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Impact of diabetes control on mortality by race in a national cohort of veterans. Ann Epidemiol 2013 Feb;23(2):74-9 PMID: 23238350

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PURPOSE: The association between glycated hemoglobin (HbA1c), medication use/adherence, and mortality stratified by race/ethnicity was examined in a national cohort of veterans with type 2 diabetes.

METHODS: A total of 892,223 veterans with diabetes in 2002 were followed through 2006. HbA1c category was the main exposure (i.e., HbA1c <7%, HbA1c 7%-8% [reference], HbA1c 8%-9%, and HbA1c >9%). Covariates included age, sex, marital status, rural/urban residence, geographic region, number of comorbidities, and diabetes medication use/adherence (i.e., adherent, medication possession ratio ≥80%; nonadherent; and nonusers). HbA1c and medication use/adherence varied over time, and Cox regression models accounting for time-varying variables were used.

RESULTS: In nonmedication users, HbA1c greater than 9% predicted higher mortality risk relative to HbA1c of 7%-8% in non-Hispanic whites (hazard ratio [HR], 1.55; 95% confidence interval [95% CI], 1.43-1.69), non-Hispanic blacks (NHB) (HR, 1.58; 95% CI, 1.34-1.87), and Hispanics (HR, 2.22; 95% CI, 1.75-2.82). In contrast, in nonadherent medication users, HbA1c less than 7% predicted higher mortality risk in NHB (HR, 1.12; 95% CI, 1.05-1.20), whereas HbA1c greater than 9% only predicted mortality in non-Hispanic whites (HR, 1.11; 95% CI, 1.06-1.16). In adherent medication users, HbA1c less than 7% predicted higher mortality in NHB (HR, 1.18; 95% CI, 1.07-1.31), whereas HbA1c greater than 9.0% predicted higher mortality risk across all race/ethnic groups.

CONCLUSION: We found evidence for racial/ethnic differences in the association between glycemic control and mortality, which varied by medication use/adherence.

Author List

Hunt KJ, Gebregziabher M, Lynch CP, Echols C, Mauldin PD, Egede LE


Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin


2-s2.0-84872138388   13 Citations

MESH terms used to index this publication - Major topics in bold

African Americans
Aged, 80 and over
Blood Glucose
Continental Population Groups
Diabetes Mellitus, Type 2
European Continental Ancestry Group
Follow-Up Studies
Glycated Hemoglobin A
Hispanic Americans
Hypoglycemic Agents
Medication Adherence
Middle Aged
Proportional Hazards Models
Residence Characteristics
Retrospective Studies
Socioeconomic Factors
United States
jenkins-FCD Prod-353 9ccd8489072cb19f5b9f808bb23ed672c582f41e