Trends in Racial/Ethnic Disparities in Early Glycemic Control Among Veterans Receiving Care in the Veterans Health Administration, 2008-2019

Objective

Racial/ethnic disparities in glycemic control among Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) veterans with type 2 diabetes (T2D) have been reported. This study examined trends in early glycemic control (EGC) by race/ethnicity to understand how disparities soon after T2D diagnosis have changed between 2008 and 2019 among cohorts of newly-diagnosed US veterans.

Research Design and Methods

We estimated annual percent of EGC (average A1c<7%) in the first 5 years post-diagnosis among 837,023 veterans (95% male) with newly-diagnosed T2D in primary care. We compared EGC by racial/ethnic group among cohorts defined by diagnosis year (2008-2010, 2011-2013, 2014-2016 and 2017-2018) using mixed effect models with random intercepts. We estimated odds ratios of EGC comparing racial/ethnic groups to NHW, adjusting for age, sex and years of diagnosis.

Results

The average annual percent of veterans who achieved EGC during follow-up was 73%, 72%, 72%, and 76% in four cohorts respectively. All racial/ethnic groups were less likely to achieve EGC compared to NHW veterans in the 2008-2010 cohort. In later cohorts, NHB and Hispanic veterans were more likely to achieve EGC; however, Hispanic veterans were also more likely to have A1c≥9% within 5 years in all cohorts. EGC disparities for Non-Hispanic Asian, Native Hawaiian/Pacific Islander, and American Indian/Alaska Native veterans persisted in cohorts until the 2017-2018 cohort.

Conclusions

Overall EGC trends among newly-diagnosed veterans have been stable since 2008, but trends differed by racial/ethnic groups and disparities in very poor control were still observed. Efforts should continue to minimize disparities between racial/ethnic groups.