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The Diabetes Educator, Vol. 34, No. 4, 655-663 (2008)
DOI: 10.1177/0145721708320903

FEATURES

Use of a Uniform Treatment Algorithm Abolishes Racial Disparities in Glycemic Control

Mary K. Rhee, MD, David C. Ziemer, MD, Jane Caudle, MLn, Paul Kolm, PhD and Lawrence S. Phillips, MD

From the Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Rhee, Dr Ziemer, Ms Caudle, Dr Phillips), and the Christiana Care Center for Outcomes Research, Newark, Deleware (Dr Kolm).

Correspondence to Mary K. Rhee, MD, Division of Endocrinology and Metabolism, Emory University School of Medicine, 49 Jesse Hill Jr Drive SE, Atlanta, GA 30303 (mrhee{at}emory.edu).

Purpose

The purpose of this study is to compare glycemic control between blacks and whites in a setting where patient and provider behavior is assessed, and where a uniform treatment algorithm is used to guide care.

Methods

This observational cohort study was conducted in 3542 patients (3324 blacks, 218 whites) with type 2 diabetes with first and 1-year follow-up visits to a municipal diabetes clinic; a subset had 2-year follow-up. Patient adherence and provider management were determined. The primary endpoint was A1c.

Results

At presentation, A1c was higher in blacks than whites (8.9% vs 8.3%; P < .001), even after adjusting for demographic and clinical characteristics. During 1 year of follow-up, patient adherence to scheduled visits and medications was comparable in both groups, and providers intensified medications with comparable frequency and amount. After 1 year, A1c differences decreased but remained significant (7.7% vs 7.3%; P = .029), even in multivariable analysis (P = .003). However, after 2 years, A1c differences were no longer observed by univariate (7.6% vs 7.5%; P = .51) or multi-variable analysis (P = .18).

Conclusions

Blacks have higher A1c than whites at presentation, but differences narrow after 1 year and disappear after 2 years of care in a setting where patient and provider behavior are comparable and that emphasizes uniform intensification of therapy. Presumably, racial disparities at presentation reflected prior inequalities in management. Use of uniform care algorithms nationwide should help to reduce disparities in diabetes outcomes.


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