Māori patients receive fewer prescriptions for the common diabetes medication Metformin than non-Māori despite suffering from the disease at twice the rate, according to a new study by the University of Waikato.
The researchers studied prescriptions from doctors, dispensing by pharmacies, and a marker of blood sugar levels over time which involved more than 1500 patients in the Waikato region.
Metformin is a common medication which lowers blood sugar levels for patients while also preventing ‘hypos’, where the level of sugar in the blood drops too low and can be dangerous.
GP and Senior Fellow Dr Rawiri Keenan said the study found that it was not a case where Māori were simply not picking up their prescriptions, but rather not getting the prescription in the first place.
“Previous reports have shown that Māori receive less medication than non-Māori, but it is often explained as Māori not picking up scripts or not wanting medication in the first place. Negative stereotypes and attitudes to Māori persist and are maintained by deficit thinking in relation to Māori.
“That’s what this study highlighted, that there’s a gap there of accessing the prescription at the beginning, and actually picking it up isn’t the problem,” he said.
Factors not explored in the study included whether patients picked up the prescription at a hospital rather than at one of the 10 GP clinics researchers looked at, or whether there was good reason for them not receiving a prescription.
“But it does add something else to that narrative that Māori don’t pick up their meds because they don’t care or what have you, there’s actually a gap there in accessing prescriptions in the health system right at the very beginning.”
Keenan said there could be a number of reasons why this was occurring, including situations people cannot control such as getting time off work to see the doctor.
But he said healthcare workers needed to look more closely at the health system and its barriers.
“Why do we have barriers? Why is it free to go to the ED [emergency department] but it costs to go to a GP? What is the health system doing about that? Is there racism in the health system? Yes, and a lot of people get defensive when they hear that,” he said.
“What is it about our health system that means Māori are going to get help and not being given the prescriptions, or Māori aren’t going in the first place. And instead of blaming Māori, we need to look at ourselves as a system and ask why, and what we can do to make sure these prescriptions are getting to the people who need them most.”
Professor of Medicine at Otago University and co-director of the Edgar Diabetes and Obesity Research Centre Jim Mann said the findings were concerning.
“Metformin was introduced as a medication for people with diabetes more than half a century ago … It is a cornerstone of treatment for the majority of people with type 2 diabetes even when other treatments including insulin are needed.
“It is therefore of considerable concern to discover that there appears to be a reduction in metformin coverage in Māori compared with New Zealand Europeans, given the appreciably higher rates of type 2 diabetes amongst Māori. Not only are type 2 diabetes rates high among Māori, but there are ethnic disparities in terms of diabetes-related health outcomes,” he said.
The study notes that Māori may be less adherent to metformin because of other reasons such as a higher rate of side effects.
“This statement concerns me because my own clinical experience suggests that, while gastrointestinal side effects to metformin are indeed common, they can be greatly reduced and adherence improved if patients are given simple advice such as gradually increasing to the full dose from a very small initial dose and having the tablets with food,” Mann said.