Racial disparities in hyperglycemia worsening for adults with diabetes in US
Click Here to Manage Email Alerts
The proportion of adults with diabetes in the U.S. achieving glycemic control was similar in 2013 to 2020 compared with 1988 to 1994, but racial-ethnic disparities worsened during that time, according to study data.
“Despite advancements in insulin formulations and diabetes management strategies over the last 30 years, glycemic control has not improved among U.S. adults,” Siddharth Venkatraman, BS, a medical student at Johns Hopkins University School of Medicine, told Healio. “In fact, we saw disparities in diabetes control by race, socioeconomic status and insurance status increase over this period. Particularly vulnerable groups included Mexican Americans and uninsured adults.”
Venkatraman and colleagues conducted a cross-sectional study analyzing data from the National Health and Nutrition Examination Survey III from 1988 to 1994 and the continuous NHANES from 1999 to 2020. Adults aged 20 years and older who were diagnosed with diabetes, not pregnant and treated with insulin were included. HbA1c was collected for each participant. Glycemic control was defined as an HbA1c of less than 7% and severe hyperglycemia as an HbA1c of more than 10%. Age, sex, race and ethnicity, health insurance status, health care utilization, age at diabetes diagnosis and family income were self-reported. Researchers compared four difference NHANES cycles to analyze HbA1c trends: 1989 to 1994, 1999 to 2004, 2005 to 2012 and 2013 to 2020.
The findings were published in JAMA Network Open.
Fewer Mexican Americans achieving glycemic control
The study included 2,482 adults with diabetes (mean age, 59.8 years; 51.3% men; 65.2% white, 17.9% Black, 7% Mexican American). The percentage of adults with diabetes did not change from 1988 to 1994 to 2013 to 2020, but mean diabetes duration increased from 12.9 years in 1988 to 1994 to 17.8 years in 2013 to 2020 (P < .001).
No change was observed in the proportion of adults achieving glycemic control or with severe hyperglycemia from 1988 to 1994 to 2013 to 2020. However, the proportion of Mexican American adults achieving glycemic control declined from 25.1% in 1988 to 1994 to 9.9% in 2013 to 2020 (P = .004). Additionally, in 2013 to 2020, 23.9% of Mexican American adults with diabetes and 22.7% of Black adults with diabetes had severe hyperglycemia compared with 9.1% of non-Hispanic white adults. Adults with a lower family income-to-poverty ratio and those without health insurance had a higher prevalence of severe hyperglycemia than those with a higher family income-to-poverty ratio and adults with health insurance, respectively.
“There are racial and ethnic disparities and profound socioeconomic disparities in diabetes control among people using insulin,” Elizabeth Selvin, PhD, MPH, professor at the Johns Hopkins Bloomberg School of Public Health, told Healio. “Improving health insurance coverage and access to care is essential to improving the lives of individuals living with diabetes.”
Strategies for reducing disparities
After adjusting for age, sex, race and ethnicity, education and income, Mexican American adults were less likely to achieve glycemic control compared with white adults (adjusted OR = 0.45; 95% CI, 0.3-0.68). Black adults (aOR = 2.48; 95% CI, 1.71-3.61) and Mexican American adults (aOR = 2.29; 95% CI, 1.32-3.98) were more likely to have severe hyperglycemia than white adults. Adults aged 65 years or older were more likely to achieve glycemic control (aOR = 1.71; 95% CI, 1.09-2.67) and less like to have severe hyperglycemia (aOR = 0.2; 95% CI, 0.12-0.32) than adults younger than 65 years.
“Reducing these disparities in glycemic control will likely require patient-level and policy-level interventions,” Venkatraman said. “At the patient level, culturally tailored patient education and timely initiation and intensification of insulin therapy may improve health care literacy and adherence among these populations. At the public policy level, we suggest improving access and addressing financial barriers to insulin therapy and insulin delivery devices for Americans.”
For more information:
Elizabeth Selvin, PhD, MPH, can be reached at eselvin@jhu.edu
Siddharth Venkatraman, BS, can be reached at svenka21@jhmi.edu
Collapse
Read more about
Click Here to Manage Email Alerts