title: Clustering of cardiometabolic risk factors and risk of elevated HbA1c in non-Hispanic White, non-Hispanic Black and Mexican-American adults with type 2 diabetes.
abstract: OBJECTIVE
  To determine which cardiometabolic risk factors and clusters of cardiometabolic risk factors that are mostly associated with elevated HbA1c in non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican-American (MA) adults who have type 2 diabetes.
  
  
  METHODS
  Data (n=2910) from the United States National Health and Nutritional Examination Surveys were used in this study. Elevated HbA1c was defined as having HbA1c value was 7% or greater. Race/ethnicity-specific associations of individual and clustered (2-5 factors) cardiometabolic risk factors with elevated HbA1c were determined using prevalence odds ratio from multivariate logistic regression analyses. Statistical adjustments were made for sex, age, education, income and marital status.
  
  
  RESULTS
  Joint occurrence of abdominal obesity, high blood pressure, and elevated triglycerides and joint occurrence of high blood pressure, elevated triglycerides and low HDL were more highly associated with elevated odds of HbA1c compared to other cardiometabolic risk factors joint occurrences. Joint occurrences of abdominal obesity, high blood pressure, and elevated triglycerides was associated with 2.3 (95% CI: 1.2-3.3), 9.1 (95% CI: 2.9-28.7) and 4.8 (95% CI: 2.0-11.5) increased odds of elevated HbA1c in NHW, NHB and MA, respectively. The corresponding values for the joint occurrence of high blood pressure, elevated triglycerides and low HDL was associated with 2.4 (95% CI: 1.2-3.7), 3.5 (95% CI: 1.1-5.5) and 2.6 (95% CI: 1.5-4.7) increased odds of elevated HbA1c in NHW, NHB and MA, respectively.
  
  
  CONCLUSIONS
  This finding calls for consideration of cardiovascular risk factor clustering in deciding medical therapies to optimize glycemic control in individuals with type 2 diabetes. Interventions designed to achieve glycemic control coupled with modification of cardiometabolic risk factors may be crucial in alleviating sequelae resulting from type 2 diabetes.
authors.affiliation: Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 30302, United States. Electronic address: iokosun@gsu.edu.
authors.forename: Ike S
authors.initials: IS
authors.lastname: Okosun
authors.affiliation: Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 30302, United States.
authors.forename: Francis
authors.initials: F
authors.lastname: Annor
authors.affiliation: Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 30302, United States.
authors.forename: Ebenezer A
authors.initials: EA
authors.lastname: Dawodu
authors.affiliation: Division of Epidemiology & Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 30302, United States.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Eriksen
mesh_terms: D000328:Adult; D001741:Black or African American; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000208:ethnology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D052456:Hypoalphalipoproteinemias / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D017058:Mexican Americans; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D056128:Obesity, Abdominal / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D014481:United States; D044465:White People
chemical_list: D006442:Glycated Hemoglobin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human
keywords: Cardiovascular risk factors; Glucose homeostasis; Glycosylated hemoglobin