Author(s): Egede LE, Mueller M, Echols CL, Gebregziabher M
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Abstract OBJECTIVE: To examine longitudinal differences in glycemic control between non-Hispanic white and non-Hispanic black veterans with type 2 diabetes. DESIGN: Retrospective cohort study. SETTING: VA facility in the Southeastern United States. PARTICIPANTS: A 3-month person-period dataset was created for 8813 veterans with type 2 diabetes between June 1997 and May 2006. MAIN OUTCOME MEASURES: Primary outcome was mean change in hemoglobin A1c (HbA1c) over time. Secondary outcome was the odds of poor glycemic control over time (HbA1c >8\%). For the primary outcome, a linear mixed model (LMM) approach was used to model the relationship of HbA1c levels and race/ethnicity over time. For the secondary outcome, generalized LMMs were used to assess whether glycemic control changed over time and whether change in glycemic control varied by racial/ethnic group. RESULTS: Mean age was 66.3 years, 36\% were non-Hispanic black (NHB), 98\% were male, 65\% were married, and 50\% were unemployed. Mean follow-up time was 4.4 years. Least square mean HbA1c levels from LMM adjusted for time and relevant confounders showed that NHBs had higher HbA1c values over time (mean difference of 0.54\% [P < 0.001]). The final model with poor versus good glycemic control as the dependent variable, race/ethnicity as primary independent variable adjusted for time, and relevant confounders showed that NHBs were likely to have poor control compared with NHWs (OR: 1.8, 95\% CI, 1.7; 2.0, P < 0.0001). CONCLUSIONS: NHB veterans were more likely to have higher mean HbA1c values and less likely to have good glycemic control over time compared with NHW veterans.
This article was published in Med Care
and referenced in Journal of Biometrics & Biostatistics