The ADA recommends an A1C <7% for most people with diabetes and <8.5% for those with relaxed glycemic goals. However, a large proportion of people with T2D fail to achieve the goal A1C. This study was performed to evaluate the factors associated with lack of improvement in A1C over a period of 3 years. This was a retrospective analysis including all patients with T2D treated at an academic center from 2015 to 2020. Patients with at least one A1C value available in each of 3 years prior to current A1C and ≥1 of those values >8.5% (poor control) were included. Patients with improved glycemic control (current A1C ≤8.5%) were compared with those with lack of improvement (current A1C >8.5%) . On multivariate logistic regression analysis including all variables in the model, independent predictors of lack of improvement were: younger age (OR 0.89 per 1-SD [12 years]; 95 % CI 0.79 - 1.00) , female gender (1.30, 1.- 1.56) , presence of hypertension (1.29, 1.- 1.55) , Black race (1.32, 1.- 1.68, White as reference) , low income area code (1.86,1.28 - 2.68, high as reference) and insurance coverage other than Medicare (1.32, 1.- 1.66) . Presence of current smoking was associated with a paradoxical improvement in A1C (0.69, 0.47 - 0.99) . We conclude that socioeconomic factors like income, insurance coverage and neighborhood are associated with lack of improvement in A1C. Further studies need to identify specific modifiable socioeconomic factors.


R. Garg: None. J.Z. Louie: None. D. Shiffman: Employee; Quest Diagnostics. Stock/Shareholder; Quest Diagnostics. C.M. Rowland: Employee; Quest Diagnostics. Stock/Shareholder; Quest Diagnostics. M.J. McPhaul: Employee; Quest Diagnostics. E. Bernal-Mizrachi: None. N. Kenyon: Research Support; Elodon Phamaceutical, Takeda Pharmaceutical Company Limited.

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