Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
Department of Clinical Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.
J Gen Intern Med. 2023 Mar;38(4):994-1000. doi: 10.1007/s11606-022-07746-4. Epub 2022 Aug 4.
Given persistent racial/ethnic differences in type 2 diabetes outcomes and the lasting benefits conferred by early glycemic control, we examined racial/ethnic differences in diabetes medication initiation during the year following diagnosis.
Among adults newly diagnosed with type 2 diabetes (2005-2016), we examined how glucose-lowering medication initiation differed by race/ethnicity during the year following diagnosis. We specified modified Poisson regression models to estimate the association between race/ethnicity and medication initiation in the entire cohort and within subpopulations defined by HbA1c, BMI, age at diagnosis, comorbidity, and neighborhood deprivation index (a census tract-level socioeconomic indicator).
Among the 77,199 newly diagnosed individuals, 47% started a diabetes medication within 12 months of diagnosis. The prevalence of medication initiation ranged from 32% among Chinese individuals to 58% among individuals of Other/Unknown races/ethnicities. Compared to White individuals, medication initiation was less likely among Chinese (relative risk: 0.78 (95% confidence interval 0.72, 0.84)) and Japanese (0.82 (0.75, 0.90)) individuals, but was more likely among Hispanic/Latinx (1.27 (1.24, 1.30)), African American (1.14 (1.11, 1.17)), other Asian (1.13 (1.08, 1.18)), South Asian (1.10 (1.04, 1.17)), Other/Unknown (1.31 (1.24, 1.39)), American Indian or Alaska Native (1.11 (1.04, 1.18)), and Native Hawaiian/Pacific Islander (1.28 (1.19, 1.37)) individuals. Racial/ethnic differences dissipated among individuals with higher HbA1c values.
Initiation of glucose-lowering treatment during the year following type 2 diabetes diagnosis differed markedly by race/ethnicity, particularly for those with lower HbA1c values. Future research should examine how patient preferences, provider implicit bias, and shared decision-making contribute to these early treatment differences.
鉴于 2 型糖尿病结局存在持续的种族/民族差异，以及早期血糖控制带来的持久益处，我们研究了诊断后 1 年内糖尿病药物起始治疗的种族/民族差异。
在 2005 年至 2016 年间新诊断为 2 型糖尿病的成年人中，我们研究了诊断后 1 年内，根据种族/民族，血糖降低药物起始治疗的差异。我们指定了改良泊松回归模型，以估计整个队列以及根据糖化血红蛋白、BMI、诊断时年龄、合并症和邻里剥夺指数（一个普查区层面的社会经济指标）定义的亚人群中种族/民族与药物起始之间的关联。
在 77199 名新诊断的个体中，有 47%在诊断后 12 个月内开始使用糖尿病药物。药物起始的患病率范围从中国人的 32%到其他/未知种族/民族的 58%。与白人相比，中国人（相对风险：0.78（95%置信区间 0.72，0.84））和日本人（0.82（0.75，0.90））药物起始的可能性较小，但西班牙裔/拉丁裔（1.27（1.24，1.30））、非裔美国人（1.14（1.11，1.17））、其他亚洲人（1.13（1.08，1.18））、南亚人（1.10（1.04，1.17））、其他/未知（1.31（1.24，1.39））、美洲印第安人或阿拉斯加原住民（1.11（1.04，1.18））和夏威夷原住民/太平洋岛民（1.28（1.19，1.37））药物起始的可能性更大。在糖化血红蛋白值较高的个体中，种族/民族差异消失。
在诊断后 1 年内，2 型糖尿病患者开始使用降血糖药物的治疗方式差异显著，种族/民族差异尤为明显，尤其是糖化血红蛋白值较低的患者。未来的研究应该研究患者偏好、提供者隐性偏见和共同决策如何导致这些早期治疗差异。
