Racial/ethnic and socioeconomic disparities in achievement of treatment goals within a clinical trial: a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial
Authors' conclusion
Racially/ethnically minoritised participants in the ACCORD trial were less likely to achieve high-burden (glycaemic) treatment goals but were generally similarly likely to achieve goals of less intensive interventions. Differences in glycaemic treatment goal achievement were partially mediated by differences in medication use but not mediated by hypoglycaemia, change in BMI or study visit attendance.
Study context
- Population
- Participants of the ACCORD trial (glycaemic, blood pressure and triglyceride-lowering interventions)
- Comparison
- Race/ethnicity and educational attainment
- Primary endpoint
- Achievement of glycaemic targets, blood pressure targets and ≥25% reduction in triglyceride levels, by race/ethnicity and educational attainment
- Follow-up
- First year
Methodological detailsmultivariable models adjusted for demographics and clinical characteristics, mediation analysis
- Multivariable models adjusted for demographics and clinical characteristics
- Mediation analysis
Primary result
As reported in the abstract
Achievement of glycaemic targets
Each group vs whiteAdjusted odds ratio (95% CI)
Black
0.63(0.55,0.71)
Hispanic
0.73(0.61–0.88)
Other
0.82(0.71–0.96)
Further findings
| Outcome | aOR (95% CI) | |
|---|---|---|
| Achievement of blood pressure targets · first yearBlackvs WhiteLess likely | 0.77 (0.65–0.90) | |
| Achievement of blood pressure targets · first yearHispanicvs White | 1.01 (0.78–1.32) | |
| Achievement of blood pressure targets · first yearOthervs White | 1.01 (0.81–1.26) | |
| ≥25% TG reduction (proxy for fenofibrate adherence) · first yearBlackvs White | 1.77 (1.38–2.28) | |
| ≥25% TG reduction (proxy for fenofibrate adherence) · first yearHispanicvs White | 1.34 (0.98–1.84) | |
| ≥25% TG reduction (proxy for fenofibrate adherence) · first yearOthervs White | 1.43 (1.10–1.85) | |
| 0.512Adjusted odds ratio (log scale) |
≥25% TG reduction (proxy for fenofibrate adherence) · first year
- Black, Hispanic and Other participants equally or more likely to achieve TG reduction
Goal achievement by educational attainment
- Differences generally not significant after adjusting for baseline characteristics
Mediation of glycaemic disparities
- Partially mediated by differences in insulin dosing and oral medication use
Safety
Hypoglycaemia requiring medical assistance · any time
- Rates highest among Black individuals and those with lower educational attainment
Original publication
Racial/ethnic and socioeconomic disparities in achievement of treatment goals within a clinical trial: a secondary analysis of the ACCORD trial. Diabetologia. Published 16 September 2023. doi:10.
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