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Risk factor control varies between races for older adults with diabetes
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Racial disparities in risk factor control were not fully accounted for by demographic and clinical traits among older adults with diabetes, according to recent findings.
In the cross-sectional study, Elizabeth Selvin, PhD, of Johns Hopkins University in Baltimore, and colleagues evaluated data from 5,018 adults aged 67 to 90 years with (n = 1, 574) and without (n = 3,444) confirmed diabetes from the Atherosclerosis Risk in Communities study between 2011 and 2013. Of the participants diagnosed with diabetes, the mean age was 75 years, 44% were men, and 29% were black.
Researchers assessed HbA1c levels in whole blood samples and determined total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides.
The American Diabetes Association’s 2015 recommended cut points were used to define stringent risk factor targets as follows: HbA1c less than 7%, LDL cholesterol less than 100 mg/dL and blood pressure less than 140/90 mm Hg. The following less stringent risk factor targets were also established: HbA1c less than 8%, LDL-cholesterol less than 130 mg/dL and BP less than 150/90 mm Hg. The researchers compared the traits of those with and without diabetes separately and additionally stratified participants with diabetes based on glucose-lowering medication use.
The researchers found that the majority of participants with diabetes achieved the stringent and less stringent goals for risk factor control. In terms of the stringent targets, 72% met the target for HbA1c, 63% for LDL cholesterol and 73% for BP. However, only 35% achieved stringent risk factor control targets. Regarding the less stringent targets, 90% met the goal for HbA1, 86% for LDL cholesterol and 87% for BP. Only 68% achieved all three less stringent targets.
Those who met risk factor goals had a greater likelihood of having the following traits: male sex, white race, higher income, higher physical function scores and short diabetes duration. The trends persisted when using the less stringent targets.
After adjusting for risk factor controlling medication use, racial disparities in the prevalence of meeting stringent targets persisted. Prevalence ratios for whites compared with blacks were 1.03 (95% CI, 0.91-1.17) for HbA1c, 1.21 (95% CI, 1.09-1.35) for LDL cholesterol, 1.1 (95% CI, 1-1.21) for BP and 1.28 (95% CI, 0.99-1.66) for all three. When using the less stringent targets, these findings were weakened but similar.
Of the race-sex combinations, black women were less likely to meet treatment targets for risk factor control and greater black compared with white discrepancies in risk factor control were noted for men compared with women.
According to the researchers, these findings underscore a need for further studies of these racial disparities.
“Our results suggest a need to improve care in ethnic minorities, particularly black women, to narrow this racial disparity,” the researchers wrote. “However, older adults are a heterogenous group, and the benefit of treatment to very low risk factor targets is unclear. To define appropriate treatment approaches and risk factor targets in older adults with diabetes, randomized clinical trials in this population may be needed.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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