Factors Affecting Health Disparities in Diabetes Patients

San Diego—After analyzing electronic health records (EHRs) of patients with type 2 diabetes living in the southeast United States, researchers concluded that improving diabetes control and health equity can be achieved through focusing on early diagnosis and treatment, having regular healthcare visits, and overcoming therapeutic inertia. The findings of the retrospective, observational study were presented at the ADA meeting in a poster titled Effect of Modifiable Variables on Demographic Differences in the Treatment and Glycemic Control of Type 2 Diabetes. From January 2004 through December 2008, the authors examined data from South Carolina’s hypertension initiative, a community-based practice network that includes approximately 150 practices with EHR systems that provide information every 3 months on >100,000 patients with type 2 diabetes. Patients were included if they had type 2 diabetes, were ≥18 years of age, and had known sex and race. Between 2004 and 2008, they must have had ≥2 clinic visits, ≥1 hemoglobin A1c (HbA1c) level value, ≥1 blood pressure value, ≥1 low-density lipoprotein cholesterol value, and ≥1 valid prescription for any medical condition. The study included 22,285 patients at 110 centers with a mean age of 55.8 years and a mean body mass index at baseline of 34.0 kg/m2. Approximately 61% of the patients were white and 58% were female. Of the white patients, 55.6% had HbA1c levels <7% compared with 44.7% of black patients (P<.0001). Meanwhile, 45.3% of patients <50 years of age had HbA1c levels <7% compared with 50.0% of patients between 50 and 64 years of age and 59.6% of patients ≥65 years of age (P<.001). In addition, 52.1% of females had HbA1c levels <7% compared with 50.0% of males (P<.01). The authors said the following 3 modifiable covariables accounted for 47.9% of the variance in diabetes control: initial HbA1c level; visit frequency; and therapeutic inertia, defined as increasing dose or adding medication for diabetes on ≥50% of visits when the HbA1c level is ≥7% unless there was a diagnosis of hypoglycemia or hypoglycemic episodes. They mentioned that the impact of race/ethnicity and increasing age on HbA1c control declined when adjusting for the 3 covariables, with the odds ratio (OR) of white versus black decreasing from 1.59 to 1.21 and the OR of increasing age dropping from 1.20 for every 10 years to 1.13 for every 10 years. The authors cited a few study limitations. First, the trial only included data from practices with EHR systems. They also did not have information about insurance status for many of the patients. In addition, they could not evaluate medication adherence, which may have affected the results. In conclusion, the authors commented, “health disparities continue to exist in treating type 2 diabetic patients. However, greater attention to early diagnosis and treatment, ensuring regular healthcare visits, and overcoming therapeutic inertia could improve diabetes control and health equity.” This study was supported by Takeda Pharmaceuticals America, Inc.