Disparities in HbA1c Levels Between African-American and Non-Hispanic White Adults With Diabetes

Abstract

OBJECTIVE—Among individuals with diabetes, a comparison of HbA1c (A1C) levels between African Americans and non-Hispanic whites was evaluated. Data sources included PubMed, Web of Science, the Cumulative Index to Nursing and Allied Health, the Cochrane Library, the Combined Health Information Database, and the Education Resources Information Center. RESEARCH DESIGN AND METHODS—We executed a search for articles published between 1993 and 2005. Data on sample size, age, sex, A1C, geographical location, and study design were extracted. Cross-sectional data and baseline data from clinical trials and cohort studies for African Americans and non-Hispanic whites with diabetes were included. Diabetic subjects aged <18 years and those with pre-diabetes or gestational diabetes were excluded. We conducted a meta-analysis to estimate the difference in the mean values of A1C for African Americans and non-Hispanic whites. RESULTS—A total of 391 studies were reviewed, of which 78 contained A1C data. Eleven had data on A1C for African Americans and non-Hispanic whites and met selection criteria. A meta-analysis revealed the standard effect to be 0.31 (95% CI 0.39–0.25). This standard effect correlates to an A1C difference between groups of ∼0.65%, indicating a higher A1C across studies for African Americans. Grouping studies by study type (cross-sectional or cohort), method of data collection for A1C (chart review or blood draw), and insurance status (managed care or nonmanaged care) showed similar results. CONCLUSIONS—The higher A1C observed in this meta-analysis among African Americans compared with non-Hispanic whites may contribute to disparity in diabetes morbidity and mortality in this population.

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

“…Black patients with diabetes are less likely than white patients to receive appropriate hemoglobin A1c and lipid testing 1,2 and less likely to achieve treatment goals including glycemic, cholesterol, and blood pressure control. [3][4][5][6][7][8] Blacks also experience worse long-term diabetes-related outcomes than whites, including diabetic retinopathy, 9 lower extremity amputations, 2,10,11 and chronic kidney disease. 12 Hispanics and Native Americans have also been found to receive lower-quality diabetes care, with Native Americans experiencing disproportionately high rates of lower extremity amputations, chronic kidney disease, and diabetes-related mortality.…”

Risk factors for micro and macrovascular disease in black and white patients with type 2 Diabetes mellitus

“…the higher prevalence of chronic complications of DM and worse evolution of DN and DR in this population. Recently, in a meta-analysis performed in American patients with type 2 DM, patients of African ethnicity had worse metabolic control than whites 23 . Black patients presented a mean A1c 0.65% higher than whites 23 .…”

“…Recently, in a meta-analysis performed in American patients with type 2 DM, patients of African ethnicity had worse metabolic control than whites 23 . Black patients presented a mean A1c 0.65% higher than whites 23 . Data on the Brazilian population are scarce and, in the present sample, the glycemic control was similar among the ethnic groups.…”

Medication Adherence Does Not Explain Black-White Differences in Cardiometabolic Risk Factor Control among Insured Patients with Diabetes

“…[3][4][5][6][7] Furthermore, suboptimal control is often more prevalent among African Americans. 1,2,[8][9][10][11][12][13][14][15][16][17][18][19][20] Prior research has consistently found racial differences in medication adherence. [21][22][23][24] The reasons underlying such differences are poorly understood, but are often thought to stem from differences in care access, care quality, and selfmanagement behaviors.…”