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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

3028 — Minority Disparities: A Comparison of Two Cohorts of Southwestern Insulin-Using Veterans

Mohler MJ (Southern Arizona VA HCS), Wendel CS (Southern Arizona VA HCS), Plummer E (Carl T. Hayden VA Medical Center), Brown V (Southern Arizona VA HCS), Adam K (New Mexico VA HCS), Collier K (Carl T. Hayden VA Medical Center), Duckworth W (Carl T. Hayden VA Medical Center), Shah JH (Southern Arizona VA HCS), Murata G (New Mexico VA HCS)

Minority populations are disproportionately affected by T2DM because they have higher incidence of disease, are more vulnerable to microvascular complications, and can encounter socio-cultural barriers to treatment. Our research group recently reported in the “Diabetes Outcomes in Veterans Study” (DOVES) that insulin-using minority veterans had poorer glycemic control and received lower doses of insulin than did non-Hispanic whites (NHW). We compared glycemic control and insulin dosing in a follow-on study, “Insulin Treatment Variation” (ITV), performed in a larger sample of the same population 6 years later.

DOVES and ITV were multicenter, observational studies of Southwestern veterans with insulin-treated Type 2 diabetes, using similar methods. Subjects were randomly selected from pharmacy records indicating the use of at least one insulin preparation daily. Psychological status, social and cultural barriers to care, self-care behaviors, and vascular disease risk factors were collected using a mail survey (ITV) or nurse-interviews (DOVES). Clinical measures included processes of care, complications, hemoglobin A1c (HbA1c), blood pressure, blood lipids, and BMI.

We enrolled 1248 subjects to ITV vs.332 to DOVES. The mean (SD) age was 67.2 (10.3) vs.65.1 (9.7) years with 4.1% vs.3.9% women, respectively. Minorities were significantly younger than NHW in ITV. In ITV, HbA1cs were: 7.7 (1.3) NHW; 7.8 (1.5) Hispanic; 8.3 (2.0) African American (AA) (p < .001). In DOVES, HbA1cs were 7.9 (1.4) NHW; 8.2 (1.6) Hispanic; 8.8 (2.9) AA (p < .05). Insulin units/day did not differ by race/ethnicity in ITV (81, 83 and 84 units, respectively), even though they had in DOVES (71, 58 and 53, respectively, p < .01). Minorities reported significantly more retinopathy in ITV (33%, 44% and 39%, respectively, p=.004).

Insulin-using AAs in VA care remain less well controlled. They have higher HbA1cs, are more likely to have retinopathy, and being younger are at risk for microvascular complications for a longer period of time. Despite these facts, insulin units/day were similar by race/ethnicity in the ITV study, unlike DOVES findings.

These findings indicate possible improvements in clinical diabetes care and underscore issues related to better control, such as the need for increased insulin dosing in more insulin-resistant minorities, and better understanding of minority self-care barriers.

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