Primary language, income and the intensification of anti-glycemic medications in managed care: The (TRIAD) study

O. Kenrik Duru, Dori Bilik, Laura N. McEwen, Arleen F. Brown, Andrew J. Karter, J. David Curb, David Marrero, Shou En Lu, Michael Rodriguez, Carol M. Mangione

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Abstract

BACKGROUND: Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity. OBJECTIVE: To examine the associations between primary language, income, and medication intensification. DESIGN: Cohort study with 18-month follow-up. PARTICIPANTS: One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care. MEASUREMENTS: Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c≥8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan. RESULTS: Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes <$15,000, patients with incomes of $15,000-$39,999 (OR 1.43, 1.07-1.92), $40,000-$74,999 (OR 1.62, 1.16-2.26) or >$75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race. CONCLUSIONS: Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care.

Original languageEnglish
Pages (from-to)505-511
Number of pages7
JournalJournal of General Internal Medicine
Volume26
Issue number5
DOIs
StatePublished - May 2011

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Managed Care Programs
Language
Research
Social Class
Type 2 Diabetes Mellitus
Cohort Studies
Insulin
Education
Health

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Duru, O. K., Bilik, D., McEwen, L. N., Brown, A. F., Karter, A. J., Curb, J. D., ... Mangione, C. M. (2011). Primary language, income and the intensification of anti-glycemic medications in managed care: The (TRIAD) study. Journal of General Internal Medicine, 26(5), 505-511. https://doi.org/10.1007/s11606-010-1588-2

Primary language, income and the intensification of anti-glycemic medications in managed care : The (TRIAD) study. / Duru, O. Kenrik; Bilik, Dori; McEwen, Laura N.; Brown, Arleen F.; Karter, Andrew J.; Curb, J. David; Marrero, David; Lu, Shou En; Rodriguez, Michael; Mangione, Carol M.

In: Journal of General Internal Medicine, Vol. 26, No. 5, 05.2011, p. 505-511.

Research output: Contribution to journalArticle

Duru, OK, Bilik, D, McEwen, LN, Brown, AF, Karter, AJ, Curb, JD, Marrero, D, Lu, SE, Rodriguez, M & Mangione, CM 2011, 'Primary language, income and the intensification of anti-glycemic medications in managed care: The (TRIAD) study', Journal of General Internal Medicine, vol. 26, no. 5, pp. 505-511. https://doi.org/10.1007/s11606-010-1588-2
Duru, O. Kenrik ; Bilik, Dori ; McEwen, Laura N. ; Brown, Arleen F. ; Karter, Andrew J. ; Curb, J. David ; Marrero, David ; Lu, Shou En ; Rodriguez, Michael ; Mangione, Carol M. / Primary language, income and the intensification of anti-glycemic medications in managed care : The (TRIAD) study. In: Journal of General Internal Medicine. 2011 ; Vol. 26, No. 5. pp. 505-511.
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AU - Duru, O. Kenrik

AU - Bilik, Dori

AU - McEwen, Laura N.

AU - Brown, Arleen F.

AU - Karter, Andrew J.

AU - Curb, J. David

AU - Marrero, David

AU - Lu, Shou En

AU - Rodriguez, Michael

AU - Mangione, Carol M.

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N2 - BACKGROUND: Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity. OBJECTIVE: To examine the associations between primary language, income, and medication intensification. DESIGN: Cohort study with 18-month follow-up. PARTICIPANTS: One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care. MEASUREMENTS: Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c≥8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan. RESULTS: Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes <$15,000, patients with incomes of $15,000-$39,999 (OR 1.43, 1.07-1.92), $40,000-$74,999 (OR 1.62, 1.16-2.26) or >$75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race. CONCLUSIONS: Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care.

AB - BACKGROUND: Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity. OBJECTIVE: To examine the associations between primary language, income, and medication intensification. DESIGN: Cohort study with 18-month follow-up. PARTICIPANTS: One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care. MEASUREMENTS: Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c≥8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan. RESULTS: Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes <$15,000, patients with incomes of $15,000-$39,999 (OR 1.43, 1.07-1.92), $40,000-$74,999 (OR 1.62, 1.16-2.26) or >$75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race. CONCLUSIONS: Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care.

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