Use of a uniform treatment algorithm abolishes racial disparities in glycemic control

Abstract

Purpose: The purpose of this study is to compare glycemic control between blacks and whites in a setting where patient and provider behavior is assessed, and where a uniform treatment algorithm is used to guide care.

Methods: This observational cohort study was conducted in 3542 patients (3324 blacks, 218 whites) with type 2 diabetes with first and 1-year follow-up visits to a municipal diabetes clinic; a subset had 2-year follow-up. Patient adherence and provider management were determined. The primary endpoint was A1c.

Results: At presentation, A1c was higher in blacks than whites (8.9% vs 8.3%; P < .001), even after adjusting for demographic and clinical characteristics. During 1 year of follow-up, patient adherence to scheduled visits and medications was comparable in both groups, and providers intensified medications with comparable frequency and amount. After 1 year, A1c differences decreased but remained significant (7.7% vs 7.3%; P = .029), even in multivariable analysis (P = .003). However, after 2 years, A1c differences were no longer observed by univariate (7.6% vs 7.5%; P = .51) or multi-variable analysis (P = .18).

Conclusions: Blacks have higher A1c than whites at presentation, but differences narrow after 1 year and disappear after 2 years of care in a setting where patient and provider behavior are comparable and that emphasizes uniform intensification of therapy. Presumably, racial disparities at presentation reflected prior inequalities in management. Use of uniform care algorithms nationwide should help to reduce disparities in diabetes outcomes.

Figure 1

A1c at presentation, 1-year and 2-year follow-up stratified by race. A, A1c at presentation and after 1 year of care (n = 3542). *P < .001 for A1c difference between blacks and whites; ^†P = .029 for A1c difference between blacks and whites. B, A1c at presentation, after 1 year of care, and after 2 years of care in patients who returned for 2-year follow-up visits (n = 1795). **P = .029 for A1c difference between blacks and whites.