Primary language, income and the intensification of anti-glycemic medications in managed care: The (TRIAD) study

O. Kenrik Duru, Dori Bilik, Laura N. McEwen, Arleen F. Brown, Andrew J. Karter, J. David Curb, David G. Marrero, Shou En Lu, Michael Rodriguez, Carol M. Mangione

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


BACKGROUND: Patients who speak Spanish and/or have low socioeconomic status are at greater risk of suboptimal glycemic control. Inadequate intensification of anti-glycemic medications may partially explain this disparity. OBJECTIVE: To examine the associations between primary language, income, and medication intensification. DESIGN: Cohort study with 18-month follow-up. PARTICIPANTS: One thousand nine hundred and thirty-nine patients with Type 2 diabetes who were not using insulin enrolled in the Translating Research into Action for Diabetes Study (TRIAD), a study of diabetes care in managed care. MEASUREMENTS: Using administrative pharmacy data, we compared the odds of medication intensification for patients with baseline A1c≥8%, by primary language and annual income. Covariates included age, sex, race/ethnicity, education, Charlson score, diabetes duration, baseline A1c, type of diabetes treatment, and health plan. RESULTS: Overall, 42.4% of patients were taking intensified regimens at the time of follow-up. We found no difference in the odds of intensification for English speakers versus Spanish speakers. However, compared to patients with incomes <$15,000, patients with incomes of $15,000-$39,999 (OR 1.43, 1.07-1.92), $40,000-$74,999 (OR 1.62, 1.16-2.26) or >$75,000 (OR 2.22, 1.53-3.24) had increased odds of intensification. This latter pattern did not differ statistically by race. CONCLUSIONS: Low-income patients were less likely to receive medication intensification compared to higher-income patients, but primary language (Spanish vs. English) was not associated with differences in intensification in a managed care setting. Future studies are needed to explain the reduced rate of intensification among low income patients in managed care.

Original languageEnglish (US)
Pages (from-to)505-511
Number of pages7
JournalJournal of General Internal Medicine
Issue number5
StatePublished - May 2011
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine


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