Journal Article

Diabetes Control Among Hispanics in the Action to Control Cardiovascular Risk in Diabetes Trial

Evans, Gregory W., Lopez-Jimenez, Carlos R., Brillon, David J., Calles Escandón, Jorge, Felicetta, James, Light, Laney S., Cuddihy, Robert, Getaneh, Asqual, Bigger, J. Thomas

2012

Overview

ABSTRACT BACKGROUND Hispanics in the United States represent diverse racial, ethnic, and socioeconomic groups, and manifest heterogeneous cardiovascular risks including diabetes. It is not known if there are residual differences in the control of diabetes among Hispanic groups given uniform access to diabetes care. OBJECTIVE To evaluate glucose control differences among Mexicans, Puerto Ricans, and Dominicans receiving substantial diabetes care and support in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. DESIGN Secondary analysis of data from a randomized trial comparing two treatment strategies: intensive, targeting glycated hemoglobin below 6.0 %, and standard, targeting glycated hemoglobin between 7.0 % and 7.9 %. PARTICIPANTS Seven hundred and sixteen Hispanic and 6066 non-Hispanic white participants were recruited from 77 clinical sites across the United States and Canada. There were 243 Mexicans, 199 Puerto Ricans, and 150 Dominicans; and 135 of these Hispanic groups were born in the United States. MAIN MEASURE Glycated hemoglobin RESULTS Compared to Puerto Ricans, Mexicans were more likely (HR = 1.38, CI:0.90–2.10) and Dominicans as likely (HR = 1.01, CI:0.66–1.54) to achieve glycated hemoglobin goal in the intensive arm. Participants born in the United States achieved glycated hemoglobin goal at a higher rate than those born elsewhere (HR = 1.57, CI:0.99–2.51 in the intensive arm, HR = 1.51, CI:0.95–2.43 in the standard arm). These differences were not statistically significant. In the intensive arm, Puerto Ricans (OR = 0.47, CI:0.31–0.71), and Dominicans (OR = 0.41, CI:0.26–0.66) were less likely than non-Hispanic whites to achieve glycated hemoglobin goal, whereas the difference between non-Hispanic whites and Mexicans was not statistically significant, (OR = 0.66, CI:0.43–1.02). CONCLUSIONS Hispanic groups, given access to comprehensive diabetes care, differed from each other non-significantly and had a variable divergence from non-Hispanic whites in achieving intensive glycated hemoglobin goal. These differences, if confirmed, could be due to such factors as variable acculturation and functional health literacy levels that were not measured in the ACCORD trial, but should be further explored in future studies.

• Publisher: Springer-Verlag,Springer,Springer Nature B.V
• Subject: Acculturation / Adult / Aged / Biological and medical sciences / Cardiovascular Diseases - prevention & control / Diabetes / Diabetes Mellitus, Type 2 - blood / Diabetes Mellitus, Type 2 - drug therapy / Diabetes Mellitus, Type 2 - ethnology / Diabetes. Impaired glucose tolerance / Endocrine pancreas. Apud cells (diseases) / Endocrinology / Endocrinopathies / Etiopathogenesis. Screening. Investigations. Target tissue resistance / Female / General aspects / Glucose / Glycated Hemoglobin - analysis / Hemoglobin / Hispanic or Latino / Hispanic people / Humans / Internal Medicine / Male / Medical sciences / Medicine / Medicine & Public Health / Mexican Americans / Middle Aged / Minority & ethnic groups / Miscellaneous / Mortality / Original Research / Proportional Hazards Models / Public health. Hygiene / Public health. Hygiene-occupational medicine / Puerto Rico - epidemiology / Randomized Controlled Trials as Topic / Risk Factors / Surgeons / United States - epidemiology