title: Diabetes control among Hispanics in the action to control cardiovascular risk in diabetes trial.
abstract: BACKGROUND
  Hispanics in the United States represent diverse racial, ethnic, and socioeconomic groups, and manifest heterogeneous cardiovascular risks including diabetes. It is not known if there are residual differences in the control of diabetes among Hispanic groups given uniform access to diabetes care.
  
  
  OBJECTIVE
  To evaluate glucose control differences among Mexicans, Puerto Ricans, and Dominicans receiving substantial diabetes care and support in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.
  
  
  METHODS
  Secondary analysis of data from a randomized trial comparing two treatment strategies: intensive, targeting glycated hemoglobin below 6.0 %, and standard, targeting glycated hemoglobin between 7.0 % and 7.9 %.
  
  
  METHODS
  Seven hundred and sixteen Hispanic and 6066 non-Hispanic white participants were recruited from 77 clinical sites across the United States and Canada. There were 243 Mexicans, 199 Puerto Ricans, and 150 Dominicans; and 135 of these Hispanic groups were born in the United States.
  
  
  METHODS
  Glycated hemoglobin
  
  
  RESULTS
  Compared to Puerto Ricans, Mexicans were more likely (HR=1.38, CI:0.90-2.10) and Dominicans as likely (HR=1.01, CI:0.66-1.54) to achieve glycated hemoglobin goal in the intensive arm. Participants born in the United States achieved glycated hemoglobin goal at a higher rate than those born elsewhere (HR=1.57, CI:0.99-2.51 in the intensive arm, HR=1.51, CI:0.95-2.43 in the standard arm). These differences were not statistically significant. In the intensive arm, Puerto Ricans (OR=0.47, CI:0.31-0.71), and Dominicans (OR=0.41, CI:0.26-0.66) were less likely than non-Hispanic whites to achieve glycated hemoglobin goal, whereas the difference between non-Hispanic whites and Mexicans was not statistically significant, (OR=0.66, CI:0.43-1.02).
  
  
  CONCLUSIONS
  Hispanic groups, given access to comprehensive diabetes care, differed from each other non-significantly and had a variable divergence from non-Hispanic whites in achieving intensive glycated hemoglobin goal. These differences, if confirmed, could be due to such factors as variable acculturation and functional health literacy levels that were not measured in the ACCORD trial, but should be further explored in future studies.
authors: Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA. ag665@columbia.edu
authors: Asqual
authors: A
authors: Getaneh
authors: Laney S
authors: LS
authors: Light
authors: David J
authors: DJ
authors: Brillon
authors: Jorge
authors: J
authors: Calles Escandón
authors: James
authors: J
authors: Felicetta
authors: Gregory W
authors: GW
authors: Evans
authors: Carlos R
authors: CR
authors: Lopez-Jimenez
authors: Robert
authors: R
authors: Cuddihy
authors: J Thomas
authors: JT
authors: Bigger
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D016016:Proportional Hazards Models; D011647:Puerto Rico / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin