OBJECTIVES : To examine disparities in the quality of diabetes care over the past 18 years among US adults with diabetes

METHODS

: Individuals with diabetes aged 20 years or older from NHANES (1999 – 2016) were included in the study. Quality indicators for diabetes care included Hemoglobin A1c (HbA1c) < 8%, Blood Pressure (BP) < 130/80 mm Hg, Low-Density Lipoprotein (LDL-C) < 100 mg/dL, triglycerides < 150 mg/dL, receiving eye and foot examinations in the past year, and meeting with a diabetes educator in the past year.

RESULTS

: A total of 7,521 adults with diabetes were identified. Adjusted regression analyses showed that compared with their White counterparts, Blacks were more likely to have received eye (OR=1.372; P=0.0138) and foot (OR=1.419;P=0.0138) examinations and met a diabetes educator (OR=1.399;P=0.0036) over the past year. However, Blacks were significantly less likely to achieve treatment goals for HbA1c (OR=0.774, P=0.0174), BP (OR=0.754, P=0.0024), LDL-C (OR=0.677, P=0.008). Hispanics in general had suboptimal healthcare utilization for diabetes but the Hispanic-White gaps in diabetes care outcomes were reduced after controlling for patient sociodemographic, clinical and utilization characteristics. Adults with college education were more likely to achieve diabetes treatment goals for HbA1c (OR=1.415;P=0.0346), LDL-C (OR=1.432,P=0.0211), and triglycerides (OR=1.580,P=0.0289) compared with those of lower educational status. The likelihood of receiving foot examination (OR=0.529;P=0.0002), eye examination (OR=0.805,P=0.0002) and meeting the recommended goal for HbA1c (OR=0.567,P<0.0001), BP (OR=0.805,P=0.03), LDL-C (OR=0.780,P=0.0417), and triglycerides (OR=0.736,P=0.021) were lower among uninsured adults.

CONCLUSIONS

: In the United States, despite persistent efforts, racial disparities in quality of diabetes care still persist. Lack of health insurance and lower socioeconomic status are among the strongest predictors of poor quality of diabetes care. The reasons for disparities are complex; further research is needed to better understand the mechanism underlying these disparities.