Ethnic Disparities in Treatment and Glycemic Control Among United States Adults with Type 2 Diabetes, 1988-1994 to 1999-2004.

Ethnic differences in the diagnosis, treatment, and control of type 2 diabetes (T2D) may help to explain variations in diabetes-related complications and death. We updated previous analyses investigating changes in prevalence, treatment, and glycemic control among different ethnicities from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and NHANES 1999-2004 among adults with T2D. This population based, cross-sectional study identified subjects with T2D, defined as current use of insulin or oral antidiabetic agents, or a physician diagnosis ≥30 years of age. The proportion of patients being treated, defined as insulin or oral antidiabetic use, as well as those with glycemic control (A1C <7%), were compared according to ethnicity: non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, non-Mexican Hispanics, and "Other". Multiple logistic regression examined prevalence, treatment, and glycemic control rates among the ethnicities in each survey and the trends from 1988-1994 to 1999-2004. The prevalence of T2D increased from 5.9% to 7% (p<0.01), largely due to the increase in prevalence among non-Mexican Hispanics (3.2% to 6.5%, p=0.06) and Other (2.6% to 7.2%, p=0.05). Compared to non-Hispanic Whites, non-Hispanic Blacks (OR=1.58, 95% CI=1.00-2.51) and Mexican Americans (OR 1.47, 95% CI 0.98-2.19) were more likely to be receiving pharmacologic treatment for diabetes during 1988-1994, but the odds of treatment were similar across all ethnicities during 1999-2004. The overall population with glycemic control increased from 44.4% to 50.1%. Among treated patients, ethnicity was not a significant predictor of glycemic control in either 1988-1994 or 1999-2004. Examination of NHANES 1999-2004 data indicates improvements in control rates. However, approximately half of patients with T2D do not achieve glycemic control. Further public health efforts should focus on continuing the positive trend in glycemic treatment and control rates and the elimination of ethnic disparities in diabetes care. [ABSTRACT FROM AUTHOR]