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Mexican Americans with diabetes less likely to be on medication
Improvement is needed in the quality of antidiabetes therapies for Mexican American patients and white patients with the most uncontrolled type 2 diabetes, according to recent findings.
In the secondary data analysis of the National Health and Nutrition Examination Survey (NHANES), Alexandra Perez, PharmD, MS, of Nova Southeastern University College of Pharmacy in Florida, and colleagues evaluated patients diagnosed with diabetes at age 20 years or older, who reported being white or Mexican American and whose type 2 diabetes was uncontrolled. The researchers defined uncontrolled diabetes as HbA1c 6.5% or more at the time of evaluation.
The study’s main outcome was defined as following a recommended or non-recommended antidiabetes regimen based on clinical guidelines.
Alexandra Perez
A secondary study outcome classified the regimens as either “preferred therapies,” “less preferred therapies” or “non-recommended therapies.” For this outcome, the researchers subclassified the main outcome “recommended” category as “preferred” and “less preferred” using safety and efficacy data from the 2013 American Association of Clinical Endocrinologists algorithm as a reference.
The researchers found that while there were no disparities in the use of recommended treatments across race/ethnicity (Mexican Americans, 63.6% vs. whites, 65.7%), Mexican Americans had a lower likelihood of treatment intensification to non-insulin triple therapies (Mexican Americans, 7.3% vs. whites, 11.3%) or insulin-based regimens (Mexican Americans, 23.7% vs. whites, 30.5%). Mexican Americans also had a higher likelihood of not being on medication at all (17.2%) compared with whites (10.4%). Among both Mexican Americans and whites, those whose diabetes was most uncontrolled were least likely to be on recommended treatments.
Eighty-three percent of patients with HbA1c ranging from 6.5% to 7.4% were on recommended treatments whereas 60.6% of those with HbA1c from 7.5% to 9% were and 50.4% of those with HbA1c greater than 9% were. This trend was most pronounced in Mexican Americans compared with whites. The decline in recommended therapy use between patients with the most controlled HbA1c and least controlled HbA1c was 50.5% in Mexican Americans and 20.1% in whites.
“These results inform health care providers about the need of frequent antidiabetic pharmacotherapy reassessment and intensification to achieve glycemic control among Mexican Americans and whites with the lowest glycemic control,” the researchers wrote. “Adherence to evidence-based antidiabetic regimen recommendations will help improve the current morbidity and mortality and help reduce the economic burden of type 2 diabetes in the United States. Measures such as the ones used in this study can be helpful in monitoring the quality of diabetes pharmacotherapy in the future.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.