344-OR: Persistent Treatment Gaps and Disparities in U.S. Diabetes Mellitus Care in 2005-2016

Abstract

We sought to evaluate whether diabetes mellitus (DM) diagnosis, linkage to care, and meeting individual and combined treatment targets improved over time and to investigate potential disparities in U.S. DM care. To do so, we derived percentages of diagnoses, linkage, and treatment goal achievement from NHANES in 2005-08, 2009-12, and 2013-16, and developed a logistic regression model adjusting for period, demographics, education, and health insurance. In 2013-16, 74% of U.S. adults with DM were aware of their diagnoses; 70% were linked to DM care, 70% met HbA1c, 70% met blood pressure, 51% met cholesterol target, and 84% did not smoke. Twenty-one percent of patients achieved all treatment goals (Figure). None of the individual and combined outcomes improved over the 3 study periods (p=0.08-0.98). Compared to middle-aged adults with DM (45-64y), older adults (≥65y) were more likely (OR 1.64, 95% CI 1.20-2.24) and younger adults (18-44y) were less likely (OR 0.50, 95% CI 0.28-0.90) to meet the combined goals. Women achieved the combined goals less often (OR 0.59, 95% CI 0.46-0.76). Reporting non-Hispanic black race (vs. non-Hispanic white race) was associated with reduced likelihood of achieving the combined goals (OR 0.59, 95% CI 0.42-0.82). Despite major advances in DM medications and new care models, U.S. DM care has not significantly improved between 2005 and 2016. Disclosure P. Kazemian: None. F.M. Shebl: None. N. McCann: None. R. Walensky: Other Relationship; Spouse/Partner; Aileron. D.J. Wexler: Other Relationship; Spouse/Partner; APOLO1BIO. Funding Boston Area Diabetes Endocrinology Research Center; Steve and Deborah Gorlin MGH Research Scholar Award