HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Adams, A. S. Articles by Ross-Degnan, D. Search for Related Content PubMed PubMed Citation Articles by Adams, A. S. Articles by Ross-Degnan, D. Social Bookmarking                What's this?

Race Differences in Long-Term Diabetes Management in an HMO

¹ Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
² General Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts

Address correspondence and reprint requests to Dr. Alyce S. Adams, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave., 6th Floor, Boston, MA 02215. E-mail: aadams{at}hms.harvard.edu

OBJECTIVE—We examined race differences in diabetes outcomes over 4–8 years in a single HMO.

RESEARCH DESIGN AND METHODS—We identified black and white adult diabetic patients who were continuously enrolled (1992–2001) and in whom diabetes was 1) diagnosed before 1994 (n = 1,686) or 2) newly diagnosed in 1994–1997 (n = 1,280). We used hierarchical models to estimate the effect of race on average annual HbA_1c (A1C) controlling for baseline A1C, BMI, and age, as well as annual measures of type of diabetes medications, diabetes-related hospitalization, time and the number of A1C tests, physician visits, and nondiabetes medications. Stratifying by sex accounted for significant interactions between sex and race.

RESULTS—At baseline, black and white patients had similar rates of A1C testing and physician visits, but blacks had higher unadjusted A1C values. In multivariate models, among patients with previously diagnosed diabetes, average A1C was nonsignificantly 0.11 higher (95% CI –0.12 to 0.34) in black than in white men but was 0.30 higher (0.14–0.46; P = 0.0007) in black than in white women. Among patients with newly diagnosed diabetes, the adjusted black-white gap was 0.49 among men (0.17–0.80; P = 0.007) and was 0.05 among women (–0.20 to –0.31), which was positive but not significant.

CONCLUSIONS—Factors other than the quality of care may explain persistent race differences in A1C in this setting. Future interventions should target normalization of A1C by identifying potential psychosocial barriers to therapy intensification among patients and clinicians and development of culturally appropriate interventions to aid patients in successful self-management.

Abbreviations: HPHC, Harvard Pilgrim Health Care • HVMA, Harvard Vanguard Medical Associates

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				M. K. Rhee, D. C. Ziemer, J. Caudle, P. Kolm, and L. S. Phillips Use of a Uniform Treatment Algorithm Abolishes Racial Disparities in Glycemic Control The Diabetes Educator, July 1, 2008; 34(4): 655 - 663. [Abstract] [Full Text] [PDF]

				T. D. Sequist, G. M. Fitzmaurice, R. Marshall, S. Shaykevich, D. G. Safran, and J. Z. Ayanian Physician Performance and Racial Disparities in Diabetes Mellitus Care Arch Intern Med, June 9, 2008; 168(11): 1145 - 1151. [Abstract] [Full Text] [PDF]

				A. S. Adams, C. M. Trinacty, F. Zhang, K. Kleinman, R. W. Grant, J. B. Meigs, S. B. Soumerai, and D. Ross-Degnan Medication Adherence and Racial Differences in A1C Control Diabetes Care, May 1, 2008; 31(5): 916 - 921. [Abstract] [Full Text] [PDF]

				R. W. Grant Invited Commentary: Untangling the Web of Diabetes Causality in African Americans Am. J. Epidemiol., August 15, 2007; 166(4): 388 - 390. [Abstract] [Full Text] [PDF]

				R. Grant, A. S. Adams, C. M. Trinacty, F. Zhang, K. Kleinman, S. B. Soumerai, J. B. Meigs, and D. Ross-Degnan Relationship Between Patient Medication Adherence and Subsequent Clinical Inertia in Type 2 Diabetes Glycemic Management Diabetes Care, April 1, 2007; 30(4): 807 - 812. [Abstract] [Full Text] [PDF]

				C. B. Hart Race Differences in Long-Term Diabetes Management in an HMO: Response to Adams et al. Diabetes Care, June 1, 2006; 29(6): 1461 - 1462. [Full Text] [PDF]

				A. S. Adams, F. Zhang, C. M. Trinacty, R. W. Grant, K. Kleinman, J. B. Meigs, and D. Ross-Degnan Race Differences in Long-Term Diabetes Management in an HMO: Response to Hart. Diabetes Care, June 1, 2006; 29(6): 1462 - 1462. [Full Text] [PDF]