2382-PUB: Socioeconomic Disparities in the Management of Glycemic Control among Adults with Type 2 Diabetes in the United States

Abstract

Optimal management of glycemic control is important to delay and prevent the onset of long-term complications in patients with type 2 diabetes (T2D). While health disparities in diabetes burden and complications are well-documented, limited data exist on socioeconomic status (SES) as a determinant of glycemic control. We conducted a study linking the National Health and Wellness Survey (NHWS), a nationally-representative, self-administered annual internet survey of about 75,000 adults (≥18), and two electronic health record (EHR) systems: Veradigm, which contains data for 46+ million unique patients, and Healthverity, a nationally-representative database with 60+ million unique patients. The study population consisted of T2D adults who responded to the NHWS between 2015-2018 and had clinical measurements in the EHR database for at least 6 months from NHWS response (i.e., at least 6 months of follow-up). Glycemic control was treated as a binary variable (HbA1c <7% or ≥7%) and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated adjusting for age and gender. Of 2,380 total T2D patients [mean age = 61.5 (standard deviation = 12.0), 54% males, 85% White, 32% employed, 84% living in an urban area], 501 (21%) had at least one HbA1c test taken within 6 months of NHWS participation. Of these 501 patients, 197 (39%) had uncontrolled HbA1c (≥7%). Black/African American patients were significantly more likely to have uncontrolled HbA1c compared with White patients (OR = 2.0; 95% CI: 1.02, 3.92; p = 0.04). Further, Medicaid and uninsured patients were significantly more likely to have uncontrolled HbA1c compared to those with commercial health insurance (OR = 2.81; 95% CI: 1.46, 5.4; p < 0.005). There were no differences by geographic regions. The observed associations of glycemic control with race and health insurance may possibly be related to disparity in diabetes management. Future studies are needed further investigating the role of SES in diabetes management. Disclosure M. Pawaskar: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. J. Nguyen: Other Relationship; Self; Merck & Co., Inc. S. Huynh: Other Relationship; Self; Merck & Co., Inc. T. Haskell: Other Relationship; Self; Merck & Co., Inc. L. Lee: Other Relationship; Self; Merck & Co., Inc. S. Rajpathak: None.