Revisiting Disparities in Quality of Care Among US Adults With Diabetes in the Era of Individualized Care, NHANES 2007-2010.
BACKGROUND
Diabetes quality of care standards promote uniform goals and are used routinely for performance measurement and reimbursement. Diabetes health disparities have been characterized using these universal goals. However, guidelines emphasize individualized goals.


OBJECTIVE
To assess diabetes care disparities using individualized goals to (1) determine their racial/ethnic distribution and (2) compare disparities using individualized versus uniform goals.


METHODS
A nationally representative sample of non-Hispanic white, non-Hispanic black, and Hispanic adults with self-reported diabetes aged 20 years or more in the National Health and Nutrition Examination Survey, 2007-2010. Individualized glycemic goals (A1C<6.5%, <7.0%, or <8.0%) assigned based on age, duration, complications, and comorbidity, and cholesterol goals [low-density lipoprotein cholesterol (LDL) <70 or <100 mg/dL] assigned based on cardiovascular history.


RESULTS
More Hispanics were recommended an individualized A1C<7.0% compared with whites (54% vs. 42%, P=0.008). Fewer blacks and Hispanics were recommended an individualized LDL<70 mg/dL than whites (21% and 19% vs. 28%, P=0.02 and 0.001). Fewer Hispanics had adequate individualized A1C control (56% vs. 68%, P<0.001), and fewer blacks and Hispanics had adequate individualized LDL control (31% and 36% vs. 51%, P≤0.001 and P=0.004). A uniform A1C<7% goal did not reveal disparities in glycemic control; individualized A1C and LDL, blood pressure <140/90 mm Hg, and nonsmoking was achieved by few adults (18%), and fewer blacks and Hispanics than whites (6% and 11% vs. 22%, P<0.001 and P=0.005).


CONCLUSIONS
Individualized goals for diabetes care may unearth greater racial/ethnic disparities in clinical performance compared with uniform goals. Diabetes performance measures should include individualized goals to prevent worsening disparities in diabetes outcomes.
Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL.
Neda
N
Laiteerapong
Paige C
PC
Fairchild
Chia-Hung
CH
Chou
Marshall H
MH
Chin
Elbert S
ES
Huang
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001786:Blood Glucose; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood; D015897:Comorbidity; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin