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HbA_1c Levels Among American Indian/Alaska Native Adults

¹ University of Southern California, Department of Preventive Medicine, Los Angeles, California
² New Mexico Veterans Health Care System, Albuquerque, New Mexico
³ Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
⁴ Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
⁵ Indian Health Service National Diabetes Programs, Albuquerque, New Mexico

OBJECTIVE—Type 2 diabetes is a major public health problem among many American Indian/Alaska Native communities. Elevated levels of HbA_1c have been observed in younger American Indian/Alaska Native adults. The objectives of this study were: 1) to determine whether HbA_1c levels were elevated among younger American Indian/Alaska Native adults nationally and, if so, 2) to determine the relationship between HbA_1c levels and age due to treatment type, BMI, renal disease, duration of diabetes, survival, or a poor diabetes health care index.

RESEARCH DESIGN AND METHODS—The national Indian Health Service Diabetes Care and Outcomes Audit was completed for a total of 11,419 American Indian/Alaska Native adults with type 2 diabetes from tribes across the U.S. in 1998. Glucose control was assessed by HbA_1c. BMI, diabetes duration, treatment type, and proteinuria were assessed from the Diabetes Care and Outcomes Audit data. To assess diabetes quality of care, an index was developed from six standard of care Diabetes Care and Outcomes Audit variables.

RESULTS—We found HbA_1c level decreased with increasing age. HbA_1c levels were 9.2, 8.9, 8.8, 8.3, and 7.8 for ages 18–39, 40–49, 50–59, 60–69, and 70 years, respectively (P < 0.0001). This inverse relationship was not accounted for by differences in BMI, diabetes duration, treatment type, proteinuria, or health care index.

CONCLUSIONS—Among American Indian/Alaska Native adults, HbA_1c levels were highest in the youngest age-group. With increasing numbers of young American Indian/Alaska Native adults with diabetes, poorer glucose control is expected to bring concomitant increased morbidity and mortality unless more effective and efficient interventions are developed to improve glucose control among young American Indian/Alaska Native adults.

Abbreviations: IHS, Indian Health Service

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