Diabetes care in black and white veterans in the southeastern U.S.
OBJECTIVE
Eliminating health disparities is a national priority, but progress has been difficult because of racial/ethnic differences in insurance coverage and access to health care. We investigated whether there were differences in diabetes care in the Veterans Administration (VA), where health care access should be relatively uniform.


METHODS
A1C and plasma glucose were compared before/after diagnosis of diabetes.


RESULTS
Data were available for 1,456 black and 2,624 white veterans who met criteria for consistent primary care. Over 4-5 years before and after diagnosis, blacks had similar glucose and approximately 0.2% higher A1C levels than whites, and A1C differences could be attributed to glucose-independent associations between race and A1C. Blacks and whites also had comparable intervals between diagnostic-level hyperglycemia and diagnosis and between diagnosis and drug initiation. However, A1C was higher in blacks at the time of diagnosis (7.8 vs. 7.1%) and at initiation of pharmacotherapy (8.5 vs. 7.8%) (both P < 0.001). Differences in A1C at diagnosis and drug initiation were too large to be explained by differences in age, sex, BMI, and glucose-independent associations between race and A1C.


CONCLUSIONS
In the VA, glucose levels are generally comparable in blacks and whites except at the times of diagnosis and initiation of pharmacotherapy, when glucose levels are higher in blacks. While understanding the basis for such residual disparities may be important to improve the health of racial/ethnic minorities in the U.S., a health care system with structure and organization similar to that in the VA may also contribute importantly to relieving disparities in health.
Twombly
Jennifer G
JG
Division of Endocrinology and Metabolism, Emory University School of Medicine, Atlanta, Georgia, USA.
Long
Qi
Q
Zhu
Ming
M
Wilson
Peter W F
PW
Narayan
K M Venkat
KM
Fraser
Lisa-Ann
LA
Webber
Brian C
BC
Phillips
Lawrence S
LS
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000208:ethnology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D015144:Southeastern United States / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human