Longitudinal Differences in Glycemic Control by Race/Ethnicity Among Veterans With Type 2 Diabetes
Longitudinal Differences in Glycemic Control by Race/Ethnicity Among Veterans With Type 2 Diabetes
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DOI：
10.1097/mlr.0b013e3181d558dc
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发表时间：
2010-06-01
期刊：
影响因子：
3
通讯作者：
Gebregziabher, Mulugeta
中科院分区：
文献类型：
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作者：
Egede, Leonard E.;Mueller, Martina;Gebregziabher, Mulugeta
目的：研究非西班牙裔白人和非西班牙裔黑人退伍军人2型糖尿病患者血糖控制的纵向差异。设计：回顾性队列研究。背景：位于美国东南部的退伍军人事务部设施。参与者：1997年6月至2006年5月期间，8813名患有2型糖尿病的退伍军人创建了一个为期3个月的个人数据集。主要结局指标：主要结局指标是血红蛋白A1c （HbA1c）随时间的平均变化。次要终点是长期血糖控制不良的几率（HbA1c为8%）。对于主要结果，使用线性混合模型（LMM）方法来模拟HbA1c水平与种族/民族随时间的关系。对于次要结局，使用广义lmm来评估血糖控制是否随时间而改变，以及血糖控制的变化是否因种族/民族而异。结果：平均年龄66.3岁，36%为非西班牙裔黑人（NHB）， 98%为男性，65%已婚，50%无业。平均随访时间4.4年。LMM经时间和相关混杂因素调整后的最小二乘平均HbA1c水平显示，随着时间的推移，NHBs的HbA1c值较高（平均差异为0.54% [P < 0.001]）。最终的模型以血糖控制差和血糖控制好为因变量，种族/民族为主要自变量，经时间和相关混杂因素调整后显示，nhb与nhw相比可能控制差（OR: 1.8, 95% CI, 1.7; 2.0, P < 0.0001）。结论：与NHW退伍军人相比，NHB退伍军人更有可能具有较高的平均HbA1c值，并且随着时间的推移，较不可能具有良好的血糖控制。
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.