Racial differences in glycemic control in a well-functioning older diabetic population: findings from the Health, Aging and Body Composition Study.
OBJECTIVE
To evaluate racial differences and factors associated with worse glycemic control in well-functioning older individuals with type 2 diabetes. Our hypothesis was that glycemic control would be worse among black than white diabetic individuals but that this association would be explained by differences in severity of diabetes, health status, health care indicators, and social, psychological, or behavioral factors. We further hypothesized that the association of race with poorer glycemic control would be limited to those with lower education or lower income.


METHODS
Cross-sectional analysis of 468 diabetic participants among a cohort of 3,075 nondisabled blacks and whites aged 70-79 years living in the community enrolled in the Health, Aging and Body Composition Study. Glycemic control was measured by the level of HbA(1c).


RESULTS
A total of 58.5% of the diabetic individuals were black. Although control was poor in all diabetic participants (HbA(1c) > or =7% in 73.7%), blacks had worse glycemic control than whites (age- and sex-adjusted mean HbA(1c), 8.4% in blacks and 7.4% in whites; P < 0.01). Race differences in glycemic control remained significant, even after adjusting for current insulin therapy, cardiovascular disease, higher total cholesterol, and not receiving a flu shot in the previous year, all of which were associated with higher HbA(1c) concentrations. Controlling for these factors reduced the association by 27%. Race remained an important factor in glycemic control, even when results were stratified by education or income.


CONCLUSIONS
HbA(1c) concentrations were higher in older black diabetic individuals. Differences in glycemic control by race were associated with disease severity, health status, and poorer quality of care, but these factors did not fully explain the higher HbA(1c) levels in older black diabetic individuals.
de Rekeneire
Nathalie
N
Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892-9205, USA. rekenein@nia.nih.gov
Rooks
Ronica N
RN
Simonsick
Eleanor M
EM
Shorr
Ronald I
RI
Kuller
Lewis H
LH
Schwartz
Ann V
AV
Harris
Tamara B
TB
D017668:Age of Onset; D000368:Aged; D000375:Aging / Q000502:physiology*; D044383:Black People; D001823:Body Composition; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000503:physiopathology; D004522:Educational Status; D006442:Glycated Hemoglobin / Q000032:analysis; D038321:Glycemic Index / Q000502:physiology*; D006801:Humans; D007182:Income; D044469:Racial Groups; D012959:Socioeconomic Factors; D014481:United States; D044465:White People; D001741:Black or African American
D006442:Glycated Hemoglobin