Racial and Ethnic Disparities in Prevalence and Care of Patients With Type 2 Diabetes

This article is a narrative review of the epidemiological data available on diabetes prevalence and care and of studies indexed in PubMed involving trials that evaluated treatments for type 2 diabetes in racial minority populations. The authors examined data from the Centers for Disease Control and Prevention and from the National Health and Nutrition Examination Survey. Table 1 provides a summary of demographic data (1–7). Because of the difficulties in gathering data for all three large racial and ethnic minorities in the United States, disparities are presented solely for African Americans compared to whites and for Hispanics compared to whites. The prevalence of diagnosed type 2 diabetes by racial/ethnic group is as follows: Asians 9.0%, African Americans 13.2%, Hispanic 12.8%, and non-Hispanic whites 7.6%. There is a wide variation in prevalance in the Native American population (e.g., 6.0% in Alaskan Natives and 24.1% in southern Arizona Native American groups) and among Hispanics (e.g., 8.5% in Central/South Americans, 9.3% in Cubans, 13.9% in Mexican Americans, and 14.8% in Puerto Ricans) (8). Objective. The purpose of this study was to identify and describe all clinical drug trials for type 2 diabetes that included Asians, African Americans, or Hispanics. Design. The authors conducted a literature review of studies indexed in MEDLINE and accessed through PubMed. Methods. The authors searched PubMed using the terms African, African American, Hispanic, Asian, type 2 diabetes, biguanides, sulfonylureas, thiazolidinediones, α-glucosidase inhibitors, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium– glucose cotransporter 2 inhibitors, and individual drugs available in each class. A narrative review of the identified studies (many of which were themselves meta-analyses) was then written. Results. Nineteen individual drugs and one drug class were tested in Asians, African Americans, or Hispanics (Table 2) (8–28). Four drugs or drug classes were tested in all three populations (Asians, African Americans, and Hispanics) (Table 3). An additonal five medications were tested in two of the three populations (Table 4). Of all of the medications or drug classes reported, only four did not include Asian subjects: exenatide extended release, canagliflozin, bromocriptine, and colesevelam. With the exeption of colesevelam, these drugs also were not tested in African Americans or Hispanics. It is important to note that the majority Racial and Ethnic Disparities in Prevalence and Care of Patients With Type 2 Diabetes