Goonesekera Sunali D, Yang May H, Hall Susan A, Fang Shona C, Piccolo Rebecca S, McKinlay John B
New England Research Institutes, Watertown, Massachusetts, USA.
BMJ Open. 2015 May 12;5(5):e007375. doi: 10.1136/bmjopen-2014-007375.
Numerous studies continue to report poorer glycaemic control, and a higher incidence of diabetes-related complications among African-Americans and Hispanic-Americans as compared with non-Hispanic Caucasians with type 2 diabetes. We examined racial/ethnic differences in receipt of hypoglycaemic medications and glycaemic control in a highly insured Massachusetts community sample of individuals with type 2 diabetes.
Community-based sample from Boston, Massachusetts, USA.
682 patients with physician-diagnosed diabetes from the third wave of the Boston Area Community Health Survey (2010-2012). The study included approximately equal proportions of African-Americans, Hispanics and Caucasians.
We examined racial/ethnic disparities in diabetes treatment by comparing proportions of individuals on mutually exclusive diabetes treatment regimens across racial/ethnic subgroups. Using multivariable linear and logistic regression, we also examined associations between race/ethnicity and glycaemic control in the overall population, and within treatment regimens, adjusting for age, gender, income, education, health insurance, health literacy, disease duration, diet and physical activity.
Among those treated (82%), the most commonly prescribed antidiabetic regimens were biguanides only (31%), insulin only (23%), and biguanides and insulin (16%). No overall racial/ethnic differences in treatment or glycaemic control (per cent difference for African-Americans: 6.18, 95% CI -1.00 to 13.88; for Hispanic-Americans: 1.01, 95% CI -10.42 to 12.75) were observed. Within regimens, we did not observe poorer glycaemic control for African-Americans prescribed biguanides only, insulin only or biguanides combined with insulin/sulfonylureas. However, African-Americans prescribed miscellaneous regimens had higher risk of poorer glycaemic control (per cent difference=23.37, 95% CI 7.25 to 43.33). There were no associations between glycaemic levels and Hispanic ethnicity overall, or within treatment regimens.
Findings suggest a lack of racial/ethnic disparities in diabetes treatment patterns and glycaemic control in this highly insured Massachusetts study population. Future studies are needed to understand impacts of increasing insurance coverage on racial/ethnic disparities in treatment patterns and related outcomes.
众多研究持续报告称，与非西班牙裔白人2型糖尿病患者相比，非裔美国人和西班牙裔美国人的血糖控制更差，糖尿病相关并发症的发生率更高。我们在马萨诸塞州一个高保险覆盖率的2型糖尿病社区样本中，研究了接受降糖药物治疗和血糖控制方面的种族/族裔差异。
来自美国马萨诸塞州波士顿的社区样本。
来自波士顿地区社区健康调查第三波（2010 - 2012年）的682例经医生诊断为糖尿病的患者。该研究纳入的非裔美国人、西班牙裔人和白种人的比例大致相等。
我们通过比较不同种族/族裔亚组中采用相互排斥的糖尿病治疗方案的个体比例，研究糖尿病治疗中的种族/族裔差异。使用多变量线性和逻辑回归，我们还研究了总体人群以及不同治疗方案中种族/族裔与血糖控制之间的关联，并对年龄、性别、收入、教育程度、健康保险、健康素养、病程、饮食和身体活动进行了调整。
在接受治疗的患者中（8₂%），最常开具的抗糖尿病方案是仅用双胍类药物（31%）、仅用胰岛素（23%）以及双胍类药物和胰岛素联合使用（16%）。未观察到治疗或血糖控制方面的总体种族/族裔差异（非裔美国人的百分比差异：6.18，95%可信区间 -1.00至13.88；西班牙裔美国人的百分比差异：1.01，95%可信区间 -10.42至12.75）。在不同治疗方案中，我们未观察到仅开具双胍类药物、仅开具胰岛素或双胍类药物与胰岛素/磺脲类药物联合使用的非裔美国人血糖控制更差。然而，开具其他杂项治疗方案的非裔美国人血糖控制较差的风险更高（百分比差异 = 23.37，95%可信区间7.25至43.33）。总体而言，以及在不同治疗方案中，血糖水平与西班牙裔族裔之间均无关联。
研究结果表明，在这个高保险覆盖率的马萨诸塞州研究人群中，糖尿病治疗模式和血糖控制方面不存在种族/族裔差异。未来需要开展研究，以了解保险覆盖率增加对治疗模式和相关结局方面种族/族裔差异的影响。
