HbA1c Levels Among American Indian/Alaska Native Adults
Abstract
OBJECTIVE—Type 2 diabetes is a major public health problem among many American Indian/Alaska Native communities. Elevated levels of HbA1c have been observed in younger American Indian/Alaska Native adults. The objectives of this study were: 1) to determine whether HbA1c levels were elevated among younger American Indian/Alaska Native adults nationally and, if so, 2) to determine the relationship between HbA1c 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 HbA1c. 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 HbA1c level decreased with increasing age. HbA1c 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, HbA1c 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.
Footnotes
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Address correspondence and reprint requests to Susan S. Gilliland, PhD, University of Southern California, Keck School of Medicine, Department of Preventive Medicine, 1540 Alcazar St., CHP 218, Los Angeles, CA 90033-9010. E-mail: sgillila{at}usc.edu.
Received for publication 1 January 2002 and accepted in revised form 2 September 2002.
J.S.C. is deceased.
The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the Indian Health Service.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE
