Comparison of laboratory test frequency and test results between African-Americans and Caucasians with diabetes: opportunity for improvement. Findings from a large urban health maintenance organization.
OBJECTIVE
To compare African-American and Caucasian patients with preexisting diabetes in a health maintenance organization (HMO) on: 1) frequency with which they received a subset of recommended laboratory tests according to the American Diabetes Association (ADA) consensus guidelines and 2) the results of laboratory test values (glycosylated hemoglobin, cholesterol, and creatinine).


METHODS
A cross-sectional study of 2,312 HMO members with diabetes continuously enrolled during 1991 was conducted using computerized medical record and billing data. Receipt of the ADA recommended tests for glycosylated hemoglobin, cholesterol, and creatinine was compared between African-Americans and Caucasians, stratified by insulin requirements. In addition, group comparisons were made based on the laboratory test results.


RESULTS
Less than 20 percent of all subjects received the recommended number of ADA tests. This did not differ by race except for creatinine and cholesterol testing in insulin users only, where African-Americans had more tests. On average, after adjusting for covariates, African-Americans had significantly higher glycosylated hemoglobin and creatinine laboratory values. Both groups had elevated cholesterol values.


CONCLUSIONS
The opportunity exists to improve the process of care for both African-Americans and Caucasians with diabetes in an HMO setting. The need to improve glycosylated hemoglobin results and subsequently limit complications is especially pressing among the African-American population.
Wisdom
K
K
Henry Ford Health System, Henry Ford Health Sciences Center, Center for Medical Treatment Effectiveness Programs, Detroit, MI 48202, USA. kwisdom1@biostat.hfh.edu
Fryzek
J P
JP
Havstad
S L
SL
Anderson
R M
RM
Dreiling
M C
MC
Tilley
B C
BC
D001741:Black or African American; D001774:Blood Chemical Analysis / Q000706:statistics & numerical data*; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006279:Health Maintenance Organizations / Q000592:standards*; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D015146:Midwestern United States; D012959:Socioeconomic Factors; D014505:Urban Population; D044465:White People
D002784:Cholesterol; D003404:Creatinine; D006442:Glycated Hemoglobin