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Blacks Have Poorer Control of Diabetes Than Whites

Finding may explain their higher complication, death rates, experts say

FRIDAY, Aug. 25, 2006 (HealthDay News) -- Blacks with diabetes tend to have worse control of the disease than whites, a new review of the data shows.

The finding could explain why black patients are typically at increased risk for diabetes-linked complications and death, the researchers said.

"This confirms what doctors have known," added Dr. Larry C. Deeb, president of medicine and science for the American Diabetes Association and a professor of social and behavioral medicine at Florida State University College of Medicine.

"What this study does is take all the [published] papers they could find and show that, across the board, the African-Americans have an increased risk," said Deeb, who was not involved in the research.

The findings were published Friday in the journal Diabetes Care.

The review is what's known as a "meta-analysis."

"We took all these studies [and] combined all the data from each individual study," explained co-author Ronny A. Bell, associate professor of epidemiology at the Wake Forest University School of Medicine.

The findings confirmed what the individual studies had already found, Bell said. "But a meta-analysis can give you more evidence to say [the finding] with more confidence," he said.

The data included information on more than 42,000 white and 14,000 black patients with diabetes. Most were older than 50 and had type 2 diabetes, the most common, obesity-linked form of the illness. In type 2 disease, the body either does not produce enough insulin or cells don't use insulin efficiently. Either way, glucose builds up in the bloodstream.

The researchers looked at the results of a blood test called the A1C, also known as glycated hemoglobin or HbA1c. The test provides a "look back," averaging a person's blood sugar control for the previous two to three months. Some doctors compare it to a baseball player's seasonal batting average, explaining that it's valuable information to have in addition to the daily blood sugar readings.

Those with diabetes should aim for an A1C of less than 7 percent, according to the American Diabetes Association.

In the study, blacks had an A1C, on average, that was 0.65 percent higher than that of whites, Bell said.

While no averages were calculated by the researchers by race, "the range of A1C values across the 11 studies was 7.3 percent to 9.4 percent for whites and 7.6 percent to 11.4 percent for blacks," he said. "As you can see, there are a lot of people whose A1C is not in good control, but especially so for blacks."

A numbers of reasons may explain the differences, the researchers said, including differences in quality of care, intensity of treatment, or in insurance coverage, such as prescription drug coverage. Genetic differences may explain the gap, too.

"The individual person with diabetes has to say to him or herself that diabetes control is critical to long-term health," Deeb said. A person with diabetes should vow to work with their doctor to bring the test result into normal range, he added.

About 20 million American children and adults have diabetes, according to American Diabetes Association estimates.

Other researchers involved in the study were from Kaiser Permanente in Oakland, Calif., and the U.S. Centers for Disease Control and Prevention in Atlanta.

More information

To learn more about the A1C test, visit the American Diabetes Association.

SOURCES: Ronny A. Bell, Ph.D., associate professor, epidemiology, Wake Forest University School of Medicine, Winston-Salem, N.C.; Larry C. Deeb, M.D., president, medicine and science, American Diabetes Association, and professor, social and behavioral medicine, Florida State University College of Medicine, Tallahassee; Aug. 25, 2006, online issue, Diabetes Care

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