Racial differences in long-term self-monitoring practice among newly drug-treated diabetes patients in an HMO.
BACKGROUND
One approach to improving outcomes for minority diabetics may be through better self-care. However, minority patients may encounter barriers to better self-care even within settings where variations in quality of care and insurance are minimized.


OBJECTIVE
The objective of the study was to evaluate racial differences in long-term glucose self-monitoring and adherence rates in an HMO using evidence-based guidelines for self-monitoring.


METHODS
Retrospective cohort study using 10 years (1/1/1993-12/31/2002) of electronic medical record data was used.


METHODS
Patients were 1,732 insured adult diabetics of black or white race newly initiated on hypoglycemic therapy in a large multi-specialty care group practice.


METHODS
Outcomes include incidence and prevalence of glucose self-monitoring, intensity of use, and rate of adherence to national recommended standards.


RESULTS
We found no evidence of racial differences in adjusted initiation rates of glucose self-monitoring among insulin-treated patients, but found lower rates of initiation among black patients living in low-income areas. Intensity of glucose self-monitoring remained lower among blacks than whites throughout follow-up [IRR for insulin = 0.41 (0.27-0.62); IRR for oral hypoglycemic = 0.75 (0.63, 0.90)], with both groups monitoring well below recommended standards. Among insulin-treated patients, <1% of blacks and <10% of whites were self-monitoring 3 times per day; 36% of whites and 10% of blacks were self-monitoring at least once per day.


CONCLUSIONS
Adherence to glucose self-monitoring standards was low, particularly among blacks, and racial differences in self-monitoring persisted within a health system providing equal access to services for diabetes patients. Early and continued emphasis on adherence among black diabetics may be necessary to reduce racial differences in long-term glucose self-monitoring.
Trinacty
Connie Mah
CM
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA. connie_trinacty@hphc.org
Adams
Alyce S
AS
Soumerai
Stephen B
SB
Zhang
Fang
F
Meigs
James B
JB
Piette
John D
JD
Ross-Degnan
Dennis
D
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000208:ethnology*; D044465:White People / Q000706:statistics & numerical data*
D007004:Hypoglycemic Agents; D007328:Insulin