Diabetes care model shows unequal benefits across racial groups

Background and goal: The Enhanced Primary Care Diabetes (EPCD) model is a nurse-led care delivery model that leverages multidisciplinary support to improve diabetes care quality in primary care settings. This study assessed whether patients of different racial and ethnic groups benefited equally.

Study approach: The authors reviewed health records for 1,749 adults aged 18 to 75 years from 13 family medicine and internal medicine practices in Mayo Clinic Rochester who joined the EPCD program from Jan. 1 to Dec. 31, 2020. They followed each patient's progress through Aug. 1, 2022, to see how long it took to meet five publicly-reported diabetes care goals known as D5: a blood pressure reading lower than 140/90; taking a statin medicine to lower bad cholesterol; blood sugar or HbA1c reading of less than 8%; living tobacco-free; and taking a daily dose of aspirin as appropriate. They then compared those times across racial and ethnic groups, accounting for differences in age, sex, where patients live, type of diabetes, number of medications, insulin use, and any gaps in care at the start.

Main results:

• 60.7% (1,061 patients) met the D5 during the study period.

• Black patients with diabetes were less likely than White patients to reach the D5 (HR 0.68; 95% CI, 0.52-0.90; P = .007). There was no difference among Asian and Hispanic patients compared to White patients. 

• Compared to White patients, Asian patients had fewer nurse touch points (median 0.8 per year) during the study period, while Black patients had more (median 2.2 per year). Hispanic patients had no significant difference. 

• Factors tied to slower D5 attainment included younger age, insulin use, fewer baseline D5 components met, and a lower medication count at program entry.

Why it matters: Black patients were significantly less likely to attain the D5 despite being engaged with the care team nurses more often than White patients. The findings of the study highlight the need to tailor chronic disease programs to socioeconomic and cultural context.