Minority Status and Diabetes Screening in an Ambulatory Population

OBJECTIVE: Ethnicity has been identified as a risk factor not only for having type 2 diabetes but for increased morbidity and mortality with the disease. Current American Diabetes Association (ADA) guidelines advocate screening high-risk minorities for diabetes. This study investigates the effect of minority status on diabetes screening practices in an ambulatory, insured population presenting for yearly health care. RESEARCH DESIGN AND METHODS: This is a retrospective population–based study of patients in a large, Midwestern, academic group practice. Included patients were insured, had ≥1 primary care visit yearly from 2003 to 2007, and did not have diabetes but met ADA criteria for screening. Odds ratios (ORs), 95% confidence intervals (CI), and predicted probabilities were calculated to determine the relationship between screening with fasting glucose, glucose tolerance test, or hemoglobin A(1c) and patient and visit characteristics. RESULTS: Of the 15,557 eligible patients, 607 (4%) were of high-risk ethnicity, 61% were female, and 86% were ≥45 years of age. Of the eight high-risk factors studied, after adjustment, ethnicity was the only factor not associated with higher diabetes screening (OR = 0.90 [95% CI 0.76–1.08]) despite more primary care visits in this group. In overweight patients <45 years, where screening eligibility is based on having an additional risk factor, high-risk ethnicity (OR 1.01 [0.70–1.44]) was not associated with increased screening frequency. CONCLUSIONS: In an insured population presenting for routine care, high-risk minority status did not independently lead to diabetes screening as recommended by ADA guidelines. Factors other than insurance or access to care appear to affect minority-preventive care.