1036-P: Ethnic Discordance between HbA1c and BP Management in Primary Care among New Zealanders with Type 2 Diabetes

Hospitalization has been higher among New Zealand (NZ) Māori and Pasifika than Europeans with type 2 diabetes (T2DM) for >20 years. We compared their metabolic profiles as possible drivers behind the worse outcomes.

Methods: We identified four 5-year cohorts incorporating 15498 Europeans, 6445 Māori 10294 Pasifika with T2DM enrolled in 1994, 1999, 2004, 2009, to a primary care audit program. Systolic blood pressure (SBP), body mass index (BMI), HbA1c, albumin creatinine ratio (ACR), total cholesterol (TC), and triglyceride were measured at baseline, 1, 2, 3, 4 and 5-years. Mean and mean-difference (reference= European) were estimated at each time-point, with adjustment for age, gender, smoking, SE status, diabetes duration, key meds and the other measures. Multiple imputation with chained equation tackled missing values. Multivariable mixed effects modelling was used to model the repeated measurements.

Results: Compared with Europeans, Māori (black) and Pasifika (grey) had higher HbA1c, ACR, and lower SBP at each time-point and within each cohort. Fig 1 shows the adjusted mean (95%CI) differences.

Conclusions: NZ Māori/Pasifika under primary care management have better SBP and lipids, but worse glycemia than Europeans. This could partly explain the worse Māori/Pasifika outcomes and suggests that glycemic management is more challenging than BP/lipid management for primary care.

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