Diabetes care in black and white veterans in the southeastern U.S

Abstract

Objective: Eliminating health disparities is a national priority, but progress has been difficult because of racial/ethnic differences in insurance coverage and access to health care. We investigated whether there were differences in diabetes care in the Veterans Administration (VA), where health care access should be relatively uniform.

Research design and methods: A1C and plasma glucose were compared before/after diagnosis of diabetes.

Results: Data were available for 1,456 black and 2,624 white veterans who met criteria for consistent primary care. Over 4-5 years before and after diagnosis, blacks had similar glucose and approximately 0.2% higher A1C levels than whites, and A1C differences could be attributed to glucose-independent associations between race and A1C. Blacks and whites also had comparable intervals between diagnostic-level hyperglycemia and diagnosis and between diagnosis and drug initiation. However, A1C was higher in blacks at the time of diagnosis (7.8 vs. 7.1%) and at initiation of pharmacotherapy (8.5 vs. 7.8%) (both P < 0.001). Differences in A1C at diagnosis and drug initiation were too large to be explained by differences in age, sex, BMI, and glucose-independent associations between race and A1C.

Conclusions: In the VA, glucose levels are generally comparable in blacks and whites except at the times of diagnosis and initiation of pharmacotherapy, when glucose levels are higher in blacks. While understanding the basis for such residual disparities may be important to improve the health of racial/ethnic minorities in the U.S., a health care system with structure and organization similar to that in the VA may also contribute importantly to relieving disparities in health.

Figures

Figure 1

Levels of A1C (A) and random plasma glucose (B) in black and white veterans before and after the diagnosis of diabetes. Years before and after the date of diagnosis are shown and measures averaged for each patient within 6 months before and 6 months after the date of diagnosis and each year before and after the date of diagnosis. Data are means ± SEM. Numbers of black and white veterans, respectively, contributing to data points were as follows: year −4, 126 and 244; year −3, 217 and 434; year −2, 389 and 742; year −1, 570 and 1,047; year 0, 1,258 and 2,166; year +1, 1,218 and 2,183; year +2, 1,199 and 2,198; year +3, 1,240 and 2,207; year +4, 1,063 and 1,846; year +5, 571 and 953.