title: Racial ethnic differences in type 2 diabetes treatment patterns and glycaemic control in the Boston Area Community Health Survey.
abstract: OBJECTIVE
  Numerous studies continue to report poorer glycaemic control, and a higher incidence of diabetes-related complications among African-Americans and Hispanic-Americans as compared with non-Hispanic Caucasians with type 2 diabetes. We examined racial/ethnic differences in receipt of hypoglycaemic medications and glycaemic control in a highly insured Massachusetts community sample of individuals with type 2 diabetes.
  
  
  METHODS
  Community-based sample from Boston, Massachusetts, USA.
  
  
  METHODS
  682 patients with physician-diagnosed diabetes from the third wave of the Boston Area Community Health Survey (2010-2012). The study included approximately equal proportions of African-Americans, Hispanics and Caucasians.
  
  
  METHODS
  We examined racial/ethnic disparities in diabetes treatment by comparing proportions of individuals on mutually exclusive diabetes treatment regimens across racial/ethnic subgroups. Using multivariable linear and logistic regression, we also examined associations between race/ethnicity and glycaemic control in the overall population, and within treatment regimens, adjusting for age, gender, income, education, health insurance, health literacy, disease duration, diet and physical activity.
  
  
  RESULTS
  Among those treated (82%), the most commonly prescribed antidiabetic regimens were biguanides only (31%), insulin only (23%), and biguanides and insulin (16%). No overall racial/ethnic differences in treatment or glycaemic control (per cent difference for African-Americans: 6.18, 95% CI -1.00 to 13.88; for Hispanic-Americans: 1.01, 95% CI -10.42 to 12.75) were observed. Within regimens, we did not observe poorer glycaemic control for African-Americans prescribed biguanides only, insulin only or biguanides combined with insulin/sulfonylureas. However, African-Americans prescribed miscellaneous regimens had higher risk of poorer glycaemic control (per cent difference=23.37, 95% CI 7.25 to 43.33). There were no associations between glycaemic levels and Hispanic ethnicity overall, or within treatment regimens.
  
  
  CONCLUSIONS
  Findings suggest a lack of racial/ethnic disparities in diabetes treatment patterns and glycaemic control in this highly insured Massachusetts study population. Future studies are needed to understand impacts of increasing insurance coverage on racial/ethnic disparities in treatment patterns and related outcomes.
authors.affiliation: New England Research Institutes, Watertown, Massachusetts, USA.
authors.forename: Sunali D
authors.initials: SD
authors.lastname: Goonesekera
authors.affiliation: New England Research Institutes, Watertown, Massachusetts, USA.
authors.forename: May H
authors.initials: MH
authors.lastname: Yang
authors.affiliation: New England Research Institutes, Watertown, Massachusetts, USA.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Hall
authors.affiliation: New England Research Institutes, Watertown, Massachusetts, USA.
authors.forename: Shona C
authors.initials: SC
authors.lastname: Fang
authors.affiliation: New England Research Institutes, Watertown, Massachusetts, USA.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Piccolo
authors.affiliation: New England Research Institutes, Watertown, Massachusetts, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: McKinlay
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001645:Biguanides / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism*; D001900:Boston; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007182:Income; D007328:Insulin / Q000627:therapeutic use; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D044465:White People
chemical_list: D001645:Biguanides; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: EPIDEMIOLOGY; PRIMARY CARE