Correlates of Glycemic Status Among American Indian Adults With Type 2 Diabetes in Rural Southeastern Oklahoma

Elevated glycosylated hemoglobin (HbA1c) levels have been associated with an increased risk for type 2 diabetes (T2D) complications.

The aim of this study was to examine the electronic health record (EHR) correlates of HbA1c levels among adults with T2D using Tribal health services.

EHR data from one Tribal health center were used for this study. Variables included driving distance to clinics, socioeconomic status, use of primary care and diabetes educators, age, sex, glycemic status, and HbA1c. Descriptive, bivariate, and linear regression analyses were performed.

Nearly 40% of the 5,205 patients in the sample had HbA1c levels <7% in 2021. HbA1c in 2020 was a strong predictor of HbA1c in 2021. Older age was weakly associated with lower HbA1c. A lack of primary care visits or diabetes educator visits was associated with lower HbA1c, likely due to patients with lower HbA1c levels having less need for T2D-related primary care or diabetes educator visits.

This study provided insight into factors associated with HbA1c levels that deserve further exploration, but it is important to note that factors included in social determinant of health frameworks specifically developed for Indigenous communities were not available in the EHR data set. Therefore, future studies are needed that examine Indigenous social determinants of health specific to the local community.