Diabetes
Trends in racial/ethnic disparities in glycemic control among veterans with newly-diagnosed diabetes receiving primary care in the Veteran’s Health Administration, 2008-2019 Simin Hua* Simin Hua Rania Kanchi Lorna E. Thorpe Rebecca Anthopolos Mark D. Schwartz Jay Pendse Andrea R. Titus
Background
Racial/ethnic disparities in glycemic control among Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) veterans with type 2 diabetes (T2D) have been reported. This study examines trends in early glycemic control (EGC) by race/ethnicity to understand how disparities soon after T2D diagnosis have changed between 2008 and 2019 among cohorts of newly-diagnosed US veterans.
Methods
We estimated annual percent of EGC (average hemoglobin A1c<7%) in the first 5 years post-diagnosis among 840,789 veterans with newly-diagnosed T2D in primary care. We compared EGC by racial/ethnic group among cohorts defined by diagnosis year (2008-2010, 2011-2013, 2014-2016 and 2017-2019) using mixed effect models with random intercepts. We estimated odds ratios of ECG comparing racial/ethnic minority groups to NHW, adjusting for years of diagnosis, age group, sex and interaction of age and racial/ethnic group with years of diagnosis. We conducted secondary analyses using A1c≥9% in the first 5 years post-diagnosis.
Results
The average annual percent of veterans who achieved EGC during follow-up was 72.8%, 71.8%, 71.5%, and 76.2% in 2008-2010, 2011-2013, 2014-2016, and 2017-2019 cohorts respectively. All racial/ethnic minority groups were less likely to achieve EGC compared to NHW veterans in the 2008-2010 cohort. In cohorts after 2011-2013, NHB and Hispanic veterans were more likely to achieve EGC; however, Hispanic veterans were also more likely to have A1c≥9% within 5 years in all cohorts. EGC disparities for Non-Hispanic Asian, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native veterans persisted during 2011-2016, but they were equally likely to achieve EGC as NHW veterans in the 2017-2019 cohort.
Conclusion
Overall EGC trends among newly-diagnosed veterans in VADR have been stable since 2008. Within that, EGC has improved in most racial/ethnic minority groups relative to NHW veterans. Efforts should continue to minimize disparities between racial/ethnic groups.