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Racial Differences in Long-Term Self-Monitoring Practice Among Newly Drug-Treated Diabetes Patients in an HMO

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One approach to improving outcomes for minority diabetics may be through better self-care. However, minority patients may encounter barriers to better self-care even within settings where variations in quality of care and insurance are minimized.


The objective of the study was to evaluate racial differences in long-term glucose self-monitoring and adherence rates in an HMO using evidence-based guidelines for self-monitoring.


Retrospective cohort study using 10 years (1/1/1993–12/31/2002) of electronic medical record data was used.


Patients were 1,732 insured adult diabetics of black or white race newly initiated on hypoglycemic therapy in a large multi-specialty care group practice.


Outcomes include incidence and prevalence of glucose self-monitoring, intensity of use, and rate of adherence to national recommended standards.


We found no evidence of racial differences in adjusted initiation rates of glucose self-monitoring among insulin-treated patients, but found lower rates of initiation among black patients living in low-income areas. Intensity of glucose self-monitoring remained lower among blacks than whites throughout follow-up [IRR for insulin = 0.41 (0.27–0.62); IRR for oral hypoglycemic = 0.75 (0.63, 0.90)], with both groups monitoring well below recommended standards. Among insulin-treated patients, <1% of blacks and <10% of whites were self-monitoring 3 times per day; 36% of whites and 10% of blacks were self-monitoring at least once per day.


Adherence to glucose self-monitoring standards was low, particularly among blacks, and racial differences in self-monitoring persisted within a health system providing equal access to services for diabetes patients. Early and continued emphasis on adherence among black diabetics may be necessary to reduce racial differences in long-term glucose self-monitoring.

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The authors wish to thank Dr. Richard Grant of the General Medicine Unit, Department of Medicine, Massachusetts General Hospital, and Harvard Medical School for his thoughtful comments on the analyses and Ms. Irina Miroshnik of the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care for her assistance in data extraction. The authors also wish to thank the reviewers for their insightful comments and suggestions made on an earlier submission of this paper. An abstract of this work was presented at the SGIM 29th Annual Meeting on April 29, 2006, Los Angeles, CA, and on May 2, 2006 at the HMO Research Network Annual Meeting, Cambridge, MA. This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and by the Harvard Pilgrim Health Care Foundation. Dr. Meigs is supported by an American Diabetes Association Career Development Award. Dr. Piette is a VA Career scientist and supported by the Michigan Diabetes Research and Training Center.

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Correspondence to Connie Mah Trinacty PhD.

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Trinacty, C.M., Adams, A.S., Soumerai, S.B. et al. Racial Differences in Long-Term Self-Monitoring Practice Among Newly Drug-Treated Diabetes Patients in an HMO. J GEN INTERN MED 22, 1506–1513 (2007).

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