Illuminating Racial Inequity in Diabetes Control: Differences Based on Gender and Geography

The objective of this study is to describe racial differences in type 2 diabetes mellitus "diabetes" control among the adults in the USA, and to examine attributes that may exacerbate racial differences. Secondary analyses of data from the National Ambulatory Medical Care Survey (NAMCS) collected in years 2012-2014 in the USA. Study sample was limited to White or African American patients aged 25 or older and living with diabetes (n = 4106). Outcome measure, poor diabetes control, was based on lab values for HbA1c (> 7%). Covariates include demographics, insurance, comorbid conditions, and continuity of care and location (urban vs. rural). Overall, African Americans have 33% higher odds of poor diabetes control compared with Whites. Adjusted probability of poor diabetes control was 48% overall, 65% for African American women and 69% for African Americans living in rural areas. African Americans continue to have poorer diabetes control compared to Whites. This difference is exacerbated for African American women, and for all African Americans living in rural areas. Policy should include concentrated screening and treatment resources for African Americans in rural settings.