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Glycemic control in diabetic American Indians. Longitudinal data from the Strong Heart Study
D Hu1, J A Henderson, T K Welty
1MedStar Research Institute, Washington, DC 20010, USA. dxha@mhg.edu
Insights
Glycemic control remains poor for American Indians with diabetes. Factors like female sex, insulin use, and younger age correlate with worse HbA1c levels, indicating a need for improved interventions.
Area of Science:
- Cardiovascular Disease Epidemiology
- Diabetes Mellitus Research
- American Indian Health
Background:
- The Strong Heart Study is a longitudinal investigation of cardiovascular disease (CVD) risk factors in American Indians.
- Diabetes mellitus is a significant health concern within this population, impacting CVD risk.
- Understanding glycemic control is crucial for managing diabetes complications.
Purpose of the Study:
- To characterize glycemic control in American Indians with diabetes.
- To identify factors associated with elevated hemoglobin A1c (HbA1c) levels.
- To inform strategies for improving diabetes management in this demographic.
Main Methods:
- Analysis of baseline and follow-up data from 1,581 diabetic American Indian participants (aged 45-74) in the Strong Heart Study.
- HbA1c levels measured at follow-up served as the primary indicator of glycemic control.
- Cross-sectional and longitudinal relationships between potential correlates and HbA1c were assessed using ANCOVA and multiple regression.
Main Results:
- Median HbA1c levels showed no significant change between baseline (8.4%) and follow-up (8.5%).
- Female sex, younger age, and use of insulin or oral hypoglycemic agents were associated with higher HbA1c levels.
- Baseline HbA1c predicted future levels, while insulin therapy demonstrated a significant decrease in HbA1c over time.
Conclusions:
- Glycemic control is suboptimal among American Indians with diabetes in the Strong Heart Study.
- Specific subgroups, including women, younger individuals, and those on medication, exhibit poorer control.
- Enhanced therapeutic approaches are necessary to improve glycemic control and mitigate diabetes-related risks in this population.
Objective:
To describe glycemic control and identify correlates of elevated HbA1c levels in diabetic American Indians participating in the Strong Heart Study, which is a longitudinal study of cardiovascular disease in American Indians in Arizona, Oklahoma, South Dakota, and North Dakota.
Research Design And Methods:
This analysis is based on data from the baseline (1989-1992) and first follow-up (1994-1995) examinations of the Strong Heart Study. The 1,581 diabetic participants included in this analysis were aged 45-74 years at baseline, were diagnosed with diabetes before and at baseline, and had their HbA1c levels measured at follow-up. HbA1c was used as the index of glycemic control. Characteristics that may affect glycemic control were evaluated for cross-sectional and longitudinal relationships by analysis of covariance and multiple regression.
Results:
There was no significant difference between median HbA1c at baseline (8.4%) and at follow-up (8.5%). Sex, age (inversely), and insulin and oral hypoglycemic agent therapy were significantly related to HbA1c levels in both the cross-sectional and longitudinal analyses. Current smoking, prior use of alcohol, and duration of diabetes were significant only for the cross-sectional data. Baseline HbA1c significantly and positively predicted HbA1c levels at follow-up. Comparison of HbA1c by therapy type shows that insulin therapy produced a significant decrease in HbA1c between the baseline and follow-up examinations.
Conclusions:
Glycemic control was poor among diabetic American Indians participating in the Strong Heart Study. Women, patients taking insulin or oral hypoglycemic agents, and younger individuals had the worst control of all the participants. Baseline HbA1c, and weight loss predicted worsening of control, whereas insulin therapy predicted improvement in control. Additional therapies and/or approaches are needed to improve glycemic control in this population.