title: Regional, geographic, and racial/ethnic variation in glycemic control in a national sample of veterans with diabetes.
abstract: OBJECTIVE
  We performed a retrospective analysis of a national cohort of veterans with diabetes to better understand regional, geographic, and racial/ethnic variation in diabetes control as measured by HbA(1c).
  
  
  METHODS
  A retrospective cohort study was conducted in a national cohort of 690,968 veterans with diabetes receiving prescriptions for insulin or oral hypoglycemic agents in 2002 that were followed over a 5-year period. The main outcome measures were HbA(1c) levels (as continuous and dichotomized at ≥8.0%).
  
  
  RESULTS
  Relative to non-Hispanic whites (NHWs), HbA(1c) levels remained 0.25% higher in non-Hispanic blacks (NHBs), 0.31% higher in Hispanics, and 0.14% higher in individuals with other/unknown/missing racial/ethnic group after controlling for demographics, type of medication used, medication adherence, and comorbidities. Small but statistically significant geographic differences were also noted with HbA(1c) being lowest in the South and highest in the Mid-Atlantic. Rural/urban location of residence was not associated with HbA(1c) levels. For the dichotomous outcome poor control, results were similar with race/ethnic group being strongly associated with poor control (i.e., odds ratios of 1.33 [95% CI 1.31-1.35] and 1.57 [1.54-1.61] for NHBs and Hispanics vs. NHWs, respectively), geographic region being weakly associated with poor control, and rural/urban residence being negligibly associated with poor control.
  
  
  CONCLUSIONS
  In a national longitudinal cohort of veterans with diabetes, we found racial/ethnic disparities in HbA(1c) levels and HbA(1c) control; however, these disparities were largely, but not completely, explained by adjustment for demographic characteristics, medication adherence, type of medication used to treat diabetes, and comorbidities.
authors.affiliation: Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA. egedel@musc.edu
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Hunt
authors.forename: Robert N
authors.initials: RN
authors.lastname: Axon
authors.forename: Carrae
authors.initials: C
authors.lastname: Echols
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Gilbert
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Mauldin
mesh_terms: D044383:Black People / Q000706:statistics & numerical data; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000208:ethnology / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D012189:Retrospective Studies; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin