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Racial and Ethnic Differences in Medication Initiation Among Adults Newly Diagnosed with Type 2 Diabetes

Abstract

Objective

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.

Methods

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).

Results

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.

Conclusions

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.

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Data Availability

The data generated and/or analyzed during the current study are not publicly available due to institutional policies but are available from the corresponding author on reasonable request and with the appropriate IRB approvals.

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Funding

The study was funded by the National Institute of Minority Health and Health Disparities (R01MD013420), the National Institute of Diabetes and Digestive and Kidney Diseases (K23DK116968, P30DK092924, P30DK092949), and the National Institute on Aging (R01AG063391). The funders had no role in the study’s design and conduct, the completed analysis, the interpretation of the data, or the content and preparation of the manuscript.

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All the listed authors have met the requirements for authorship. A.G. and A.N.W. oversaw the study design, data analysis, result interpretation, and manuscript preparation. A.J.K. and N.L. contributed to the study design, result interpretation, and review/editing of the manuscript. A.G. is the guarantor of this manuscript.

Corresponding author

Correspondence to Anjali Gopalan MD, MS.

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This work was approved by the Kaiser Permanente Northern California Institutional Review Board.

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Anjali Gopalan and Aaron N Winn are co-first authors.

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Gopalan, A., Winn, A.N., Karter, A.J. et al. Racial and Ethnic Differences in Medication Initiation Among Adults Newly Diagnosed with Type 2 Diabetes. J GEN INTERN MED (2022). https://doi.org/10.1007/s11606-022-07746-4

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