Diabetes in the African-Caribbean and the Romford Experience (DARE): A Retrospective Study.

backgroundDiabetes mellitus is a significant public health challenge in the United Kingdom, with higher prevalence and complication rates among minority ethnic groups, especially those of African and Caribbean descent. Evidence shows that these populations have an increased risk of developing type 2 diabetes and related metabolic issues, often presenting late with acute hyperglycemic emergencies like diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). Understanding patterns of disease onset and early management in these communities is crucial for reducing health disparities and improving outcomes.

aimThe DARE study aimed to describe the clinical characteristics, presentation patterns, diabetes subtypes, and early management of Afro-Caribbean patients admitted to a hospital in Romford with diabetes or diabetes-related complications. The objectives were to identify the prevalence of diabetes subtypes, assess demographic trends, document acute presentations, and evaluate early inpatient management.

methodsThis retrospective observational study focused on Afro-Caribbean adults who were admitted to Queen's Hospital, Romford, for diabetes or related complications from January 2020 to December 2024. Eligible patients were identified through CareFlow Connect, the London Care Record, and EPRO, applying specific inclusion criteria. In total, 52 individuals comprised the final study group. Descriptive statistics were used to summarise the data, with analysis performed in Microsoft Excel (Redmond, USA) and Google Sheets (California, USA).

resultsThe study cohort included 52 patients (mean age 46 years, range 18 to 86), of whom 33 (63.5%) were male. Type 2 diabetes was the most prevalent subtype (39 of 52, 75.0%), followed by type 1 diabetes (7 of 52, 13.5%) and latent autoimmune diabetes in adults (LADA) (5 of 52, 9.6%). Acute metabolic emergencies were common: diabetic ketoacidosis (DKA) occurred in 20 of 52 patients (38.5%), hyperosmolar hyperglycaemic state (HHS) in 13 of 52 (25.0%), and a mixed DKA/HHS presentation in 1 of 52 (1.9%). Among patients younger than 30 years, 4 of 9 (44.4%) presented with DKA. Non-emergency presentations included hyperglycaemia without ketosis (n = 9) and polyuria or polydipsia (n = 4). Insulin use was frequently documented, with both long-acting and short-acting insulin each recorded in 28 of 52 patients (53.8%). Six patients (11.5%) were identified as deceased in available hospital-linked records; information regarding place of death and complete follow-up outside these records was unavailable.

conclusionIn this admission-based cohort of Afro-Caribbean adults in Romford, acute hyperglycaemic emergencies (DKA/HHS) were common at first hospital presentation, and insulin therapy was frequently recorded. These findings are descriptive and hypothesis-generating and support the need for locally responsive, culturally informed approaches to earlier identification and continuity of diabetes care in high-risk communities. Further multi-centre studies with standardised definitions and improved linkage to community and primary care records are warranted to clarify pathways to diagnosis, barriers to timely care, and the impact and cost-effectiveness of targeted interventions.