Racial Disparity in Diabetes Control

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Among diabetics, Hispanics have higher HbA1c levels than non-Hispanic whites, meta-analysis shows.

Diabetes control may be more challenging for Hispanics than for non-Hispanic whites, a meta-analysis suggests.

 

Researchers found that hemoglobin A1c (HbA1c) levels are higher in Hispanics than non-Hispanic whites, with an overall mean HbA1c difference of 0.5%. The reasons for the disparity in HbA1c levels are not known, but plausible explanations include differences in biology, access to care, insurance status, and diabetes treatment adherence.

 

The investigators reviewed data from 11 studies that contained data on HbA1c for Hispanics and non-Hispanic whites. The meta-analysis revealed a significant mean difference of -0.46, which correlated to an approximately 0.5% higher HbA1c for Hispanics. Findings appear in Diabetes Care (2008;31:240-246).

 

“We were not surprised by these findings since ethnic minorities in the U.S. are disproportionately affected by diabetes, and we found a similar trend in the African-American population with diabetes a year ago,” said lead author Julienne Kirk, PharmD, associate professor of family and community medicine at Wake Forest University School of Medicine in Winston-Salem, N.C.

 

“What did surprise us were the results of our analysis of subgroups of patients with managed care and non-managed care insurance. The largest difference for HbA1c was among non-managed care insurance groups.”

 

Knowing some minority groups may have higher HbA1c could impact early treatment and awareness, Dr. Kirk said. She and her colleagues recommend developing strategies that focus not only on discovering the source of the differences in diabetes control between the two groups, but also on reducing these disparities.

 

“The role of a genetic factor contributing to these disparities warrants further investigation because it may be playing a role in the etiology,” Dr. Kirk told Renal & Urology News.

 

“We need greater outreach to His-panics. We know that Hispanics with diabetes have higher risk factors for cardiovascular disease compared to whites and, specifically, they have a higher prevalence of cardiovascular risk factors that are often undiagnosed or treated, such as elevated glucose levels and elevated blood pressure in some studies. So this population may be more difficult to treat and more awareness may be warranted.”

 

According to the Centers for Disease Control and Prevention, the prevalence of diabetes in the U.S. in 2005 was 5.4% and 4.7% among white males and white females, respectively, and 7.1% and 7.5% among Hispanic males and females.

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