Longitudinal differences in glycemic control by race/ethnicity among veterans with type 2 diabetes.
OBJECTIVE
To examine longitudinal differences in glycemic control between non-Hispanic white and non-Hispanic black veterans with type 2 diabetes.


METHODS
Retrospective cohort study.


METHODS
VA facility in the Southeastern United States.


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


METHODS
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.
Egede
Leonard E
LE
Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA. egedel@musc.edu
Mueller
Martina
M
Echols
Carrae L
CL
Gebregziabher
Mulugeta
M
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000208:ethnology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin