title: Ethnic disparities in glycemic control among rural older adults with type 2 diabetes.
abstract: Glycemic control is a predictor of diabetes-related morbidity and mortality. However, little is known about how well older adults in rural communities, with limited access to self-care resources and specialty care practitioners, control their diabetes. Even less is known about whether minority, older, rural adults are at increased risk for poor glycemic control. We analyzed data from a cross-sectional survey of randomly selected older (> or =65 years) adults with type 2 diabetes in rural North Carolina. Participants (N=693) were men and women from three ethnic groups: African American, Native American, and White. Capillary blood samples were collected for HbA1C analysis. HbA1C levels (<7%, 7%-<8%, and > or =8%) were compared across ethnic and gender groups. Two multiple logistic regression models (model 1: personal characteristics; model 2: personal and health characteristics) were used to evaluate potential predictors of HbA1C > or =7%. Overall, 36.4% had HbA1C > or =7%. Native Americans and African-American men had the highest proportion at levels of poor glycemic control (> or =7%), and African-American women and White men had the lowest. In bivariate analysis, ethnicity, living arrangements, use of medications for diabetes, having a diabetes-related healthcare visit in the past year, and duration of diabetes were significantly associated with glycemic control. In multivariate analysis (model 1), being Native American, having low income without Medicaid, and being married were associated with poor glycemic control. Adding health characteristics (model 2), longer diabetes duration and diabetes medication therapy were significant predictors. These data indicate that older ethnic minorities in rural communities are at increased risk for diabetes complications and need diabetes management strategies to improve glycemic control.
authors.affiliation: Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA. squandt@wfubmc.edu
authors.forename: Sara A
authors.initials: SA
authors.lastname: Quandt
authors.forename: Ronny A
authors.initials: RA
authors.lastname: Bell
authors.forename: Beverly M
authors.initials: BM
authors.lastname: Snively
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Smith
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Stafford
authors.forename: Lindsay K
authors.initials: LK
authors.lastname: Wetmore
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Arcury
mesh_terms: D000368:Aged; D044467:American Indian or Alaska Native; D044383:Black People; D001786:Blood Glucose / Q000378:metabolism*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000208:ethnology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D009657:North Carolina; D011237:Predictive Value of Tests; D012423:Rural Health; D016896:Treatment Outcome; D044465:White People; D001741:Black or African American
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents