de Rekeneire Nathalie, Rooks Ronica N, Simonsick Eleanor M, Shorr Ronald I, Kuller Lewis H, Schwartz Ann V, Harris Tamara B
Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland 20892-9205, USA.
Diabetes Care. 2003 Jul;26(7):1986-92. doi: 10.2337/diacare.26.7.1986.
To evaluate racial differences and factors associated with worse glycemic control in well-functioning older individuals with type 2 diabetes. Our hypothesis was that glycemic control would be worse among black than white diabetic individuals but that this association would be explained by differences in severity of diabetes, health status, health care indicators, and social, psychological, or behavioral factors. We further hypothesized that the association of race with poorer glycemic control would be limited to those with lower education or lower income.
Cross-sectional analysis of 468 diabetic participants among a cohort of 3,075 nondisabled blacks and whites aged 70-79 years living in the community enrolled in the Health, Aging and Body Composition Study. Glycemic control was measured by the level of HbA(1c).
A total of 58.5% of the diabetic individuals were black. Although control was poor in all diabetic participants (HbA(1c) > or =7% in 73.7%), blacks had worse glycemic control than whites (age- and sex-adjusted mean HbA(1c), 8.4% in blacks and 7.4% in whites; P < 0.01). Race differences in glycemic control remained significant, even after adjusting for current insulin therapy, cardiovascular disease, higher total cholesterol, and not receiving a flu shot in the previous year, all of which were associated with higher HbA(1c) concentrations. Controlling for these factors reduced the association by 27%. Race remained an important factor in glycemic control, even when results were stratified by education or income.
HbA(1c) concentrations were higher in older black diabetic individuals. Differences in glycemic control by race were associated with disease severity, health status, and poorer quality of care, but these factors did not fully explain the higher HbA(1c) levels in older black diabetic individuals.
评估功能良好的老年2型糖尿病患者的种族差异以及与血糖控制较差相关的因素。我们的假设是，黑人糖尿病患者的血糖控制要比白人糖尿病患者差，但这种关联可以通过糖尿病严重程度、健康状况、医疗保健指标以及社会、心理或行为因素的差异来解释。我们还进一步假设，种族与较差血糖控制之间的关联将仅限于那些教育程度较低或收入较低的患者。
对参与健康、衰老和身体成分研究的3075名70 - 79岁社区居住的非残疾黑人和白人队列中的468名糖尿病参与者进行横断面分析。通过糖化血红蛋白（HbA₁c）水平来衡量血糖控制情况。
共有58.5%的糖尿病患者为黑人。尽管所有糖尿病参与者的血糖控制都很差（73.7%的患者糖化血红蛋白≥7%），但黑人的血糖控制比白人更差（年龄和性别调整后的平均糖化血红蛋白，黑人8.4%，白人7.4%；P < 0.01）。即使在调整了当前胰岛素治疗、心血管疾病、总胆固醇升高以及前一年未接种流感疫苗（所有这些都与较高的糖化血红蛋白浓度相关）之后，血糖控制方面的种族差异仍然显著。控制这些因素后，这种关联降低了27%。即使按教育程度或收入进行分层，种族仍然是血糖控制的一个重要因素。
老年黑人糖尿病患者的糖化血红蛋白浓度较高。种族间血糖控制的差异与疾病严重程度、健康状况以及较差的医疗质量相关，但这些因素并不能完全解释老年黑人糖尿病患者较高的糖化血红蛋白水平。
