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Revisiting Disparities in Quality of Care Among US Adults With Diabetes in the Era of Individualized Care, NHANES 2007–2010

Laiteerapong, Neda, MD, MS; Fairchild, Paige C., MPH; Chou, Chia-Hung, PhD; Chin, Marshall H., MD, MPH; Huang, Elbert S., MD, MPH

doi: 10.1097/MLR.0000000000000255
Original Articles

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.

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

Research Design, Subjects, and Measures: 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

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N.L.: supported by NIDDK K23 DK097283. M.H.C.: supported by NIDDK K24 DK071933. N.L., P.C.F., C.-H.C., M.H.C., and E.S.H.: members of the NIDDK Chicago Center for Diabetes Translation Research at the University of Chicago (P30 DK092949).

The authors declare no conflict of interest.

Reprints: Neda Laiteerapong, MD, MS, Section of General Internal Medicine, Department of Medicine, University of Chicago, 5421S Maryland Avenue, MC 2007, Chicago, IL 60637. E-mail:

© 2015 by Lippincott Williams & Wilkins.