Race differences in long-term diabetes management in an HMO
Race differences in long-term diabetes management in an HMO
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DOI：
10.2337/diacare.28.12.2844
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发表时间：
2005-12-01
期刊：
影响因子：
16.2
通讯作者：
Ross-Degnan, D
中科院分区：
文献类型：
--
作者：
Adams, AS;Zhang, F;Ross-Degnan, D
研究设计与方法：我们确定了连续入选(1992-2001年)的成年黑人和白人糖尿病患者，其中1)在1994年前诊断为糖尿病(n=1,686)，2)在1994-1997年新诊断(n=1,280)。我们使用分层模型来评估种族对控制基线A1C BMI和年龄的年均HBA(1C)(A1C)的影响，以及对糖尿病药物类型、糖尿病相关住院、A1C测试时间和次数、医生就诊和非糖尿病药物的年度测量的影响。结果：在基线时，黑人和白人患者的A1C测试率和就诊率相似，但黑人的未调整A1C值更高。在多变量模型中，在既往诊断为糖尿病的患者中，黑人的平均A1C比白人男性高0.11(95%CI-0.12~0.34)，但黑人比白人女性高0.30(0.14~0.46；P=0.0007)。在新诊断的糖尿病患者中，调整后的黑白差距男性为0.49(0.17-0.80；P=0.007)，女性为0.05(-0.20--0.31)，这是积极的，但没有显著意义。结论-在这种情况下，除护理质量之外的其他因素可能是A1C持续存在种族差异的原因。未来的干预措施应该以糖化血红蛋白正常化为目标，确定潜在的心理社会障碍，加强患者和临床医生的治疗，并开发文化上适当的干预措施，帮助患者成功地进行自我管理。
OBJECTIVE- We examined race differences in diabetes outcomes over 4-8 years in a single HMO.RESEARCH DESIGN AND METHODS - We identified black and white adult diabetic patients who were continuously enrolled (1992-2001) and in whom diabetes was 1) diagnose before 1994 (n = 1,686) or 2) newly diagnosed in 1994-1997 (n = 1,280). We used hierarchical models to estimate the effect of race on average annual HbA(1C) (A1C) controlling for baseline A1C BMI, and age, as well as annual measures of type of diabetes medications, diabetes-relate hospitalization, time and the number of A1C tests, physician visits, and nondiabetes medications. Stratifying by sex accounted for significant interactions between sex and race.RESULTS - At baseline, black and white patients had similar rates of A1C testing and physician visits, but blacks had higher unadjusted A1C values. In multivariate models, among patients with previously diagnosed diabetes, average A1C was nonsignificantly 0.11 higher (95% CI -0.12 to 0.34) in black than in white men but was 0.30 higher (0.14-0.46; P = 0.0007) in black than in white women. Among patients with newly diagnosed diabetes, the adjusted black-white gap was 0.49 among men (0.17-0.80; P = 0.007) and was 0.05 among women (-0.20 to -0.31), which was positive but not significant.CONCLUSIONS - Factors other than the quality of care may explain persistent race differences in A1C in this setting. Future interventions should target normalization of A1C by identifying potential psychosocial barriers to therapy intensification among patients and clinicians and development of culturally appropriate interventions to aid patients in successful self-management.