Disparities in guideline-adherent cardiovascular preventive care for people with diabetes: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis examined whether receipt of guideline-recommended cardiovascular preventive care differed by sociodemographic characteristics among people with type 1 or type 2 diabetes. Across 25 studies, pooled analyses found lower odds of lipid-lowering medication prescription for female versus male individuals (OR:0.89, 95%CI:0.79,1.00) and Black versus White individuals (OR:0.78, 95%CI:0.74,0.81). Adults aged 18-45 years also had lower odds than the comparison age groups (OR:0.33, 95%CI:0.19,0.57). Findings varied by care measure and population group.

Key findings

• Female versus male individuals had lower odds of guideline-recommended lipid-lowering prescriptions (OR:0.89, 95%CI:0.79,1.00; moderate certainty).
• Black versus White individuals had lower odds of lipid-lowering prescriptions (OR:0.78, 95%CI:0.74,0.81; high certainty).
• Individuals aged 18-45 years had lower odds of lipid-lowering prescriptions (OR:0.33, 95%CI:0.19,0.57; moderate certainty).
• Asian individuals had lower odds of antihypertensive medication prescription (OR:0.42, 95%CI:0.38,0.46; high certainty).

Why it matters

Guideline-recommended cardiovascular prevention is intended to reduce progression of cardiovascular disease in people with diabetes. Differences in receipt of preventive care across sociodemographic groups indicate that guideline availability does not ensure equitable delivery. Identifying which care measures and groups show disparities can inform efforts to improve guideline equity and dissemination, while the varying certainty of evidence calls for careful interpretation.

What to keep in mind

The review pooled observational comparisons, so the reported differences do not establish that sociodemographic characteristics caused disparities. Certainty varied across findings, and some estimates were imprecise.