Race and gender differences in abnormal blood glucose screening and clinician response to prediabetes: A mixed-methods assessment
- Resource Type
- Authors
- Carol E. Golin; M. Sue Kirkman; Alexandra F. Lightfoot; Carmen D. Samuel-Hodge; Tainayah Thomas; Shelley D. Golden
- Source
- Prev Med
- Subject
- Blood Glucose
Male
medicine.medical_specialty
Epidemiology
Logistic regression
01 natural sciences
Article
Odds
Prediabetic State
03 medical and health sciences
Race (biology)
0302 clinical medicine
Diabetes mellitus
Internal medicine
medicine
Diabetes Mellitus
North Carolina
Humans
030212 general & internal medicine
Prediabetes
0101 mathematics
Generalized estimating equation
Sex Characteristics
business.industry
010102 general mathematics
Public Health, Environmental and Occupational Health
medicine.disease
Health equity
United States
Female
Implicit bias
business
- Language
- ISSN
- 1096-0260
The projected three-fold increase in diabetes burden by 2060 in the United States will affect certain race and gender groups disproportionately. The objective of this mixed-methods study was to assess differences in prediabetes screening and clinician response to prediabetes by patient race and gender. We utilized data from 18,742 patients seen between 11/1/15 and 4/30/17 who met criteria for blood glucose screening by the 2015 US Preventive Service Task Force recommendation and had at least one visit to a primary care practice within a large, academic health system located in North Carolina. We utilized generalized estimating equations with logistic regression to assess race and gender differences in two outcomes: prediabetes screening and clinician response to prediabetes. We conducted twenty in-depth interviews (October 2018–May 2019) with physicians to assess their approach to screening for and treating prediabetes. Black patients had 11% higher odds (95% CI:1.02–1.20) of being screened for prediabetes than White patients. Men had 19% higher odds (95% CI:1.09–1.30) of being screened for prediabetes than women. There were no significant differences in clinician response to prediabetes by patient race or gender. Qualitatively, physicians reported a non-systematic approach to prediabetes screening and follow-up care related to: 1) System-level barriers to screening and treatment; 2) Implicit bias; 3) Patient factors; and 4) Physician preferences for prediabetes treatment. Targeted risk-based screening for prediabetes along with increased treatment for prediabetes are critical for preventing diabetes and reducing diabetes-related disparities.