The Potentially Poor Response to Outpatient Diabetes Care in Urban African-Americans
- Curtiss B. Cook, MD,
- Robert H. Lyles, PHD,
- Imad El-Kebbi, MD,
- David C. Ziemer, MD,
- Daniel L. Gallina, MD,
- Virginia G. Dunbar, BS and
- Lawrence S. Phillips, MD
- From the Division of Endocrinology and Metabolism (C.B.C., I.E.-K., D.C.Z., D.L.G., L.S.P.), Department of Medicine, Emory University School of Medicine; the Department of Biostatistics (R.H.L.), Rollins School of Public Health, Emory University; and the Diabetes Clinic (V.G.D.), Grady Health System, Inc., Atlanta, Georgia.
- Address correspondence and reprint requests to Curtiss B. Cook, MD, Emory University School of Medicine, 69 Butler St., SE, Atlanta, GA, 30303. E-mail:cbcook{at}emory.edu .
Abstract
OBJECTIVE— HbAlc levels can be reduced in populations of diabetic patients, but some individuals may exhibit little improvement. To search for reasons underlying differences in HbAlc outcome, we analyzed patients managed in an outpatient diabetes clinic.
RESEARCH DESIGN AND METHODS— African-Americans with type 2 diabetes were categorized as responders, intermediate responders or poor responders according to their HbAlc level after 1 year of care. Logistical regression was used to determine baseline characteristics that distinguished poor responders from responders. Therapeutic strategies were examined for each of the response categories.
RESULTS— The 447 patients had a mean age and disease duration of 58 and 5 years, respectively, and BMI of 32 kg/m2. Overall, the mean HbAlc level fell from 9.6 to 8.1% after 12 months. Mean HbAlc levels improved from 8.8 to 6.2% in responders, and from 9.5 to 7.9% in intermediate responders. In poor responders, the average HbAlc level was 10.8% on presentation and 10.9% at 1 year. The odds of being a poor responder were significantly increased with longer disease duration, higher initial HbAlc level, and greater BMI. Although doses of oral agents and insulin were significantly higher among poor responders at most visits, the acceleration of insulin therapy did not occur until late in the follow-up period.
CONCLUSIONS— Clinical diabetes programs need to devise methods to identify patients who are at risk for persistent hyperglycemia. Whereas patient characteristics explain some heterogeneity of HbAlc outcome (and may aid in earlier identification of patients who potentially may not respond to conventional treatment), insufficient intensification of therapy may also be a component underlying the failure to achieve glycemic goals.
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted October 27, 2000.
- Received May 22, 2000.
- by the American Diabetes Association, Inc.
