title: Minority status and diabetes screening in an ambulatory population.
abstract: OBJECTIVE
  Ethnicity has been identified as a risk factor not only for having type 2 diabetes but for increased morbidity and mortality with the disease. Current American Diabetes Association (ADA) guidelines advocate screening high-risk minorities for diabetes. This study investigates the effect of minority status on diabetes screening practices in an ambulatory, insured population presenting for yearly health care.
  
  
  METHODS
  This is a retrospective population-based study of patients in a large, Midwestern, academic group practice. Included patients were insured, had ≥1 primary care visit yearly from 2003 to 2007, and did not have diabetes but met ADA criteria for screening. Odds ratios (ORs), 95% confidence intervals (CI), and predicted probabilities were calculated to determine the relationship between screening with fasting glucose, glucose tolerance test, or hemoglobin A(1c) and patient and visit characteristics.
  
  
  RESULTS
  Of the 15,557 eligible patients, 607 (4%) were of high-risk ethnicity, 61% were female, and 86% were ≥45 years of age. Of the eight high-risk factors studied, after adjustment, ethnicity was the only factor not associated with higher diabetes screening (OR = 0.90 [95% CI 0.76-1.08]) despite more primary care visits in this group. In overweight patients <45 years, where screening eligibility is based on having an additional risk factor, high-risk ethnicity (OR 1.01 [0.70-1.44]) was not associated with increased screening frequency.
  
  
  CONCLUSIONS
  In an insured population presenting for routine care, high-risk minority status did not independently lead to diabetes screening as recommended by ADA guidelines. Factors other than insurance or access to care appear to affect minority-preventive care.
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. asr@medicine.wisc.edu
authors.forename: Ann
authors.initials: A
authors.lastname: Sheehy
authors.forename: Nancy
authors.initials: N
authors.lastname: Pandhi
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Coursin
authors.forename: Grace E
authors.initials: GE
authors.lastname: Flood
authors.forename: Sally A
authors.initials: SA
authors.lastname: Kraft
authors.forename: Heather M
authors.initials: HM
authors.lastname: Johnson
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D008913:Minority Groups; D050177:Overweight / Q000175:diagnosis; D012307:Risk Factors; D014922:Wisconsin / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human