Insulin Use Among Asian and Pacific Islander Adults with Diabetes Receiving Pharmacotherapy

The burden of diabetes is high among U.S. Asian and Native Hawaiian/Pacific Islander (NHPI) adults, but studies examining ethnic differences in diabetes pharmacotherapy remain limited. This study examines prevalent insulin use in adults with treated diabetes, with a focus on Asian/NHPI subgroups. Among 81,692 adults aged 45-79 years with pre-existing diabetes and pharmacotherapy in 2019, 34.6% had prevalent insulin use. Insulin use was significantly lower for Asian/NHPI (24.8%) compared to Black (39.1%), White (38.4%), and Hispanic (37.2%) adults, but varied by subgroup: 31.8-33.1% (Japanese and NHPI), 27.5% (Filipino), 22.9% (South Asian), and 20.4-20.8% (Southeast Asian and Chinese). In multivariable analyses, adjusting for age, sex, social factors, body mass index, comorbidity index, duration of diabetes and hemoglobin A1c level, all racial and ethnic minority groups had lower adjusted prevalence of insulin use compared to White adults, including 12-17% lower for Hispanic and Black, 12% lower for Japanese, 23-25% lower for Filipino and NHPI, and 30-33% lower for other Southeast Asian, Chinese, and South Asian adults. Differences between Chinese and Japanese adults were significant, and findings were also similar for the older subset aged 65-79 years. This study is among the first to report prevalent insulin use in a large and disaggregated population of Asian/NHPI adults with treated diabetes, where use was consistently lower than White adults. However, Japanese adults had higher insulin use than Chinese adults, whereas Filipino, other Southeast Asian, South Asian, and NHPI adults were similar.