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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)
Objectives:
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.
Methods:
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.
Results:
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).
Implications:
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.
Impacts:
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.
