title: Diabetes care and outcomes for American Indians and Alaska natives in commercial integrated delivery systems: a SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) Study.
abstract: OBJECTIVE
  To compare cardiovascular disease risk factor testing rates and intermediate outcomes of care between American Indian/Alaska Native (AI/AN) patients with diabetes and non-Hispanic Caucasians enrolled in nine commercial integrated delivery systems in the USA.
  
  
  METHODS
  We used modified Poisson regression models to compare the annual testing rates and risk factor control levels for glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP); number of unique diabetes drug classes; insulin use; and oral diabetes drug medication adherence between insured AI/AN and non-Hispanic white adults with diabetes aged ≥18 in 2011.
  
  
  RESULTS
  5831 AI/AN patients (1.8% of the cohort) met inclusion criteria. After adjusting for age, gender, comorbidities, insulin use, and geocoded socioeconomic status, AI/AN patients had similar rates of annual HbA1c, LDL-C, and SBP testing, and LDL-C and SBP control, compared with non-Hispanic Caucasians. However, AI/AN patients were significantly more likely to have HbA1c >9% (>74.9 mmol/mol; RR=1.47, 95% CI 1.38 to 1.58), and significantly less likely to adhere to their oral diabetes medications (RR=0.90, 95% CI 0.88 to 0.93) compared with non-Hispanic Caucasians.
  
  
  CONCLUSIONS
  AI/AN patients in commercial integrated delivery systems have similar blood pressure and cholesterol testing and control, but significantly lower rates of HbA1c control and diabetes medication adherence, compared with non-Hispanic Caucasians. As more AI/ANs move to urban and suburban settings, clinicians and health plans should focus on addressing disparities in diabetes care and outcomes in this population.
authors.affiliation: Division of Research , Kaiser Permanente Northern California , Oakland, California , USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado , Denver, Colorado , USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.affiliation: Division of Research , Kaiser Permanente Northern California , Oakland, California , USA.
authors.forename: Alyce S
authors.initials: AS
authors.lastname: Adams
authors.affiliation: Division of Research , Kaiser Permanente Northern California , Oakland, California , USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Dyer
authors.affiliation: Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA.
authors.forename: Janette
authors.initials: J
authors.lastname: Beals
authors.affiliation: Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA.
authors.forename: William G
authors.initials: WG
authors.lastname: Henderson
authors.affiliation: HealthPartners Institute for Education and Research , Minneapolis, Minnesota , USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Desai
authors.affiliation: Group Health Research Institute , Seattle, Washington , USA.
authors.forename: Leo S
authors.initials: LS
authors.lastname: Morales
authors.affiliation: Kaiser Permanente Center for Health Research , Portland, Oregon , USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.affiliation: Department of Research & Evaluation , Kaiser Permanente Southern California , Pasadena, California , USA.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
authors.affiliation: Kaiser Permanente Hawaii , Honolulu, Hawaii , USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Waitzfelder
authors.affiliation: Kaiser Permanente Georgia Center for Health Research-Southeast , Atlanta , Georgia , USA.
authors.forename: Melissa G
authors.initials: MG
authors.lastname: Butler
authors.affiliation: Marshfield Clinic.
authors.forename: Ram D
authors.initials: RD
authors.lastname: Pathak
authors.affiliation: Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Hamman
authors.affiliation: Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA.
authors.forename: Spero M
authors.initials: SM
authors.lastname: Manson
keywords: American Indian(s); Health Care Delivery