title: Do ethnic disparities extend to subspecialty diabetes care?
abstract: OBJECTIVE
  It is unclear if disparities described in diabetes primary care extend to subspecialty diabetes care. This retrospective observational study examined disparities in diabetes outcomes in a subspecialty practice by assessing glycemic improvement in type 2 diabetes patients during the first year of enrollment.
  
  
  METHODS
  Electronic data were gathered on 3,945 subjects. The outcome was the proportion of white and minority (Asian, black, and Hispanic) subjects achieving a hemoglobin A1C (A1C) level of ≤7% after the first year of care. Logistic regression was used to identify factors associated with odds of achieving A1C ≤7%.
  
  
  RESULTS
  Minority patients had greater diabetes duration, more social disadvantages and missed appointments, and worse control at presentation than whites. The proportion of patients reaching target A1C rose from 37 to 52% among white patients and from 28 to 40% among minority patients. Significant differences between whites and minorities in the rates of patients reaching A1C ≤7% were found only among those with higher initial A1C (iA1C) levels (32% vs. 20.9%; P = .002 in third iA1C quartile, and 28.2% vs. 17.9%; P = .0003 in fourth iA1C quartile). The interaction between race/ethnicity and the top two iA1C quartiles remained significant in the fully adjusted model.
  
  
  CONCLUSIONS
  Reaching an A1C level of ≤7% depends strongly upon the glycemic level at initial presentation to specialty care, not race. However, minority patients with the highest baseline A1C levels do not improve to the same degree as white patients, and therefore should be targeted for more intensive diabetes care management.
authors: Division of Adult Diabetes, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215, USA. Eyiuche.okeke@joslin.harvard.edu
authors: Eyiuche N
authors: EN
authors: Okeke
authors: Hillary A
authors: HA
authors: Keenan
authors: Katie
authors: K
authors: Weinger
authors: Martin J
authors: MJ
authors: Abrahamson
authors: William C
authors: WC
authors: Hsu
mesh_terms: D001741:Black or African American; D044466:Asian People; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin