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Race differences in long-term diabetes management in an HMO
Alyce S Adams1, Fang Zhang, Connie Mah
1Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave., 6th Floor, Boston, MA 02215, USA. aadams@hms.harvard.edu
Diabetes Care
|November 25, 2005
Summary
Racial disparities in diabetes management persist, with Black women showing higher HbA1c (A1C) levels than White women. Further research is needed to understand and address these persistent race differences in diabetes outcomes.
Area of Science:
- Clinical Medicine
- Health Disparities
- Diabetes Research
Background:
- Race influences health outcomes, including diabetes management.
- Understanding persistent racial disparities in diabetes care is crucial for equitable healthcare.
Purpose of the Study:
- To examine race-based differences in diabetes outcomes over 4-8 years within a single health maintenance organization (HMO).
- To identify potential factors contributing to observed race differences in glycemic control.
Main Methods:
- A cohort of Black and White adult diabetic patients (diagnosed before 1994 or newly diagnosed 1994-1997) were analyzed.
- Hierarchical models estimated the effect of race on average annual Hemoglobin A1c (HbA1c), controlling for clinical and demographic factors.
- Analyses were stratified by sex due to significant sex-race interactions.
Main Results:
- Black patients had higher unadjusted HbA1c values at baseline compared to White patients.
- Among patients with previously diagnosed diabetes, Black women had significantly higher average HbA1c than White women (0.30 higher).
- Among patients with newly diagnosed diabetes, Black men showed a significant increase in HbA1c compared to White men (0.49 higher).
Conclusions:
- Observed race differences in HbA1c may be attributed to factors beyond the quality of care received.
- Future interventions should focus on identifying psychosocial barriers impacting therapy intensification and self-management.
- Development of culturally sensitive interventions is recommended to improve diabetes outcomes for all racial groups.