Racial Disparity in Glycemic Control among U.S. Older Adults with Diabetes: Evidence from the Health and Retirement Study

Glycemic control remains one of the key elements in diabetes management and tertiary prevention. The objectives of this study were: to identify factors associated with effective glycemic control among U.S. older adults with diabetes and to examine potential racial disparity in effective glycemic control in this population. We used longitudinal data from the Health and Retirement Study (HRS), a nationally representative sample of community-dwelling U.S. older adults. Data on glycemic control came from the 2006 and 2008 HRS data. Effective glycemic control was defined as having HbA1C level of lower than 7% using blood spot assays. Independent variables included: age, race, gender, household income, self-reported health, mobility difficulty, activities of daily living, comorbid medical conditions, body mass index, and tobacco and alcohol use. We used multivariate logistic regression model to estimate the effect of race/ethnicity on the likelihood of having effective glycemic control. A total of 2638 older adults with diabetes were included in the analysis. The average age of the sample was 69.1 and 55.3% were female. Age, race, education, income, number of chronic conditions, depressive symptoms, and self-rated health were associated with glycemic control. In multivariate analysis, African Americans and Hispanics with diabetes were less likely to have effective glycemic control (p<0.01) after controlling for potential confounding variables. These findings suggest that race/ethnicity is an important indicator for the quality of glycemic control in diabetes management. Interventions designed to improve diabetes management and reduce complications due to poor glycemic control should consider tailoring to different racial/ethnic groups.