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BMJ Open Diabetes Res Care. 2014 Nov 17;2(1):e000043. doi: 10.1136/bmjdrc-2014-000043. eCollection 2014.

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.

Author information

1
Division of Research , Kaiser Permanente Northern California , Oakland, California , USA.
2
Institute for Health Research, Kaiser Permanente Colorado , Denver, Colorado , USA.
3
Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA.
4
HealthPartners Institute for Education and Research , Minneapolis, Minnesota , USA.
5
Group Health Research Institute , Seattle, Washington , USA.
6
Kaiser Permanente Center for Health Research , Portland, Oregon , USA.
7
Department of Research & Evaluation , Kaiser Permanente Southern California , Pasadena, California , USA.
8
Kaiser Permanente Hawaii , Honolulu, Hawaii , USA.
9
Kaiser Permanente Georgia Center for Health Research-Southeast , Atlanta , Georgia , USA.
10
Marshfield Clinic.

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.

RESEARCH DESIGN AND 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.

KEYWORDS:

American Indian(s); Health Care Delivery

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