Regional, Geographic, and Racial/Ethnic Variation in Glycemic Control in a National Sample of Veterans With Diabetes

April 2011
Diabetes Care;Apr2011, Vol. 34 Issue 4, p938
Academic Journal
OBJECTIVE--We performed a retrospective analysis of a national cohort of veterans with diabetes to better understand regional, geographic, and racial/ethnic variation in diabetes control as measured by HbA1c. RESEARCH DESIGH AND METHODS--A retrospective cohort study was conducted in a national cohort of 690,968 veterans with diabetes receiving prescriptions for insulin or oral hypoglycemic agents in 2002 that were followed over a 5-year period. The main outcome measures were HbA1c levels (as continuous and dichotomized at ≥8.0%). RESULTS--Relative to non-Hispanic whites (NHWs), HbA1c levels remained 0.25% higher in non-Hispanic blacks (NHBs), 0.31% higher in Hispanics, and 0.14% higher in individuals with other/unknown/missing racial/ethnic group after controlling for demographics, type of medication used, medication adherence, and comorbidities. Small but statistically significant geographic differences were also noted with HbA1c being lowest in the South and highest in the Mid-Atlantic. Rural/urban location of residence was not associated with HbA1c levels. For the dichotomous outcome poor control, results were similar with race/ethnic group being strongly associated with poor control (i.e., odds ratios of 1.33 [95% CI 1.31-1.35] and 1.57 [1.54-l.61] for NHBs and Hispanics vs. NHWs, respectively), geographic region being weakly associated with poor control, and rural/urban residence being negligibly associated with poor control. CONCLUSIONS--In a national longitudinal cohort of veterans with diabetes, we found racial/ethnic disparities in HbA1c levels and HbA1c, control; however, these disparities were largely, but not completely, explained by adjustment for demographic characteristics, medication adherence, type of medication used to treat diabetes, and comorbidities.


Related Articles

  • Management of diabetes in the elderly with canagliflozin: A newer hypoglycemic drug on the horizon: Erratum.  // Journal of Pharmacology & Pharmacotherapeutics;Jan-Mar2015, Vol. 6 Issue 1, p58 

    A correction to the article "Management of diabetes in the elderly with canagliflozin: A newer hypoglycemic drug on the horizon" that was published in the October-December 2014 issue is presented.

  • Diabetes Mellitus Is Associated With an Increased Risk of Falls in Elderly Residents of a Long-Term Care Facility. Maurer, Mathew S.; Burcham, Joyce; Huai Cheng; Morley, John E. // Journals of Gerontology Series A: Biological Sciences & Medical ;Sep2005, Vol. 60 Issue 9, p1157 

    Background. Diabetes mellitus is common among elderly persons, with several potential complications that could contribute to falls. However, diabetes mellitus is not widely recognized as an important risk factor for falls among elderly persons. Accordingly, the purpose of the current study was...

  • Antihypertensive Medication Prescribing in 27,822 Elderly Canadians With Diabetes Over the Past Decade. McAlister, Finlay A.; Campbell, Norman R. C.; Duong-Hua, Minh; Chen, Zhongliang; Tu, Karen // Diabetes Care;Apr2006, Vol. 29 Issue 4, p836 

    OBJECTIVE -- The purpose of this study was to examine whether prescribing practices for elderly individuals with diabetes and hypertension changed over the past decade. RESEARCH DESIGN AND METHODS -- We linked the Ontario Diabetes Database and four administrative databases in Ontario, Canada, to...

  • Diabetes is still a CV risk factor in the elderly.  // Cortlandt Forum;Dec2006, Vol. 19 Issue 12, p15 

    The article offers information on a study which appeared in the October 2006 issue of the journal "PloS Medicine," which depicts cardiovascular (CV) risk factors due to diabetes mellitus (DM) in the elderly. Relative risk for CV disease and coronary heart disease is of 2 and 2.5 respectively...

  • Management of Type 2 Diabetes in Treatment-Naive Elderly Patients. Pratley, Richard E.; Rosenstock, Julio; Pi-Sunyer, F. Xavier; Banerji, Mary Ann; Schweizer, Anja; Couturier, Andre; Dejager, Sylvie // Diabetes Care;Dec2007, Vol. 30 Issue 12, p3017 

    OBJECTIVE -- The purpose of this study was to evaluate the efficacy and safety of vildagliptin in elderly patients with type 2 diabetes. RESEARCH DESIGN AND METHODS -- Efficacy data from five double-blind, randomized, placebo- or active-controlled trials of ≥24 weeks' duration were pooled....

  • Starting insulin therapy in elderly patients. Hendra, T. J. // Journal of the Royal Society of Medicine;Sep2002, Vol. 95 Issue 9, p453 

    The article discusses the important factors to consider in using insulin to treat elderly patients with diabetes. The benefits and disadvantages of the insulin must be explained to and understood by patients and carers. Insulin is usually started at home when full doses of oral hypoglycemic...

  • Obesity in the Elderly Diabetic Patient. Kyrou, Ioannis; Tsigos, Constantine // Diabetes Care;Nov2009 Supplement, Vol. 32, pS403 

    The article examines the benefits and risks linked to weight loss in elderly patients with diabetes. It recommends some measures to be taken in the weight management plan such as lifestyle changes, diet and physical activity. It cites some antidiabetic drugs that enhance glycemic control and...

  • Impact of Diabetes on Physical Function in Older People. Sinclair, Alan J.; Conroy, Simon P.; Bayer, Antony J. // Diabetes Care;Feb2008, Vol. 31 Issue 2, p233 

    OBJECTIVE -- To explore the nature of functional impairment in older people with diabetes. RESEARCH DESIGN AND METHODS -- A population-based case-control study with detailed assessment of diabetes and functional status was undertaken. RESULTS -- Altogether, 403 case subjects and 403 matched...

  • Increasing Incidence of Type 1 Diabetes in 0- to 17-Year-Old Colorado Youth. Vehik, Kendra; Hamman, Richard F.; Lezotte, Dennis; Norris, Jill M.; Klingensmith, Georgeanna; Bloch, Clifford; Rewers, Marian; Dabelea, Dana // Diabetes Care;Mar2007, Vol. 30 Issue 3, p503 

    OBJECTIVE -- We sought to assess the long-term trends in the incidence of type 1 diabetes among non-Hispanic white and Hispanic youth aged 0-17 years from Colorado using data from the Colorado IDDM Study Registry (1978-1988) and SEARCH for Diabetes in Youth (2002-2004). RESEARCH DESIGN AND...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics