Michael Soljak, together with colleagues from Imperial College, London, UK, investigated the treatment received in 2002 by 21,343 diabetic patients in three North West London Primary Care Trusts (PCTs): Ealing, Hammersmith & Fulham, and Hounslow. The researchers also compared the patients general health, shown by factors such as blood pressure and cholesterol levels, and diabetes control, to the patients treatment.

General practitioners (GPs) were encouraged to record new patients ethnicity by providing training and support to the practices. Of the diabetic patients in the three PCTs, 70 percent had a valid ethnicity code, obtained through patient questionnaires and entered by practice staff.

The authors found that although diabetes control was worse among the South Asian population, a smaller proportion of South Asians were prescribed insulin. They also found that although the White population studied was older, blood pressure differences between the groups were small, indicating poorer control in non-White ethnic groups.

The poorer quality of care for Asian diabetic patients could be explained by patient factors- such as poor understanding of the disease- or by the standard of care their GPs offered. Institutional racism is unlikely to be a major cause, as many South Asian patients are registered with GPs from their own ethnic group.

"This study highlights the need to capture ethnicity data in clinical trials and in routine care, to specifically investigate the reasons for these ethnic differences. But we don't just need to know more about both the practice and patient factors involved," says Soljak, "there should be more intensive management of diabetes and education about the disease in South Asian patients. The best option would be trials comparing different types of such interventions. Our study also shows that in future these trials can be carried out using routinely collected clinical information".

biomedcentral

Patients with psoriasis are twice as likely to be overweight compared to the general population. They often gain weight because the disease limits their physical activity, or erodes their self-esteem and causes depression, leading the patient to eat excessively. Obesity is also associated with more severe psoriasis. Certain co-morbidities associated with heavy individuals such as hypertension, diabetes, or high cholesterol may influence a dermatologist's choice of therapy for this subpopulation.

Efalizumab, marketed by Genentech as Raptiva?®, is a humanized therapeutic antibody designed to selectively and reversibly block the activation, reactivation and trafficking of T-cells that lead to the development of psoriasis. In October 2003, Raptiva received U.S. Food and Drug Administration approval for the treatment of chronic moderate-to-severe plaque psoriasis in adults 18 years or older who are candidates for systemic therapy or phototherapy. Raptiva can be self-administered by patients as a single dose, once-weekly, subcutaneous injection after proper training by a healthcare professional

The most serious side effects experienced by patients in trials with RAPTIVA?® (efalizumab) were low platelet counts (thrombocytopenia), low blood counts (anemia), new or worsening psoriasis, and new or worsening arthritis. Because RAPTIVA is an immunosuppressive agent, it has the potential to increase the risk of infection and cancer. The most common side effects of RAPTIVA include headache, chills, fever, nausea, and muscle aches.

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