The High Prevalence of Diabetes in a Large Cohort of Patients Drawn From Safety Net Clinics

Abstract

IntroductionUnderserved populations have been overlooked or underrepresented in research based on data from diabetes registries. We estimated diabetes prevalence using a cohort developed from the electronic health records of 3 networks of safety net clinics that provide care to underserved populations.MethodsADVANCE (Accelerating Data Value Across a National Community Health Center Network) is a partnership of the OCHIN Community Health Information Network (OCHIN), the Health Choice Network (HCN), and the Fenway Health Institute (FHI), representing 97 federally qualified health centers (FQHCs) and 744 clinic sites in 22 US states. Among 952,316 adults with a body mass index (BMI) measurement and at least 2 outpatient visits in 2012 to 2014, we calculated diabetes prevalence using outpatient diagnoses, diagnostic laboratory results, or dispenses of anti-hyperglycemic agents no more than 730 days apart. We calculated prevalence by age, sex, race, Hispanic ethnicity, and BMI class.ResultsThe crude prevalence of diabetes was 14.4%. Men had a higher prevalence than women (16.5% vs 13.2%); diabetes prevalence increased across age categories. White patients had the lowest prevalence (11.4%) and Hawaiian/Pacific Islanders, the highest prevalence (21.9%), with prevalence ranging from 15.2% to 16.5% for other race/ethnicities. The association between BMI class and diabetes prevalence was similar across all racial/ethnic groups.ConclusionThe ADVANCE diabetes cohort offers an opportunity to conduct epidemiologic and comparative effectiveness research on underserved and underrepresented individuals, who have a higher prevalence of diabetes than the general US population.

Personalized medicine and Hispanic health: improving health outcomes and reducing health disparities – a National Heart, Lung, and Blood Institute workshop report

“…The patients served in community clinical settings or health systems experience a broad range of healthcare environments, social determinants of health, and complex co-morbidities [ 51 ]. The results of research studies in these settings would be more representative of those communities than results of research carried out in academic settings, which tend to be highly selective with respect to patients, providers and healthcare environments [ 49 – 52 ].…”

A Multidisciplinary Diabetes Clinic Improves Clinical and Behavioral Outcomes in a Primary Care Setting

“…To date, there are limited studies evaluating the feasibility and efficacy of this team care approach, 9 especially in safety-net clinics that serve a greater number of patients who are uninsured. 10 According to the 2020 Standards of Medical Care in Diabetes, the use of multidisciplinary teams including primary care physicians, nurses, dietitians, pharmacists, and mental health professionals ranks only as an expert consensus because of limited clinical data. 11 Preliminary studies have shown that treatment of diabetes in multidisciplinary teams with pharmacists or behavioral health professionals is associated with decreased A1c concentrations [12][13][14][15] and more rapid attainment of associated goals.…”

Building Meaningful Patient Engagement in Research

“…Patient coauthors have advised, guided, and been published on accepted manuscripts, including key reviews and contributions from PEP member coauthors with lived experience of the condition of study. 32 Patient investigators have presented at national and international conferences and coauthored research proposals and manuscripts. 33 , 34 ADVANCE patient and clinician leaders recently acted as copresenters in the 2016 OCHIN Learning Forum (a national conference), with 5 PEP members and 2 PBRN steering committee members supporting 5 panels covering the impacts of the Affordable Care Act, stakeholder engagement, patient portal adoption, and enhancement and the OpenNotes movement, which provides patient access to visit notes through their patient portal.…”