Egede LE (Charleston VA TREP), Mauldin PD
(Charleston VA TREP), Mueller M
(Charleston VA TREP), Durkalski VL
(Charleston VA TREP), Chen GJ
(Charleston VA TREP), Moran PW
(Charleston VA TREP)
To assess glycemic control over time across racial/ethnic groups of veterans with type 2 diabetes.
In this retrospective longitudinal study, a sample of 4,521 veterans from the Ralph H. Johnson VA medical center in Charleston SC with type 2 diabetes were identified in DSS databases and followed from Q1 2003 through Q4 2005. Diabetes Control was measured by HbA1c levels through time (treated as continuous). Race/ethnicity was defined as “non-Hispanic Black/African American”, “non-Hispanic White”, “Hispanic”, and “Missing”. The Modified Deyo-Charlson co-morbidity index was calculated to adjust for co-morbidity (the score for type 2 diabetes was subtracted from the final index score). For the multivariate analysis, a mixed model was created and adjusted for repeated measures. Significance was determined at the 0.05 level.
Of the 4,524 veterans in the sample, the average age was 65±10. Ninety seven percent were male, and 30% were non-Hispanic Black/African American, 50% non-Hispanic White, 1% Hispanic, and nearly 14% classified as “Missing Race/Ethnicity Data.” The average modified Deyo-Charlson score was 0.68±1.91, and average HbA1c level 7.35±1.67. Multivariate analysis revealed that compared to non-Hispanic Whites, non-Hispanic Black/African Americans had the strongest association with poor diabetes control (high levels of HbA1c ) (0.49 estimate; p < 0.0001). No other race/ethnicity variables were significant compared to non-Hispanic Whites. Age was negatively associated with diabetes control (p < 0.0001); however, the modified Deyo-Charlson co-morbidity index had a positive association (p=0.05).
After controlling for demographic characteristics, baseline HbA1c and co-morbidity, non-Hispanic Black/African Americans had poorer glycemic control compared to non-Hispanic Whites.
Previous non-VA studies have shown that African Americans have poorer glycemic control and are disproportionately burdened with the complications and disability that result from poorly treated diabetes. The results from this longitudinal analysis suggest similar racial/ethnic differences in glycemic control exist within the VA. Clinical interventions to improve glycemic control that specifically target African American veterans with type 2 diabetes are needed.