Alyce S. Adams|Connie Mah Trinacty|Fang Zhang|Ken Kleinman|Richard W. Grant|James B. Meigs|Stephen B. Soumerai|Dennis Ross?Degnan
Medication Adherence and Racial Differences in A1C Control
Harvard University|Harvard University|Harvard University|Harvard University|Massachusetts General Hospital|Massachusetts General Hospital|Harvard University|Harvard University
purpose study examine medication adherence selfmanagement practices potential determinants higher glycemic risk among black relative white patientswe used retrospective longitudinal repeatedmeasures design model contribution medication adherence blackwhite differences a1c among type 2 diabetic patients large multispecialty group practice identified 1806 adult aged 18 diagnosis patients 467 black 1339 white newly initiated oral hypoglycemic therapy 1 december 1994 31 december 2000 race identified using electronic medical record patient selfreport baseline defined 13 months preceding included month therapy initiation patients required least 12 months followupat initiation therapy black patients higher average a1c values compared whites 98 vs 89 difference 088 p 00001 blacks lower average medication adherence first year therapy 72 vs 78 p 00001 although frequent medication refills associated lower average a1c values adjustment adherence eliminate blackwhite gapwe found persistent racial differences a1c explained differences medication adherence findings suggest targeting medication adherence alone unlikely reduce disparities glycemic control setting research needed explore possible genetic environmental determinants higher a1c among blacks diagnosis may represent critical period intensive intervention