Blacks receive worse care and suffer worse outcomes than whites when it comes to diabetes, according to a study in the Journal of Clinical Endocrinology & Metabolism. In a retrospective study published online January 6, researchers at Emory University in Atlanta examined ICD-9 data from 2012 and 2013 on 35,866 adults, about 40% of whom were black.
“Black patients have higher rates of hyperglycemia and diabetes, worse inpatient glycemic control, and greater frequency of hospital complications compared to whites,” said the Emory research team.
Their research showed that 34.5% of hospitalized black patients had diabetes and 42.3% had hyperglycemia, compared with 22.8% and 36.7% of white patients, respectively. The cause for disparities is not known, they cautioned, but they dangled several possible explanations: genetic predisposition for more severe disease, differences in income and health insurance, and less access to diabetes care.
The Emory researchers found that HbA1c levels were higher among black patients than white patients, and insulin therapy was given to 38% of black patients, compared with 33% of white patients in the entire cohort. Among patients with a known diagnosis of diabetes prior to admission, a higher share of blacks received insulin than whites (75.6% vs. 72.6%).
Yet the risk for myocardial infarction, pneumonia, bacteremia, respiratory failure, acute kidney injury, and death was greater among black patients compared with whites.
The study identified nondiabetic blacks with hyperglycemia as a particularly vulnerable group who were less likely to receive insulin (62.7%) compared with whites (66.1%).
The study continues: “Blacks have 2–4 times the rate of renal disease, blindness, amputations, and amputation-related mortality. In addition, after adjusting for confounders, blacks with diabetes have higher mortality rates compared with whites.”
Black patients tended to be younger, have a higher BMI, and a higher proportion of obesity. They were also more likely to be admitted to medical services rather than surgery services.