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Medication Adherence and Racial Differences in HbA1c Control

¹Ambulatory Care and Prevention, Harvard Medical School
²General Medicine Unit, Massachusetts General Hospital

aadams{at}hms.harvard.edu

ABSTRACT

Objective: The purpose of this study was to examine medication adherence and other self-management practices as potential determinants of higher glycemic risk among black relative to white patients.

Research Design and Methods: We used a retrospective, longitudinal repeated measures design to model the contribution of medication adherence to black-white differences in HbA1c among Type 2 diabetes patients at a large multi-specialty group practice. We identified 1,806 adult (age 18+ at diagnosis) patients (black=467, white=1339) newly initiated on oral hypoglycemic therapy between 01/01/94 and 12/31/00. Race was identified using an electronic medical record and patient self-reports. Baseline was defined as the 13-months preceding and including the month of therapy initiation. All patients were required to have at least 12 months of follow up.

Results: At initiation of therapy, black patients had higher average hemoglobin A_1c values compared to whites 9.8 vs. 8.9, a difference of 0.88 (p<0.0001). Blacks had lower average medication adherence during the first year on therapy [72% vs. 78%; p<0.0001]. While more frequent medication refills were associated with lower average HbA1c values, adjustment for adherence did not eliminate the black-white gap.

Conclusions: We found persistent racial differences in hemoglobin A1c that were not explained by differences in medication adherence. Our findings suggest that targeting medication adherence alone is unlikely to reduce disparities in glycemic control in this setting. Further research is needed to explore possible genetic and environmental determinants of higher A1c among blacks at diagnosis, which may represent a critical period for more intensive intervention.

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