OBJECTIVE: Significant race and ethnic disparities exist in diabetes-related 
health care. Using a nationally representative database, we sought to determine 
if use of thiazolidinediones (TZDs) differs by race and ethnicity. As a 
secondary objective, we sought to determine if race and ethnicity is associated 
with use of older oral antidiabetic agents, such as sulfonylureas and metformin.
RESEARCH DESIGN AND METHODS: Adult respondents to the 2003 Medical Expenditure 
Panel Survey with diabetes, identified by diagnosis code or self-report, were 
included. Race/ethnic groups were defined as: White/not-Hispanic; 
Black/not-Hispanic; Hispanic; or Other/not-Hispanic. Associations between use of 
oral antidiabetic agents (defined as > or = 1 prescription for a TZD, 
sulfonylurea, or metformin) and race/ethnicity, sex, age, insurance status, 
poverty status, and having a usual source of care were evaluated in univariate 
analyses with chi(2) tests and in adjusted analyses using logistic regression 
methods for survey data.
RESULTS: A total of 1873 US adults with diabetes were identified, with use of 
oral antidiabetic agents varying by drug class: 23.1% received TZDs, 45.3% 
received metformin, and 43.8% received sulfonylureas. Use of oral antidiabetic 
agents, by drug class, did not differ significantly by race/ethnicity (p = 0.33 
for TZDs, p = 0.43 for metformin, p = 0.38 for sulfonylureas). In univariate 
analyses, only insurance status was significantly associated with use of TZDs (p 
= 0.03), and no variables were associated with use of sulfonylureas or 
metformin. In adjusted logistic regression analyses, there were no significant 
predictors of the use of TZDs or metformin, and only age was significantly 
associated with the use of sulfonylureas.
CONCLUSIONS: In a nationally representative database, fewer US adults with 
diabetes received TZDs compared with sulfonylureas or metformin in 2003. 
Although we were not able to differentiate between type 1 and type 2 diabetes, 
nor did we assess oral agent monotherapy versus combination therapy, we found 
that use of TZDs, sulfonylureas, and metformin did not differ based on 
race/ethnicity or other demographic variables such as sex, insurance status, 
poverty status, or having a usual source of health care.