NEW YORK — How do demographic, social and geographic factors affect glycemic control over time in veterans newly diagnosed with diabetes?
That was the question raised in a new study conducted by researchers from NYU Grossman School of Medicine and the VA New York Harbor Healthcare System, both in New York. Results were published in BMJ Open.1
The study team used the VA Diabetes Risk national cohort to track glycemic control among patients 20 to 79-years old with a new diagnosis of Type 2 diabetes. Researchers modeled associations between glycemic control at follow-up clinical assessments and geographic factors including neighborhood race/ethnicity, socioeconomic, land use and food environment measures.
The study also adjusted for individual demographics, comorbidities, hemoglobin A1c (HbA1c) at diagnosis and duration of follow-up. Analysis of those factors occurred within a stratum of community types: high-density urban, low-density urban, suburban/small town and rural areas.
Included in the study were 246 079 veterans who developed a new Type 2 diabetes diagnosis in 2008-2018 and had at least two years of follow-up data available.
“Across all community types, we found that lower baseline HbA1c and female sex were strongly associated with a higher likelihood of within-range HbA1c at follow-up,” the authors wrote. “Surprisingly, patients who were older or had more documented comorbidities were more likely to have within-range follow-up HbA1c results.”
The study concluded that, while there was variation by community type, none of the geographic measures analyzed consistently demonstrated significant associations with glycemic control across all community types.
Background information in the article pointed out that maintaining appropriate glycemic control is critically important in mitigating the effects of diabetes complications. “A clinically-feasible reduction in hemoglobin A1c (HbA1c) of 1% is associated with a reduced likelihood of macrovascular complications such as heart attack and stroke by approximately 14% and a reduced likelihood of microvascular complications by approximately 37%,” the researchers wrote. “Without appropriate glycemic control, many patients with diabetes experience these adverse health effects and are at risk for premature death. While appropriate clinical care is of paramount importance, a wide array of demographic, social and geographic factors play a strong role in health outcomes, but data are limited on their influences on glycemic control among patients with diagnosed diabetes. Understanding the exact influence of these determinants is critical in addressing the enormous impact that diabetes has on health outcomes.”
A key question was whether neighborhood influences that lead to higher rates of diabetes diagnosis also influence glycemic control after diagnosis.
- Lee DC, Orstad SL, Kanchi R, Adhikari S, Rummo PE, Titus AR, Aleman JO, Elbel B, Thorpe LE, Schwartz MD. Demographic, social and geographic factors associated with glycaemic control among US Veterans with new onset type 2 diabetes: a retrospective cohort study. BMJ Open. 2023 Oct 13;13(10):e075599. doi: 10.1136/bmjopen-2023-075599. PMID: 37832984; PMCID: PMC10582880.