title: Primary language, income and the intensification of anti-glycemic medications in managed care: the (TRIAD) study.
abstract: BACKGROUND
  Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity.
  
  
  OBJECTIVE
  To examine the associations between primary language, income, and medication intensification.
  
  
  METHODS
  Cohort study with 18-month follow-up.
  
  
  METHODS
  One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care.
  
  
  METHODS
  Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c ≥ 8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan.
  
  
  RESULTS
  Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes <$15,000, patients with incomes of $15,000-$39,999 (OR 1.43, 1.07-1.92), $40,000-$74,999 (OR 1.62, 1.16-2.26) or >$75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race.
  
  
  CONCLUSIONS
  Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care.
authors.affiliation: Division of General Internal Medicine/Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA. kduru@mednet.ucla.edu
authors.forename: O Kenrik
authors.initials: OK
authors.lastname: Duru
authors.forename: Dori
authors.initials: D
authors.lastname: Bilik
authors.forename: Laura N
authors.initials: LN
authors.lastname: McEwen
authors.forename: Arleen F
authors.initials: AF
authors.lastname: Brown
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: J David
authors.initials: JD
authors.lastname: Curb
authors.forename: David G
authors.initials: DG
authors.lastname: Marrero
authors.forename: Shou-En
authors.initials: SE
authors.lastname: Lu
authors.forename: Michael
authors.initials: M
authors.lastname: Rodriguez
authors.forename: Carol M
authors.initials: CM
authors.lastname: Mangione
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D015331:Cohort Studies; D003144:Communication Barriers; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics* / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000494:pharmacology / Q000627:therapeutic use; D007182:Income; D007802:Language; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000592:standards; D008875:Middle Aged; D011446:Prospective Studies; D012959:Socioeconomic Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents