MMWR Morb Mortal Wkly Rep. 2006 Nov 24;55(46):1248-51.
Previous studies have indicated that, in the United States, black persons with diabetes have lower levels of glycemic and lipid control and are at increased risk for diabetes-related complications than white persons with the disease. Clinical trials have demonstrated that glycemic and lipid control can reduce the risk for microvascular and macrovascular complications among adults. In addition, recent studies of national survey data have indicated a secular trend of gradual improvements in blood pressure, cholesterol levels, and smoking rates among U.S. persons with diabetes. These studies have demonstrated an increase in the proportion of persons who meet recommended levels for blood pressure, glycated hemoglobin (HbA1c), and cholesterol. Whether black persons in the United States have benefited from these overall improvements is unclear. Surveys conducted among black adults in Raleigh and Greensboro, North Carolina, as part of Project DIRECT (Diabetes Intervention Reaching and Educating Communities Together), provided an opportunity to examine trends in diabetes control and risk for complications. Project DIRECT is a community-based intervention aimed at improving self-care, access to care, and quality of care for residents with diabetes. The analyses described in this report examined whether glycemic and lipid control improved in both communities from 1997 to 2004, a period of rapid advances in clinical understanding of how to control diabetes and its complications. This report summarizes the results of those analyses, which indicated improvements in the proportion of black adults with diabetes who reported that they were meeting recommended levels of HbA1c, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, and total cholesterol. However, a substantial number of these persons smoked and were above recommended glycemic and lipid levels at follow-up. Therefore, continued education of the public is important in improving quality of care and reducing risk factors for persons at high risk for diabetes and cardiovascular disease.
