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CS Wendel, Southern Arizona VA Health Care System; C Dalton, Southern Arizona VA Health Care System; JH Shah, Southern Arizona VA Health Care System; WC Duckworth, Carl T Hayden Medical Center; SU Bokhari, Carl T. Hayden Medical Center; MT Montagnini, Carl T. Hayden Medical Center; KD Adam, New Mexico VA Health Care System; GH Murata, New Mexico VA Health Care System

Objectives: The purpose of this study was to examine the relationship between Glycemic control, access barriers and lifestyle in insulin-treated Hispanic and non-Hispanic white veterans in the Southwest.

Methods: We performed a cross-sectional observational study. Prospective subjects were randomly selected from pharmacy records at the Albuquerque, Phoenix, and Tucson VAMCs. Subjects were eligible if, during the preceding two months, they received no new prescriptions for oral hypoglycemic agents and insulin doses were not increased by more than 10 units or 15%. Subjects were interviewed and given a battery of questionnaires. Hemoglobin A1c and a number of physiological parameters were measured. Fund of knowledge was assessed by the University of Michigan Diabetes Knowledge Test. The Geriatric Depression Scale was used to rate the severity of depression. Exercise was quantified by the Modifiable Activities Questionnaire. The Mini-Mental Status Exam was used to screen for cognitive deficits. Supportive family behaviors were measured by the Diabetes Family Behavior Checklist.

Results: We recruited 170 veterans. The analysis is restricted to the 146 veterans who categorized themselves as either Hispanic (32 or 21.9%) or non-Hispanic white (114 or 78.1%). The mean age (+/- SD) was 61.7 +/- 10.6 years for Hispanics versus 65.0 +/- 9.6 years for non-Hispanic whites (P=.09). Hispanic patients had significantly higher hemoglobin A1c than non-Hispanics (8.5 +/- 1.8 vs. 7.9 +/- 1.6%, respectively; P<.05). No differences were found between Hispanic and non-Hispanic white patients with respect to the number of oral hypoglycemic agents prescribed (0.52 +/- 0.81 vs. 0.55 +/- 0.82 per patient) or daily insulin dose (59.3 +/- 29.9 vs. 70.2 +/- 47.3 units). Hispanic subjects were more likely to prefer a language other than English (16% vs. 1%; P=.002), had fewer years of education (12.3 +/- 3.4 vs. 13.9 +/- 2.7; P=.02), scored lower on the 30-point Mini-Mental Status Exam (26.5 +/- 3.2 vs. 28.4 +/- 1.9; P=.001), were more depressed (10.4 +/- 8.0 vs. 7.4 +/- 6.8 on the 30-point scale; P=.05), and answered fewer questions correctly on the diabetes knowledge test (59.9 +/- 14.4 vs. 66.6 +/- 14.2%; P=.02). Hispanic patients ate fewer meals per day (2.2 +/- 0.7 vs. 2.5 +/- 0.8; P=.01) and were more likely to skip meals frequently (58.1 vs. 36.3%; P=.03). No group differences were found with respect to self-perceived disabilities, need for a caregiver, employment, financial status, the amount of alcohol consumed, distance traveled to VA, usual transportation mode to VA, the degree of family support, the proportion of family members with alcoholism or disabilities, body mass index or number of met-hour of exercise per week.

Conclusions: Language preferences, level of education, diabetes knowledge, depression, and irregular dietary habits may be contributing factors in glycemic control of Hispanic veterans with insulin-treated, type II diabetes mellitus.

Impact: Access barriers (language, education, and ethnicity) and lifestyle factors (dietary habits, ethnicity) play important roles in glycemic control of type II diabetics. Psychological profiling may be of value tailoring education programs for diabetic veterans.