Skip to main content
SpringerLink
Log in

Factors Associated with Diabetes Control in Predominately African American and Hispanic Population with Newly Diagnosed Type 2 Diabetes

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

Background

This study characterizes factors affecting glycemic control in a predominately African American and Hispanic population with newly diagnosed type 2 diabetes (T2DM).

Methods

Retrospective longitudinal cohort study of 1638 patients with newly diagnosed T2DM to determine factors associated with improved HbA1c (ΔHbA1c ≤ − 0.5%) and achieving target HbA1c < 7%.

Results

At baseline, mean age 51.7 ± 11.5 years, males 52.9%, mean BMI 33.9 ± 7.8 kg/m2, median HbA1c 9.9 (7.6–12.1)%. At study end, median follow-up duration 27 (13–54) months, median HbA1c 7.0 (6.2–8.7)%, 69.6% with improved HbA1c, 48.3% achieved target HbA1c < 7%, 88.4% monitored blood glucose, 40.1% used insulin, and 72.4% reported not missing medications. In multivariate analysis, improved HbA1c significantly correlated with glucose monitoring (OR = 2.65), higher initial HbA1c (OR = 1.85), and medication adherence (OR = 1.66) and inversely correlated with insulin use (OR = 0.38) and follow-up duration (OR = 0.99). Achieving HbA1c < 7% significantly correlated with glucose monitoring (OR = 2.14), medication adherence (OR = 1.88), more provider visits (OR = 1.04), and older age (OR = 1.03). It inversely correlated with insulin use (OR = 0.47), initial HbA1c (OR = 0.93), and follow-up duration (OR = 0.98).

Conclusions

In those with newly diagnosed T2DM, achieving better glycemic control was mainly related to patient self-management behaviors and inversely related to insulin use. Emphasis on patients’ diabetes education and empowerment are critical to improved glycemic control.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2017. Atlanta: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017.

    Google Scholar 

  2. Baicker K, Taubman SL, Allen HL, Bernstein M, Gruber JH, Newhouse JP, et al. The Oregon experiment—effects of Medicaid on clinical outcomes. N Engl J Med. 2013;368:1713–22.

    Article  CAS  Google Scholar 

  3. Berkowitz SA, Meigs JB, DeWalt D, Seligman HK, Barnard LS, Bright OJM, et al. Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the Measuring Economic Insecurity in Diabetes study. JAMA Intern Med. 2015;175:257–65.

    Article  Google Scholar 

  4. Golden SH, Brown A, Cauley JA, Chin MH, Gary-Webb TL, Kim C, et al. Health disparities in endocrine disorders: biological, clinical, and nonclinical factors—an Endocrine Society scientific statement. JCEM. 2012;97:E1579.

    Article  Google Scholar 

  5. Philis-Tsimikas A, Walker C. Improved care for diabetes in underserved populations. J Ambul Care Manage. 2001;24:39–43.

    Article  CAS  Google Scholar 

  6. Morkos M, Tahsin B, Fogg L, Fogelfeld L. Newly diagnosed type 2 diabetes in an ethnic minority population: clinical presentation and comparison to other populations. BMJ Open Diabetes Res Care. 2018 Oct 11;6(1):e000568.

    Article  Google Scholar 

  7. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.

    Article  Google Scholar 

  8. Diabetes Control and Complications Trial Research Group, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  9. Action to Control Cardiovascular Risk in Diabetes Study Group, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.

    Article  Google Scholar 

  10. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360:129–39.

    Article  CAS  Google Scholar 

  11. Currie CJ, Peters JR, Tynan A, Evans M, Heine RJ, Bracco OL, et al. Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study. Lancet. 2010;375:481–9.

    Article  CAS  Google Scholar 

  12. Dluhy RG, McMahon GT. Intensive glycemic control in the ACCORD and ADVANCE trials. N Engl J Med. 2008;358(24):2630–3.

    Article  CAS  Google Scholar 

  13. American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Suppl 1):S61–70.

  14. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2019. Diabetes Care. 2019;42(Suppl 1):S13–28.

    Article  Google Scholar 

  15. Guerci B, Drouin P, Grange V, et al. Self-monitoring of blood glucose significantly improves metabolic control in patients with type 2 diabetes mellitus: the Auto-Surveillance Intervention Active (ASIA) study. Diabetes Metab. 2003;29:587–94.

    Article  CAS  Google Scholar 

  16. Norris SL, Engelgau MM, Narayan KV. Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care. 2001;24:561–87.

    Article  CAS  Google Scholar 

  17. Berikai P, Meyer PM, Kazlauskaite R, Savoy B, Kozik K, Fogelfeld L. Gain in patients' knowledge of diabetes management targets is associated with better glycemic control. Diabetes Care. 2007;30:1587–9.

    Article  Google Scholar 

  18. Koro CE, Bowlin SJ, Bourgeois N, Fedder DO. Glycemic control from 1988 to 2000 among US adults diagnosed with type 2 diabetes: a preliminary report. Diabetes Care. 2004;27:17–20.

    Article  Google Scholar 

  19. El-Kebbi IM, Cook CB, Ziemer DC, et al. Association of younger age with poor glycemic control and obesity in urban African Americans with type 2 diabetes. Arch Intern Med. 2003;163:69–75.

    Article  Google Scholar 

  20. Halban PA, Polonsky KS, Bowden DW, Hawkins MA, Ling C, Mather KJ, et al. β-Cell failure in type 2 diabetes: postulated mechanisms and prospects for prevention and treatment. JCEM. 2014;99(6):1983–92.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Endocrinology and Diabetes, John H. Stroger, Jr. Hospital of Cook County and Rush University Medical Center, Chicago, IL, 60612, USA

    Michael Morkos, Bettina Tahsin & Leon Fogelfeld

  2. Department of Medicine, Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, IN, USA

    Michael Morkos

Authors
  1. Michael Morkos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bettina Tahsin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leon Fogelfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Michael Morkos: Conceptualization, methodology, formal analysis, investigation, writing—original draft, writing—review and editing, visualization. Bettina Tahsin: formal analysis, data curation, writing—review and editing, visualization. Leon Fogelfeld: conceptualization, methodology, formal analysis, data curation, writing—review and editing, visualization, supervision, project administration.

Corresponding author

Correspondence to Leon Fogelfeld.

Ethics declarations

Conflict of Interest

The authors declare they have no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morkos, M., Tahsin, B. & Fogelfeld, L. Factors Associated with Diabetes Control in Predominately African American and Hispanic Population with Newly Diagnosed Type 2 Diabetes. J. Racial and Ethnic Health Disparities 8, 332–338 (2021). https://doi.org/10.1007/s40615-020-00785-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-020-00785-9

Keywords

Search

Navigation