Disparities in Achieving Diabetes Care Goals Among Patient Groups in Primary Care Program

A recent study evaluated the effectiveness of the Enhanced Primary Care Diabetes (EPCD) model, a nurse-led approach that integrates multidisciplinary support to improve diabetes management in primary care settings. Published in The Annals of Family Medicine, the research focused on whether different racial and ethnic groups benefited equally from this program.

The study analyzed health records from 1,749 adults aged 18 to 75 years across 13 family and internal medicine practices affiliated with Mayo Clinic Rochester, covering data from January 1 to December 31, 2020. Patient progress was tracked until August 1, 2022, to assess how quickly they achieved five key diabetes care goals, collectively known as D5. These include maintaining blood pressure below 140/90 mmHg, using statin therapy to lower cholesterol, achieving an HbA1c level under 8%, remaining tobacco-free, and regularly taking aspirin when indicated.

The analysis revealed that 60.7% of patients met all five targets during the study period. Notably, Black patients were significantly less likely than white patients to reach these goals, with a hazard ratio of 0.68. While Asian and Hispanic patients showed similar outcomes to white patients overall, differences emerged in the frequency of nurse interactions: Asian patients had fewer nurse touchpoints (median 0.8 per year), whereas Black patients engaged more frequently (median 2.2 per year). Hispanic patients' engagement was comparable to white patients.

Factors such as younger age, insulin use, fewer baseline care goal components, and a lower medication count at the time of program initiation were associated with slower achievement of the D5 targets. Interestingly, despite increased nursing support, Black patients faced greater challenges in reaching their diabetes management goals, emphasizing the need for tailored approaches that consider socioeconomic and cultural contexts.

This study underscores the importance of addressing disparities in chronic disease management and highlights the necessity for culturally sensitive interventions in primary care models to ensure equitable health outcomes for all racial and ethnic groups.

For more details, see the original study: Diabetes care delivery and outcomes by race and ethnicity: evaluation of an enhanced primary care practice model in the US Upper Midwest.