RACIAL AND REGIONAL VARIATION IN DISEASE PROGRESSION AND OUTCOMES AMONG VETERANS ADHERENT TO THEIR INITIAL ORAL ANTIDIABETIC MEDICATION

• Published in: Value in health 2017-05, Vol.20 (5), p.A176
• Main Authors: Gatwood, J, Chisholm-Burns, M, Davis, R, Thomas, F, Potukuchi, P, Hung, A, Kovesdy, C
• Format: Article
• Language: English
• Subjects: Adherents; African Americans; Antidiabetics; Cerebrovascular system; Demography; Diabetes; Diabetes mellitus; Diabetic neuropathy; Drug therapy; Drugs; First year; Hemoglobin; Medical diagnosis; Microvascular complications; Microvasculature; Nephropathy; Outpatient treatment; Peripheral neuropathy; Pharmacy; Race; Racial differences; Racial inequality; Retinopathy; Revascularization; Veterans
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.05.005

OBJECTIVES: To investigate whether racial disparities and regional variation in outcomes and disease progression exist among veterans with incident diabetes mellitus (DM) who were initially adherent to oral antidiabetic medications (OAD). METHODS: The VA Corporate Data Warehouse was used to identify the first diagnosis for uncomplicated DM during 2002-2014. OAD use was assessed by proportion of days covered (PDC) for the first year of therapy using outpatient VA pharmacy records, and those with a PDC > 80% were deemed adherent. Changes in clinical measures and the odds of cardiovascular outcomes, cerebrovascular events, revascularization, and microvascular complications were assessed during the first year of therapy with a focus on differences among races and geographic regions while controlling for baseline demographic and clinical characteristics. RESULTS: A total of 159,032 veterans were identified, and 62.5% were initially adherent to OADs. Significant improvement was observed across nearly all clinical measures, regardless of patient race or location, including an unadjusted mean reduction of 0.7% in hemoglobin A1C (p< 0.0001). Less than 1% were diagnosed with a cardiovascular, cerebrovascular, or microvascular complication or required revascularization; African Americans had a lower adjusted odds of revascularization (OR: 0.59; 95% CI: 0.378-0.915) while those residing in Western states had higher odds of these procedures (OR: 1.6; 95% CI: 1.02-2.48). Microvascular complications were slightly more evident and differences in the adjusted odds of disease were observed in multiple races and regions but were again especially prominent among African Americans (neuropathy [OR 0.92; 95%CI: 0.846-0.997], nephropathy [OR: 2.0; 95% CI: 1.825-2.262], and retinopathy [OR: 1.4; 95%CI: 1.24-1.50]) and veterans residing in Western states (neuropathy [OR: 0.83; 95%CI: 0.753-0.917] and retinopathy [OR: 1.5; 95%CI: 1.28-1.65]). CONCLUSIONS: Disparities in macro-and microvascular complications among patients with DM may begin to develop within the first year of OAD therapy, and additional attention may be warranted among particular sections of the population.