Improved eye and health care for UK South Asian population suffering from diabetes

Evidence-based data was provided for a joint report by Diabetes UK and the South Asian Health Foundation, whose principal purpose is to highlight the gaps in our understanding of diabetes in the UK-based South Asian population as well as to identify recommendations and priorities for future research areas.

The report is to be used by funding agencies that support research in order to improve the health of the two million South Asian population living in the UK today and which represents 4% of the total UK population. This is particularly important with diabetes, as South Asian people who live in the UK are up to six times more likely to have the disease than the white population, and with diabetes prevalence in England predicted to increase by 47% by 2025, the condition will have a considerable impact on South Asian communities across the UK.

Evidence-based data has been provided for reports commissioned by the Royal National Institute of the Blind (RNIB) as part of Care Needs Assessment Eye Health: Epidemiology, Intervention and Ethnicity, to examine the barriers that affect access to primary and secondary eye-care across the UK. The report focuses upon the causes of inequality in eye health, in an effort to develop interventions to reduce inequality, with particular reference to ethnicity, age, and socio-economic deprivation. The report serves to inform health care providers, enabling them to help increase uptake of eye-care services by highlighting at risk groups, and emphases the criticality of early detection to prevent sight-loss.

Evidence-based data has been been provided to the Southampton City, Hampshire, Isle of Wight and Portsmouth City Primary Care Trust (PCT) a Health Equity Audit, to identify how equitably Health Care Services or other resources are distributed in relation to the health needs for different groups in different geographic areas, and to identify priority actions in order to focus services to areas of specific need. The report is designed to inform the commissioning of services by identifying groups currently under served, not accessing or utilising services, or for whom the clinical outcome is particularly poor. The health equity audit identified patient factors (such as the groups of people at most risk of retinopathy, those less able to access and take up the opportunity for retinal screening) and recommended that procedures/policies put into place improved recording of potential inequity such as ethnicity recording.

Case Study: Improved Eye and Healthcare for diabetic patients of South Asian origin

Research led by Pardhan has enhanced the healthcare offered to diabetic patients of South Asian origin in the UK and overseas (Pakistan, East Africa). Prevalence of diabetes within this ethnic group is six times higher than in Caucasians. VERU’s research into this group, which demonstrated an increased risk of sight-threatening eye disease and poor engagement with screening/treatment regimes, has impacted upon both patients and healthcare practitioners. Ophthalmologists, general practitioners and other clinicians have used the findings to target various physiological and cultural factors that influence diabetic control and eye health in the South Asian population.

The reports demonstrate the increased prevalence of eye problems in patients of South Asian origin,and highlight the barriers that affect patients’ access to primary and secondary eye care across the UK. The reports evaluate the effectiveness of current management, and suggest strategies to improve the eye health of this group of patients. These reports have led directly to the creation of dedicated community-based eye care programmes. Funded by the Royal National Institute of Blind People (400K) and Innovation, Excellence and Strategic Development Fund (Department of Health), the programmes are designed to reduce diabetic-related complications through improved self care by patients in Bradford and Glasgow, regions that have significant Asian diabetic populations. The ground-breaking research was led by Professor Pardhan as part of her wider research interest into the factors that influence diabetic eye changes. Her current research project in diabetes and its complications is supported by NHS Cambridgeshire NIHR Research Capability Funding and employs a full-time postdoctoral Research Fellow. She also leads a joint collaborative project with the Aga-Khan Hospital, Nairobi, to investigate the impact of lifestyle on diabetic complications in South Asian patients. The prevalence of diabetes in England alone is predicted to increase by 47% by 2025 and this will inevitably lead to a broad range of complications, including diabetic eye changes. A comparison of the clinical and demographic characteristics of patients on the Bradford low vision register demonstrated that diabetic eye complications caused 3.5 times more blind registrations of patients of South Asian origin compared to Caucasians. A subsequent large-scale study carried out in Bradford (500 patients) provided evidence that these patients had significantly higher prevalence of sight-threatening retinopathy compared to Caucasians. Statistical analysis showed that Asians were presenting with levels of eye disease comparable to those of the Caucasian cohort who were either 12 ½ years older, or had had diabetes for 12 ½ years longer. This worrying finding highlighted the urgent need for improved eye care for Asian diabetic patients in the UK.