Evidence map›Paper›PMID 39242122›Full record

ArticleBMJ open diabetes research & care2024

Not all healthcare inequities in diabetes are equal: a comparison of two medically underserved cohorts.

Ashby F Walker, Michael J Haller, Ananta Addala, Stephanie L Filipp, Rayhan Lal, Matthew J Gurka, Lauren E Figg, Melanie Hechavarria, Dessi P Zaharieva, Keilecia G Malden and 8 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open diabetes research & care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Trial
  2. Article
  3. Review
  4. Review
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Ashby F WalkerUniversity of Florida Diabetes Institute, Gainesville, Florida, USA afwalker@ufl.edu.ORCID 0000-0002-7554-2344
Michael J HallerUniversity of Florida Diabetes Institute, Gainesville, Florida, USA.ORCID 0000-0002-2803-1824
Ananta AddalaStanford Diabetes Research Center, Stanford, California, USA.ORCID 0000-0002-0508-4309
Stephanie L FilippDepartment of Pediatrics, University of Florida, Gainesville, Florida, USA.
Rayhan LalDivision of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Matthew J GurkaDepartment of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA.
Lauren E FiggDivision of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Melanie HechavarriaDepartment of Pediatrics, University of Florida, Gainesville, Florida, USA.ORCID 0000-0003-2222-3451
Dessi P ZaharievaDivision of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.ORCID 0000-0002-9374-8469
Keilecia G MaldenDepartment of Pediatrics, University of Florida, Gainesville, Florida, USA.
Korey K HoodStanford Diabetes Research Center, Stanford, California, USA.
Sarah C WestenDepartment of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA.
Jessie J WongStanford Diabetes Research Center, Stanford, California, USA.
William T DonahooUniversity of Florida Diabetes Institute, Gainesville, Florida, USA.
Marina BasinaStanford Diabetes Research Center, Stanford, California, USA.
Angelina V BernierDepartment of Pediatrics, University of Florida, Gainesville, Florida, USA.
Paul DuncanDepartment of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA.
David M MaahsStanford Diabetes Research Center, Stanford, California, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionDiabetes disparities exist based on socioeconomic status, race, and ethnicity. The aim of this study is to compare two cohorts with diabetes from California and Florida to better elucidate how health outcomes are stratified within underserved communities according to state location, race, and ethnicity. RESEARCH DESIGN AND

methodsTwo cohorts were recruited for comparison from 20 Federally Qualified Health Centers as part of a larger ECHO Diabetes program. Participant-level data included surveys and HbA1c collection. Center-level data included Healthcare Effectiveness Data and Information Set metrics. Demographic characteristics were summarized overall and stratified by state (frequencies, percentages, means (95% CIs)). Generalized linear mixed models were used to compute and compare model-estimated rates and means.

resultsParticipant-level cohort: 582 adults with diabetes were recruited (33.0% type 1 diabetes (T1D), 67.0% type 2 diabetes (T2D)). Mean age was 51.1 years (95% CI 49.5, 52.6); 80.7% publicly insured or uninsured; 43.7% non-Hispanic white (NHW), 31.6% Hispanic, 7.9% non-Hispanic black (NHB) and 16.8% other. Center-level cohort: 32 796 adults with diabetes were represented (3.4% with T1D, 96.6% with T2D; 72.7% publicly insured or uninsured). Florida had higher rates of uninsured (p<0.0001), lower continuous glucose monitor (CGM) use (18.3% Florida; 35.9% California, p<0.0001), and pump use (10.2% Florida; 26.5% California, p<0.0001), and higher proportions of people with T1D/T2D>9% HbA1c (p<0.001). Risk was stratified within states with NHB participants having higher HbA1c (mean 9.5 (95% CI 8.9, 10.0) compared with NHW with a mean of 8.4 (95% CI 7.8, 9.0), p=0.0058), lower pump use (p=0.0426) and CGM use (p=0.0192). People who prefer to speak English were more likely to use a CGM (p=0.0386).

conclusionsCharacteristics of medically underserved communities with diabetes vary by state and by race and ethnicity. Florida's lack of Medicaid expansion could be a factor in worsened risks for vulnerable communities with diabetes.

Indexed as

Diabetes Mellitus, Type 2Healthcare DisparitiesAdultCaliforniaCohort StudiesDiabetes MellitusDiabetes Mellitus, Type 1FemaleFloridaFollow-Up StudiesGlycated HemoglobinHumansMaleMedically Underserved AreaMiddle AgedSocioeconomic FactorsGlycated Hemoglobinhemoglobin A1c protein, humanDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2Healthcare DisparitiesHealth Policy

Identifiers

PMID39242122
PMCPMC11381725

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.