Impact of a diabetes disease management program by race and ethnicity

Background: In the US, diabetes mellitus affects people in all racial and ethnic groups, but the prevalence and risk of complications are considerably higher among African Americans, Hispanics, American Indians, and Alaskan Natives. This study aimed to evaluate the impact of enrollment for at least I calendar year in a diabetes disease management program (DDMP) in a large, commercially insured, managed care population. We assessed changes in utilization of preventive services and adoption of diabetes self-management behaviors by race and ethnicity. Methods: Participants were aged > 17 years and had type 1 or 2 diabetes. They were enrolled in a targeted, high-risk level DDMP between January 2003 and September 2003 and were enrolled in the managed care organization (MCO) for a 2-year period beginning I year prior to their enrollment in the DDMP. At baseline, 19 483 MCO enrollees who were participating in the targeted high-risk level DDMP were mailed a 40-item, self-administered baseline survey, which took between 10 and 15 minutes to complete. Baseline results are reported elsewhere. One year later, in June 2004, 5174 of the baseline responders were mailed a slightly modified version of the 40-item survey. The survey measured use of eight preventive services (cholesterol test, dental examination, dilated eye examination, urinalysis, foot examination, influenza vaccination, pneumococcal vaccination, and glycated hemoglobin testing) and engagement in four self-management behaviors (blood glucose tests, diet monitoring, exercise, and smoking avoidance). Results: Of the 5174 follow-up surveys mailed, 1961 (37.9%) were eligible for comparative analysis. Blacks and Hispanics reported more annual healthcare visits (average of 6.2 and 6.5, respectively) compared with Whites (average of 5.0, p < 0.0001). However, at follow-up, both Blacks and Hispanics had lower utilization rates than Whites for six of the eight preventive services that were measured. At follow-up, both Blacks and Whites were more likely than at baseline to report up-to-date status of influenza and pneumococcal vaccination (p <= 0.0001). At follow-up, the racial/ethnic gap in self-management behaviors that was observed at baseline had reduced and in fact had reversed direction for glucose tests, as Blacks were more likely than Whites to routinely test their blood glucose. Conclusions: These data indicate that DDMP enrollment for at least 1 calendar year had a mixed impact on overall diabetes behaviors and on racial/ethnic disparities in preventive services utilization and self-management behaviors. Further studies are needed to give a clearer understanding of why some diabetic MCO enrollees are less likely to use preventive services, and why disparities remain even in settings where healthcare services are universally available.