Ethnic Inequities in Achieving Glycaemic and Other Clinical Targets in Type 2 Diabetes

Background/Objectives: Ethnic disparities in type 2 diabetes (T2D) outcomes remain a significant public health challenge in Aotearoa New Zealand (NZ), but are not accurately reported in large datasets. This cross-sectional study used linked regional health records to examine ethnic inequities in glycaemic control and achievement of clinical targets among adults with T2D in the Waikato and Auckland regions. Methods: A cross-sectional analysis was conducted on 57,734 adults aged 18–75 years with confirmed T2D enrolled in four Primary Healthcare Organisations. Clinical and sociodemographic data from February 2021 to December 2023 were linked via National Health Index numbers. Key outcomes included the percentage of patients at target for HbA1c, blood pressure, lipid profiles, renal and liver function tests. Logistic regression assessed associations between ethnicity, socioeconomic deprivation, and clinical target attainment. Results: The mean age was 56.5 ± 12.4 years, and 86.8% of the cohort were overweight or obese. Overall, only 46.3% achieved the HbA1c target (<53 mmol/mol) in their most recent test, with Māori (OR 1.35) and Pacific (OR 1.84) ethnicities, higher deprivation, obesity, and younger age independently associated with elevated HbA1c. Hypertension affected two-thirds of participants (71.9% above target), notably Asians and Pacific peoples. Māori and Pacific peoples had over twice the odds of renal impairment and were 2.5 times more likely to have elevated albumin-to-creatinine ratios. Abnormal liver function test decreased with age (OR ≤ 0.65), though Asians had over twice the odds of elevated ALT and AST compared to Europeans. Conclusions: Significant ethnic inequities exist in glycaemic and clinical target attainment among people with T2D in NZ. These findings highlight critical gaps in diabetes management and underscore the urgent need for targeted, equity-focused interventions addressing both socioeconomic and ethnic disparities to improve outcomes and reduce health inequities.