314-OR: Racial/Ethnic and Geographic Variation in the Initiation of Antidiabetic Therapies in Medicare Enrollees with Newly Diagnosed Type 2 Diabetes (T2D)

The study’s objective was to determine to what extent the initiation of antidiabetic therapy differs across racial groups and geographic regions. We used a 5% random sample of Medicare enrollees newly diagnosed with T2D in 2007-2017 and followed them for one year (n=231,408). The outcome was time to initiation of an antidiabetic agent following T2D diagnosis as determined by ICD9/10 code. We constructed Cox proportional hazard models to quantify the association of race/ethnicity with the outcome, adjusting for demographic and clinical factors. We constructed Poisson models to estimate the adjusted incidence density of treatment initiation by state. Among patients newly diagnosed with T2D, 13.6% of White and 14.8% of Black patients initiated therapy within a year. Black patients were less likely to initiate antidiabetic therapy (HR 0.89, 95%CI [0.77-0.96]) than White after adjustment. We identified a strong interaction between race and sex (p<0.05): the difference in the hazards of antidiabetic initiation between Black and White was significant in men (0.84 [0.80-0.89] but not in women 0.98 [0.94-1.03]). The initiation varied substantially across states (Figure). Significant racial and geographic variation exists in the initiation of pharmacotherapy after T2D diagnosis. Further research is needed to reveal factors contributing to these disparities.

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