315-OR: Trends in Racial and Ethnic Difference in Glucose-Lowering Medication (GLM) Use, Out of Pocket (OOP) Payment, and HbA1c Control in U.S. Adults with Diabetes, 2005-2018

Abstract

Fast escalating price of insulin and introductions of high-cost new GLMs in the last decade could affect racial/ethnic groups differently. This study examined trends in GLM uses, OOP payments for GLMs, and HbA1c control by racial/ethnic group among US adults with diabetes from 2005 to 2018. Data were from the Medical Expenditure Panel Survey and the National Health and Nutrition Examination Survey. Persons with diabetes were identified by self-report or lab test. GLM uses were identified by national drug code. We compared trends in the three study outcomes among non-Hispanic White perons, non-Hispanic Black perons, and Hispanic perons. Between 2005 and 2018, the use of newer GLM (dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose transport protein 2 inhibitors) was higher in non-Hispanic White persons (0% to 24.9%) than non-Hispanic Black persons (0% to 19.9%,) or Hispanic persons (0% to 19.5%, all p<0.05). Use of insulin analogue increased from 43.4% to 87.3% in Non-Hispanic White persons, 22.3% to 78.4% in non-Hispanic Black persons and 32.8% to 77.9% in Hispanic persons. Significant falls in annual OOP payments for GLMs were seen among Hispanic perons ($350 in 2005 to $205 in 2018) and non-Hispanic Black persons ($350 to $210), but not among non-Hispanic White persons ($355 to $345). In 2005, a higher proportion of non-Hispanic White persons achieved the HbA1c goal of <7.0%, compared with Hispanic persons and non-Hispanic Black persons (68.4% vs. 47.2% vs. 52.3%, p<0.05). Non-Hispanic White persons also had a lower average HbA1c level than Hispanic persons or non-Hispanic Black persons (6.7% vs. 7.8% vs. 7.4%, p<0.05). These differences remained throughout the study period. Our findings providevidence on racial/ethnic differences in GLM and insulin usage over time and could assist decision-makers in identifying the means to reduce racial/ethnic disparities in HbA1c control. Disclosure P. Li: None. D. Guan: None. J. Guo: None. A. G. Winterstein: Research Support; Self; Merck Sharp & Dohme Corp. P. Zhang: None. H. Shao: Research Support; Self; Sanofi.