title: Glycemic control and health disparities in older ethnically diverse underserved adults with diabetes: five-year results from the Informatics for Diabetes Education and Telemedicine (IDEATel) study.
abstract: OBJECTIVE
  The Informatics for Diabetes Education and Telemedicine (IDEATel) project randomized ethnically diverse underserved older adults with diabetes to a telemedicine intervention or usual care. Intervention participants had lower A1C levels over 5 years. New analyses were performed to help better understand this difference.
  
  
  METHODS
  IDEATel randomized Medicare beneficiaries with diabetes (n = 1,665) to receive home video visits with a diabetes educator and upload glucose levels every 4-6 weeks or usual care (2000-2007). Annual measurements included BMI, A1C (primary outcome), and completion of questionnaires. Mixed-model analyses were performed using random effects to adjust for clustering within primary care physicians.
  
  
  RESULTS
  At baseline, A1C levels (mean ± SD) were 7.02 ± 1.25% in non-Hispanic whites (n = 821), 7.58 ± 1.78% in non-Hispanic blacks (n = 248), and 7.79 ± 1.68% in Hispanics (n = 585). Over time, lower A1C levels were associated with more glucose uploads (P = 0.02) and female sex (P = 0.002). Blacks, Hispanics, and insulin-users had higher A1C levels than non-Hispanic whites (P < 0.0001). BMI was not associated with A1C levels. Blacks and Hispanics had significantly fewer uploads than non-Hispanic whites over time. Hispanics had the highest baseline A1C levels and showed the greatest improvement in the intervention, but, unlike non-Hispanic whites, Hispanics did not achieve A1C levels <7.0% at 5 years.
  
  
  CONCLUSIONS
  Racial/ethnic disparities were observed in this cohort of underserved older adults with diabetes. The IDEATel telemedicine intervention was associated with improvement in glycemic control, particularly in Hispanics, who had the highest baseline A1C levels, suggesting that telemedicine has the potential to help reduce disparities in diabetes management.
authors.affiliation: SUNY Upstate Medical University, Syracuse, New York, USA. weinstor@upstate.edu
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Teresi
authors.forename: Robin
authors.initials: R
authors.lastname: Goland
authors.forename: Roberto
authors.initials: R
authors.lastname: Izquierdo
authors.forename: Walter
authors.initials: W
authors.lastname: Palmas
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Eimicke
authors.forename: Susana
authors.initials: S
authors.lastname: Ebner
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
mesh_terms: D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000208:ethnology; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D017216:Telemedicine / Q000379:methods*; D014481:United States; D014743:Videotape Recording; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human