Background:
Previous studies have shown that cardiovascular risk factors among Hispanic and Black patients with type 2 diabetes are poorly controlled, but no studies have been conducted in Asian American populations.
Objective:
To examine racial/ethnic differences in control of cardiovascular risk factors in patients with type 2 diabetes across Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), compared to Non-Hispanic Whites (NHWs) in a multi-specialty healthcare organization in California.
Methods:
Electronic health records of 12,804 active primary care Asian American (n=4,594) and NHW (n=8,210) patients, ages 35 years and older, with type 2 diabetes were examined from 2007-2009. Diabetes was classified through ICD-9 codes, abnormal laboratory values, or use of anti-diabetic medications. Sex-age directly standardized prevalence rates and multivariate adjusted odds ratios (OR) were calculated for attainment of the following cardiovascular risk factor goals: glycosylated hemoglobin (A1C) < 7%, blood pressure (BP) < 130/80 mmHg, and low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, and simultaneous control (A1C, BP, and LDL-C). ORs were calculated accounting for race/ethnicity, age, sex, BMI, insurance, and number of clinic visits.
Results:
The ranges of standardized goal attainment rates among Asian American subgroups and NHWs were as follows: A1C (58.5% in Filipinos to 75.3% in Vietnamese), BP (39.9% in Vietnamese to 53.4% in Chinese), LDL-C (50.3% in Koreans to 65.5% in Asian Indians), and simultaneous control (18.1% in Filipinos to 24.8% in Chinese). After adjusting for patient characteristics, Asian Americans had significantly lower odds of A1C goal attainment (OR=0.76, 95% CI: 0.69-0.85), and higher odds of LDL-C goal attainment (1.17, 1.05-1.29), compared to NHWs. Among Asian subgroups, Asian Indians, Filipinos, Japanese and Koreans had significantly lower odds of goal attainment for A1C, compared to NHWs. Asian Indians (OR= 1.15, 95% CI: 1.01-1.32) and Chinese (1.28, 1.12-1.46) had significantly higher odds of goal attainment for BP, compared to NHWs. Odds of LDL-C goal attainment were also significantly higher for Asian Indians (1.29, 1.11-1.49) and Filipinos (1.19, 1.01-1.39), compared to NHWs.
Conclusion:
Among our type 2 diabetes patients, Asian Americans have worse control of A1C, despite better control of LDL-C and BP, compared to NHWs. There is also significant heterogeneity in control of cardiovascular risk factors among Asian American subgroups. Optimal simultaneous goal attainment was seen in a small proportion of diabetes patients. Achieving goals for cardiovascular risk factors is difficult and health care providers may need to alter their treatment focus for different racial/ethnic groups.
Racial/ethnic differences in control of cardiovascular risk factors among type 2 diabetes patients in an insured, ambulatory care population
