Racial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study

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dc.contributor.authorWendel, Christopher S
dc.contributor.authorShah, Jayendra H
dc.contributor.authorDuckworth, William C
dc.contributor.authorHoffman, Richard M
dc.contributor.authorMohler, M Jane
dc.contributor.authorMurata, Glen H
dc.date.accessioned2019-08-14T15:04:21Z
dc.date.available2019-08-14T15:04:21Z
dc.date.issued2006
dc.description.abstractBackground Racial/ethnic disparities in cardiovascular disease complications have been observed in diabetic patients. We examined the association between race/ethnicity and cardiovascular disease risk factor control in a large cohort of insulin-treated veterans with type 2 diabetes. Methods We conducted a cross-sectional observational study at 3 Veterans Affairs Medical Centers in the American Southwest. Using electronic pharmacy databases, we randomly selected 338 veterans with insulin-treated type 2 diabetes. We collected medical record and patient survey data on diabetes control and management, cardiovascular disease risk factors, comorbidity, demographics, socioeconomic factors, psychological status, and health behaviors. We used analysis of variance and multivariate linear regression to determine the effect of race/ethnicity on glycemic control, insulin treatment intensity, lipid levels, and blood pressure control. Results The study cohort was comprised of 72 (21.3%) Hispanic subjects (H), 35 (10.4%) African Americans (AA), and 226 (67%) non-Hispanic whites (NHW). The mean (SD) hemoglobin A1c differed significantly by race/ethnicity: NHW 7.86 (1.4)%, H 8.16 (1.6)%, AA 8.84 (2.9)%, p = 0.05. The multivariate-adjusted A1c was significantly higher for AA (+0.93%, p = 0.002) compared to NHW. Insulin doses (unit/day) also differed significantly: NHW 70.6 (48.8), H 58.4 (32.6), and AA 53.1 (36.2), p < 0.01. Multivariate-adjusted insulin doses were significantly lower for AA (-17.8 units/day, p = 0.01) and H (-10.5 units/day, p = 0.04) compared to NHW. Decrements in insulin doses were even greater among minority patients with poorly controlled diabetes (A1c ≥ 8%). The disparities in glycemic control and insulin treatment intensity could not be explained by differences in age, body mass index, oral hypoglycemic medications, socioeconomic barriers, attitudes about diabetes care, diabetes knowledge, depression, cognitive dysfunction, or social support. We found no significant racial/ethnic differences in lipid or blood pressure control. Conclusion In our cohort, insulin-treated minority veterans, particularly AA, had poorer glycemic control and received lower doses of insulin than NHW. However, we found no differences for control of other cardiovascular disease risk factors. The diabetes treatment disparity could be due to provider behaviors and/or patient behaviors or preferences. Further research with larger sample sizes and more geographically diverse populations are needed to confirm our findings.
dc.description.urihttp://dx.doi.org/10.1186/1472-6963-6-58
dc.identifierhttps://doi.org/10.13016/au1h-qpep
dc.identifier.citationWendel, Christopher S and Shah, Jayendra H and Duckworth, William C and Hoffman, Richard M and Mohler, M Jane and Murata, Glen H (2006) Racial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study. BMC Health Services Research, 6 (1). p. 58.
dc.identifier.issn14726963
dc.identifier.otherEprint ID 3062
dc.identifier.urihttp://hdl.handle.net/1903/23678
dc.subjectDisparities
dc.subjectCardiovascular Disease
dc.subjectDiabetes
dc.subjectHealth Risk Factors
dc.subjectResearch
dc.subjectRacial/ethnic disparities
dc.subjectcardiovascular disease
dc.subjecttype 2 diabetes
dc.subjectveterans
dc.titleRacial and ethnic disparities in the control of cardiovascular disease risk factors in Southwest American veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study
dc.typeArticle

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