Longitudinal differences in glycemic control by race/ethnicity among veterans with type 2 diabetes

Med Care. 2010 Jun;48(6):527-33. doi: 10.1097/MLR.0b013e3181d558dc.

Abstract

Objective: To examine longitudinal differences in glycemic control between non-Hispanic white and non-Hispanic black veterans with type 2 diabetes.

Design: Retrospective cohort study.

Setting: VA facility in the Southeastern United States.

Participants: A 3-month person-period dataset was created for 8813 veterans with type 2 diabetes between June 1997 and May 2006.

Main outcome measures: Primary outcome was mean change in hemoglobin A1c (HbA1c) over time. Secondary outcome was the odds of poor glycemic control over time (HbA1c >8%). For the primary outcome, a linear mixed model (LMM) approach was used to model the relationship of HbA1c levels and race/ethnicity over time. For the secondary outcome, generalized LMMs were used to assess whether glycemic control changed over time and whether change in glycemic control varied by racial/ethnic group.

Results: Mean age was 66.3 years, 36% were non-Hispanic black (NHB), 98% were male, 65% were married, and 50% were unemployed. Mean follow-up time was 4.4 years. Least square mean HbA1c levels from LMM adjusted for time and relevant confounders showed that NHBs had higher HbA1c values over time (mean difference of 0.54% [P < 0.001]). The final model with poor versus good glycemic control as the dependent variable, race/ethnicity as primary independent variable adjusted for time, and relevant confounders showed that NHBs were likely to have poor control compared with NHWs (OR: 1.8, 95% CI, 1.7; 2.0, P < 0.0001).

Conclusions: NHB veterans were more likely to have higher mean HbA1c values and less likely to have good glycemic control over time compared with NHW veterans.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • African Americans / statistics & numerical data*
  • Aged
  • Cohort Studies
  • Confidence Intervals
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / ethnology*
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Glycated Hemoglobin A / analysis
  • Hispanic Americans / statistics & numerical data*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use
  • Linear Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Prevalence
  • Retrospective Studies
  • United States / epidemiology
  • United States Department of Veterans Affairs
  • Veterans / statistics & numerical data*

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin