Disparities in A1C Levels Between Hispanic and Non-Hispanic White Adults With Diabetes

A meta-analysis

  1. Julienne K. Kirk, PHARMD, CDE1,
  2. Leah V. Passmore, MS2,
  3. Ronny A. Bell, PHD3,
  4. K.M. Venkat Narayan, MD, MSC, MBA, FRCP4,
  5. Ralph B. D'Agostino, Jr., PHD2,
  6. Thomas A. Arcury, PHD1 and
  7. Sara A. Quandt, PHD3
  1. 1Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  2. 2Division of Public Health Sciences, Department of Biostatical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  3. 3Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  4. 4Hubert Department of Global Health, Emory University and Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta Georgia
  1. Address correspondence and reprint requests to Julienne K. Kirk, PharmD, CDE, Associate Professor, Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1084. E-mail: jkirk{at}wfubmc.edu

Abstract

OBJECTIVE—Hispanics have higher rates of diabetes and diabetes-related complications than do non-Hispanic whites. A meta-analysis was conducted to estimate the difference between the mean values of A1C for these two groups.

RESEARCH DESIGN AND METHODS—We executed a PubMed search of articles published from 1993 through July 2007. Data sources included PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, the Cochrane Library, Combined Health Information Database, and Education Resources Information Center. Data on sample size, age, sex, A1C, geographical location, and study design were extracted. Cross-sectional data and baseline data from clinical trials and cohort studies for Hispanics and non-Hispanic whites with diabetes were included. Studies were excluded if they included individuals <18 years of age or patients with pre-diabetes or gestational diabetes.

RESULTS—A total of 495 studies were reviewed, of which 73 contained data on A1C for Hispanics and non-Hispanic whites, and 11 met the inclusion criteria. Meta-analysis revealed a statistically significant mean difference (P < 0.0001) of −0.46 (95% CI −0.63 to −0.33), correlating to an ∼0.5% higher A1C for Hispanics. Grouping studies by design (cross-sectional or cohort), method of data collection for A1C (chart review or blood sampling), and care type (managed or nonmanaged) yielded similar results.

CONCLUSIONS—In this meta-analysis, A1C was ∼0.5% higher in Hispanic patients with diabetes than in non-Hispanic patients. Understanding the reasons for this disparity should be a focus for future research.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 31 October 2007. DOI: 10.2337/dc07-0382.

    The contents of this article are the responsibility of the authors and do not necessarily reflect the official views of Centers for Disease Control and Prevention or Association of Teachers of Preventive Medicine.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted October 19, 2007.
    • Received February 23, 2007.
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  1. Published online before print October 31, 2007, doi: 10.2337/dc07-0382 Diabetes Care February 2008 vol. 31 no. 2 240-246
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