OBJECTIVES: To examine racial and ethnic differences in antidiabetic drug use and glycemic control among US adults with diabetes in recent years, and to investigate factors attributing to these differences.

METHODS: Repeated cross-sectional study of individuals (≥20 years old) with diabetes, using the National Health and Nutrition Examination Survey from 2003 to 2014. The outcomes were utilization of diabetes medications (overall and class-specific) and glycemic control (HbA1c<7%). SAS Survey Procedures were applied for all data analyses with appropriate weights accounting for differential probabilities of selection and the complex multistage sample survey design.

RESULTS: Among 5190 survey participants with diabetes, significant differences in sociodemographic and clinical characteristics and health care utilization were found among the three racial groups (Whites, Blacks and Hispanics). The overall rates of utilizing any diabetes medications and glycemic control were 63.2% (95% CI: 61.4%-65.0%) and 59.9% (95% CI: 57.8%-61.9%), respectively. Compared to White counterparts, Blacks were more likely to utilize any diabetes medication (Odds Ration (OR)=1.68, P<0.01) and fixed-dose combinations (OR=1.89, P<0.01), and less likely to utilize biguanides (OR=0.67, P<0.05), thiazolidinediones (OR=0.73, P<0.001), and dipeptidyl peptidase-4 inhibitors (OR=0.55, p<0.05); while Hispanics were more likely to utilize fixed-dose combinations (OR=2.00, P<0.05) and less likely to utilize dipeptidyl peptidase-4 inhibitors (OR=0.52, P<0.05) than Whites. Blacks and Hispanics were also less likely to achieve glycemic control than their White counterparts. Factors affecting the likelihood of utilizing different classes of diabetes medications and glycemic control include age, gender, race, insurance status, education, poverty-to-income ratio, smoking status, body mass index, and related comorbidities.

CONCLUSIONS: Black and Hispanic patients had poorer glycemic control compared with Whites. Black patients received more intense antidiabetic therapy. Further research is needed to identify tailored treatment strategies based on patient racial and ethnic background to achieve optimal outcomes in diabetes care.