clearly associated with not being treated with cholesterol-lowering medication.

However, why people with a migrant background are not treated as often with cholesterol-lowering medication may also have several explanations. Perhaps they often develop type 2 diabetes earlier, which may mean that the doctor may overlook elevated cholesterol because the doctor is not aware of the risk for younger people.

Language barriers between doctors and patients may also be part of the explanation, and finally, the cost of medicine may also have an influence on why fewer migrants with type 2 diabetes are properly treated for risk factors.

“We need to be careful in claiming that the reasons are the same for all groups of migrants, because they certainly differ. But clearly, delving deeper into the causes of these differences will be relevant to determine whether any interventions would be useful if differences in treatment lead to poorer disease control and a greater risk of complications. Perhaps we general practitioners need to find additional time to explain to migrants how our healthcare system works, so that the differences at least do not result from misunderstandings. The inequality in access to healthcare services between native Danes and migrants needs to be minimised,” concludes Anders Isaksen.

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