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 by race/ethnicity to understand how disparities soon after T2D diagnosis have changed between 2008 and 2019 among cohorts of U.S. veterans with newly diagnosed T2D. RESEARCH DESIGN AND METHODS We estimated the annual percentage of early glycemic control (average A1C <7%) in the first 5 years after diagnosis among 837,023 veterans (95% male) with newly diagnosed T2D in primary care. We compared early glycemic control by racial/ethnic group among cohorts defined by diagnosis year (2008–2010, 2011–2013, 2014–2016, and 2017–2018) using mixed-effects models with random intercepts. We estimated odds ratios of early glycemic control comparing racial/ethnic groups with NHW, adjusting for age, sex, and years since diagnosis. RESULTS The average annual percentage of veterans who achieved early glycemic control during follow-up was 73%, 72%, 72%, and 76% across the four cohorts, respectively. All racial/ethnic groups were less likely to achieve early glycemic control compared with NHW veterans in the 2008–2010 cohort. In later cohorts, NHB and Hispanic veterans were more likely to achieve early glycemic control; however, Hispanic veterans were also more likely to have an A1C ≥9% within 5 years in all cohorts. Early glycemic control 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 early glycemic control trends among veterans with newly diagnosed T2D have been stable since 2008, but trends differed by racial/ethnic groups and disparities in very poor glycemic control were still observed. Efforts should continue to minimize disparities among racial/ethnic groups.

中文翻译：

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2008-2019 年在退伍军人健康管理局接受护理的退伍军人早期血糖控制种族/民族差异的趋势


目的 据报道，患有 2 型糖尿病 （T2D） 的非西班牙裔黑人 （NHB） 和非西班牙裔白人 （NHW） 退伍军人在血糖控制方面存在种族/民族差异。本研究按种族/族裔检查了早期血糖控制的趋势，以了解 2008 年至 2019 年期间新诊断出 T2D 的美国退伍军人队列中 T2D 诊断后不久的差异如何变化。研究设计和方法 我们估计了 837,023 名在初级保健中新诊断为 T2D 的退伍军人（95% 男性）在诊断后的前 5 年内早期血糖控制（平均 A1C <7%）的年百分比。我们使用随机截距的混合效应模型比较了按诊断年份 （2008-2010、2011-2013、2014-2016 和 2017-2018） 定义的队列中按种族/族裔群体划分的早期血糖控制。我们估计了比较种族/族裔群体与 NHW 的早期血糖控制的比值比，并调整了年龄、性别和诊断后的年数。结果 在四个队列中，在随访期间实现早期血糖控制的退伍军人的平均年百分比分别为 73%、72%、72% 和 76%。与 2008-2010 队列中的 NHW 退伍军人相比，所有种族/族裔群体实现早期血糖控制的可能性较小。在后来的队列中，NHB 和西班牙裔退伍军人更有可能实现早期血糖控制;然而，在所有队列中，西班牙裔退伍军人在 5 年内的 A1C ≥9% 的可能性也更大。非西班牙裔亚洲人、夏威夷原住民/太平洋岛民和美洲印第安人/阿拉斯加原住民退伍军人的早期血糖控制差异在队列中持续存在，直到 2017-2018 年队列。 结论 自 2008 年以来，新诊断的 T2D 退伍军人的总体早期血糖控制趋势一直稳定，但趋势因种族/民族群体而异，并且仍然观察到血糖控制非常差的差异。应继续努力减少种族/族裔群体之间的差异。