Skip to main content
The William Harvey Research Institute - Faculty of Medicine and Dentistry

Breadcrumb

  1. WHRI
  2. Study
  3. Barts Charity Doctoral Training Programme
  4. Projects
  5. BC-DTP_2026_61

Delays in type 2 diabetes diagnosis & management in Black and mixed ethnicity people: a population data-driven study to improve NHS care and outcomes

Code: BC-DTP_2026_61

Title: Delays in type 2 diabetes diagnosis & management in Black and mixed ethnicity people: a population data-driven study to improve NHS care and outcomes

Primary Supervisor: Sarah Finer

Email: s.finer@qmul.ac.uk

Institute: Wolfson Institute of Population Health

Secondary Supervisor: Veline L'Esperance

Email: v.lesperance@qmul.ac.uk

Institute: Wolfson Institute of Population Health

Lay Summary:

This studentship aims to understand why people in the UK from Black African, Black Caribbean, and mixed‑ethnicity backgrounds are more likely to face delays in being diagnosed with type 2 diabetes (T2D), and why they may receive lower‑quality care after diagnosis compared with other groups.

The PhD student will use securely stored, anonymous NHS health records from a large database called the Clinical Practice Research Datalink (CPRD), along with information from a new study called Black Health Legacy, which collects health and genetic data. Using these studies, the student will track when people are diagnosed with T2D, what treatments they receive, and how closely their care follows national guidelines. They will compare these patterns across ethnic groups while taking into account factors like age, sex, deprivation, and existing health conditions.

The student will also explore whether naturally occurring genetic differences might influence how accurately the common diagnostic blood test known as HbA1c works for different people. This will help determine whether biology contributes to delayed or missed diagnoses.

By combining health record analysis with genetic research, the project will build a detailed picture of where inequalities arise along the diabetes care pathway, from diagnosis and treatment to complications such as kidney disease, eye disease, and amputations. The study will also use advanced statistical techniques to assess whether unequal care leads to worse long‑term health outcomes and higher NHS costs. The findings will guide practical recommendations to make NHS diabetes care fairer and more effective for Black and mixed‑ancestry communities.

Aims:

To identify the determinants and consequences of delayed diagnosis and inequitable management of T2D in East London’s Black African, Black Caribbean, and mixed‑ethnicity communities, and to co‑produce recommendations that improve equity in care.

Specific Objectives

  1. Quantify diagnostic delays and their determinants.
  2. Assess variation in guideline‑recommended monitoring, treatment initiation, and follow‑up care.
  3. Evaluate the impact of diagnostic and care inequalities on T2D complications, healthcare utilisation, and NHS costs.
  4. Integrate genetic and ancestry data to determine whether HbA1c‑altering variants influence diagnostic delays.
  5. Work with East London communities and NHS stakeholders to co‑produce feasible, culturally sensitive, and cost‑effective recommendations.

References:

  1. National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. NICE guideline [NG28]. 2022. Available from: https://www.nice.org.uk/guidance/ng28
  2. Holman N, Knighton P, O’Keefe J, Wild SH, Brewster S, Price H, et al. Completion of annual diabetes care processes and mortality: A cohort study using the National Diabetes Audit for England and Wales. Diabetes Obes Metab. 2021;23(12):2728–40. doi:10.1111/dom.14528
  3. National Diabetes Audit 2021–22. Report 1: Care Processes and Treatment Targets. NHS Digital; 2023.
  4. Mathur R, Farmer RE, Eastwood SV, Chaturvedi N, Douglas I, Smeeth L. Ethnic disparities in initiation and intensification of diabetes treatment in adults with type 2 diabetes in the UK, 1990–2017: A cohort study. PLoS Med. 2020;17(5):e1003106. doi:10.1371/journal.pmed.1003106
  5. Au-Yeung CH, Ellis D, Dallaway A, Riley J, Varney J, Howell-Jones R. Socioeconomic and ethnic inequalities increase the risk of type 2 diabetes: an analysis of NHS health check attendees in Birmingham. Front Public Health. 2024;12:1477418. doi:10.3389/fpubh.2024.1477418
  6. Khunti K, Chen H, Cid-Ruzafa J, Fenici P, Gomes MB, Hammar N, et al. Glycaemic control in patients with type 2 diabetes initiating second-line therapy: Results from the global DISCOVER study programme. Diabetes Obes Metab. 2020;22(1):66–78. doi:10.1111/dom.13866
  7. Hodgson S, Williamson A, Bigossi M, Stow D, Jacobs BM, Samuel M, et al. Genetic basis of early onset and progression of type 2 diabetes in South Asians. Nat Med. 2025;31(1):323–31. doi:10.1038/s41591-024-03317-8
  8. Fatumo S, Chikowore T, Choudhury A, et al. A roadmap to increase diversity in genomic studies. Nat Med. 2022;28:243–50. doi:10.1038/s41591-021-01672-4
  9. Breeyear JH, Hellwege JN, Schroeder PH, et al. Adaptive selection at G6PD and disparities in diabetes complications. Nat Med. 2024;30:2480–8. doi:10.1038/s41591-024-03089-1
  10. Wheeler E, Leong A, Liu CT, Hivert MF, Strawbridge RJ, et al. Impact of common genetic determinants of haemoglobin A1c on type 2 diabetes risk and diagnosis in ancestrally diverse populations: a transethnic genome-wide meta-analysis. PLoS Med. 2017;14(9):e1002383. doi:10.1371/journal.pmed.1002383
  11. Suzuki K, … Vujkovic M, Voight BF, Morris AP, Zeggini E. Genetic drivers of heterogeneity in type 2 diabetes pathophysiology. 2024;627(8003):347–57. PMID:38374256
  12. Martin S, Samuel M, Stow D, Ridsdale A, Chen J, Young KG, Green HD, Genes & Health Research Team, Hattersley AT, L’Esperance V, McKinley TJ, Finer S, Barroso I. Undiagnosed G6PD deficiency in Black and Asian individuals is prevalent and contributes to health inequalities in type 2 diabetes diagnosis and complications. Diabetes Care. In press (2025).
  13. NHS Race and Health Observatory. Ethnic Inequalities in Healthcare: A Rapid Evidence Review.
  14. Diabetes UK. Inequalities in Diabetes Care: Position Statement.
  15. Chan J, Finer S, et al. Addressing health inequalities in diabetes through research: Recommendations from Diabetes UK’s 2022 health inequalities workshop. PLoS Glob Public Health. 2025;5(3):e0004274. doi:10.1371/journal.pgph.0004274
  16. Department of Health and Social Care. The 10‑Year Plan for England.
  17. UK Parliament. Debate on diabetes prevention and care. 2023.
  18. Cook S, Schmedt N, Broughton J, et al. Characterising the burden of chronic kidney disease among people with type 2 diabetes in England: a cohort study using the Clinical Practice Research Datalink. BMJ Open. 2023;13:e065927. doi:10.1136/bmjopen-2022-065927
  19. Mora T, Rodríguez-Sánchez B. Diabetes diagnosis based on glucose control levels and time until diagnosis: a regression discontinuity approach to assess the effect on direct healthcare costs. Health Econ Rev. 2025;15:26. doi:10.1186/s13561-025-00613-y
Back to top