Quandt Sara A, Bell Ronny A, Snively Beverly M, Smith Shannon L, Stafford Jeanette M, Wetmore Lindsay K, Arcury Thomas A
Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
Ethn Dis. 2005 Autumn;15(4):656-63.
Glycemic control is a predictor of diabetes-related morbidity and mortality. However, little is known about how well older adults in rural communities, with limited access to self-care resources and specialty care practitioners, control their diabetes. Even less is known about whether minority, older, rural adults are at increased risk for poor glycemic control. We analyzed data from a cross-sectional survey of randomly selected older (> or =65 years) adults with type 2 diabetes in rural North Carolina. Participants (N=693) were men and women from three ethnic groups: African American, Native American, and White. Capillary blood samples were collected for HbA1C analysis. HbA1C levels (<7%, 7%-<8%, and > or =8%) were compared across ethnic and gender groups. Two multiple logistic regression models (model 1: personal characteristics; model 2: personal and health characteristics) were used to evaluate potential predictors of HbA1C > or =7%. Overall, 36.4% had HbA1C > or =7%. Native Americans and African-American men had the highest proportion at levels of poor glycemic control (> or =7%), and African-American women and White men had the lowest. In bivariate analysis, ethnicity, living arrangements, use of medications for diabetes, having a diabetes-related healthcare visit in the past year, and duration of diabetes were significantly associated with glycemic control. In multivariate analysis (model 1), being Native American, having low income without Medicaid, and being married were associated with poor glycemic control. Adding health characteristics (model 2), longer diabetes duration and diabetes medication therapy were significant predictors. These data indicate that older ethnic minorities in rural communities are at increased risk for diabetes complications and need diabetes management strategies to improve glycemic control.
血糖控制是糖尿病相关发病率和死亡率的一个预测指标。然而，对于农村社区中自我护理资源和专科护理从业者获取机会有限的老年人如何很好地控制其糖尿病，人们知之甚少。关于少数族裔、老年农村成年人血糖控制不佳的风险是否增加，了解得更少。我们分析了对北卡罗来纳州农村地区随机选择的年龄在65岁及以上的2型糖尿病老年人进行的横断面调查数据。参与者（N = 693）来自三个种族群体的男性和女性：非裔美国人、美洲原住民和白人。采集毛细血管血样进行糖化血红蛋白（HbA1C）分析。比较了不同种族和性别组之间的HbA1C水平（<7%、7% - <8%和≥8%）。使用两个多元逻辑回归模型（模型1：个人特征；模型2：个人和健康特征）来评估HbA1C≥7%的潜在预测因素。总体而言，36.4%的人HbA1C≥7%。美洲原住民和非裔美国男性在血糖控制不佳水平（≥7%）的比例最高，而非裔美国女性和白人男性比例最低。在双变量分析中，种族、生活安排、糖尿病用药情况、过去一年中有与糖尿病相关的医疗就诊以及糖尿病病程与血糖控制显著相关。在多变量分析（模型1）中，身为美洲原住民、低收入且无医疗补助以及已婚与血糖控制不佳相关。加入健康特征（模型2）后，糖尿病病程较长和糖尿病药物治疗是显著的预测因素。这些数据表明，农村社区中的老年少数族裔糖尿病并发症风险增加，需要糖尿病管理策略来改善血糖控制。
