School of Public Health, University of California, Berkeley, Berkeley, California.
School of Public Health, University of California, Berkeley, Berkeley, California.
Womens Health Issues. 2020 May-Jun;30(3):191-199. doi: 10.1016/j.whi.2020.03.003. Epub 2020 Apr 25.
Diabetes is increasingly prevalent among women of reproductive age, yet little is known about quality of diabetes care for this population at increased risk of diabetes complications and poor maternal and infant health outcomes. Previous studies have identified racial/ethnic disparities in diabetes care, but patterns among women of reproductive age have not been examined.
This retrospective cohort study analyzed 2016 data from Kaiser Permanente Northern California, a large integrated delivery system. Outcomes were quality of diabetes care measures-glycemic testing, glycemic control, and medication adherence-among women ages 18 to 44 with type 1 or type 2 diabetes (N = 9,923). Poisson regression was used to estimate the association between patient race/ethnicity and each outcome, adjusting for other patient characteristics and health care use.
In this cohort, 83% of participants had type 2 diabetes; 31% and 36% of women with type 2 and type 1 diabetes, respectively, had poor glycemic control (hemoglobin A1c of ≥9%), and approximately one-third of women with type 2 diabetes exhibited nonadherence to diabetes medications. Compared with non-Hispanic White women with type 2 diabetes, non-Hispanic Black women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) and Hispanic women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) were more likely to have poor control. Findings among women with type 1 diabetes were similar.
Our findings indicate opportunities to decrease disparities and improve quality of diabetes care for reproductive-aged women. Elucidating the contributing factors to poor glycemic control and medication adherence in this population, particularly among Black, Hispanic, and Asian women, should be a high research and practice priority.
糖尿病在育龄期女性中越来越普遍，但对于这一人群，其糖尿病护理质量知之甚少，因为她们有更高的糖尿病并发症风险和较差的母婴健康结局。先前的研究已经确定了糖尿病护理方面的种族/民族差异，但尚未研究育龄期女性的模式。
本回顾性队列研究分析了来自 Kaiser Permanente Northern California 的 2016 年数据，该研究是一个大型综合交付系统。结果是 18 至 44 岁患有 1 型或 2 型糖尿病（N=9923）的女性的糖尿病护理质量指标-血糖检测、血糖控制和药物依从性。使用泊松回归估计患者种族/民族与每个结果之间的关联，同时调整其他患者特征和医疗保健使用情况。
在本队列中，83%的参与者患有 2 型糖尿病；分别有 31%和 36%的 2 型和 1 型糖尿病女性的血糖控制不佳（血红蛋白 A1c≥9%），大约三分之一的 2 型糖尿病女性未遵医嘱服用糖尿病药物。与非西班牙裔白人 2 型糖尿病女性相比，非西班牙裔黑人女性（调整后的风险比，1.2；95%置信区间，1.1-1.3）和西班牙裔女性（调整后的风险比，1.2；95%置信区间，1.1-1.3）更有可能血糖控制不佳。1 型糖尿病女性的发现类似。
我们的研究结果表明，有机会减少育龄期女性的差异并改善糖尿病护理质量。阐明该人群中血糖控制和药物依从性不良的促成因素，特别是在黑人、西班牙裔和亚裔女性中，应成为研究和实践的重点。
