839-P: Impact of Culturally Specific Care Teams on Mitigation of Racial Disparities in Diabetes Care: A Five-Year EHR-Based Study

Cultural and language barriers are known to reduce the likelihood of Asian-American patients (AA) with diabetes achieving recommended goals for HbA1c, blood pressure, and LDL, known as ‘ABCs of DM.’ Our previous study of an integrated Asian clinic for AA (AAC) at Joslin Diabetes Center, showed more AA patients achieving ABC goals 1-year after their initial visit, than whites in the Adult Diabetes clinic (WDC). AAC staff, including MDs, dietitians, educators, and patient coordinators, are all multi-lingual AAs who offer culturally-tailored management approaches. In a 5-year follow-up study between 2014 to 2019, we examined the clinical performance of new patients with T2D, comparing the following groups: AAC (n=166), AA in Adult Diabetes Clinic (ADC) (n=186), and WDC (n=2993). Compared to WDC and ADC, AAC patients were older (P=0.06), had lower BMI (P<0.001), lower education levels (P<0.001), more likely to be on Medicare (P<0.001), more likely to be non-native English speakers, and had significantly more educator sessions (P<0.001). At the initial visit, AAC patients had similar metabolic profiles as ADC and WDC (P=0.50). At the end of 5 years, 32.0% of AAC patients achieved the ABC goals, compared to 23.7% in WDC and 34.6% in ADC. Across all patients, the odds of meeting ABC goals are significantly higher (P<0.01) by having English as a primary language (OR:1.51; 95% CI: 1.19 - 1.26) and not being on Medicare (OR:1.24; 95% CI: 1.09 - 1.41). After adjusting for these factors, over 5-years of follow-up, the odds of AAC patients meeting ABC goals are similar to WDC patients (OR:0.58; 95% CI:0.25- 2.31, P=0.11) and better than ADC patients (OR:1.30, 95% CI:0.98- 3.22; P=0.06). Despite the financial, language, and educational disadvantages, AAC patients have achieved similar ABC targets as WDC and ADC patients. These findings suggest that culturally-specific care for AA can mitigate healthcare disparity in T2D management and can be maintained over prolonged periods of time.