Objective: Evaluate the impact of demographic and socio-economic factors on diabetic control (Hba1c) among patients in an outpatient setting.
Methods: A prospective study from January 2015 to May 2017 involving 211 patients with diabetes mellitus managed at an outpatient endocrinology clinic. Serial measurements of HbA1c were collected at baseline, 3 and 6 months. HbA1c was treated as a continuous variable and presented as mean ± standard deviation. Baseline HbA1c level was compared among dichotomized socio-economic variables (married vs. not married; employed vs. unemployed; health literacy (using the REALM survey) and educational level using t-test. A multivariable linear regression model was used to examine the association between Hb1Ac control and patient demographic and socio-economic characteristics.
Results: Among study participants, 96% were African American, 63.5% female, with mean age of 53 ± 14.7) and baseline mean Hb1Ac of 8.80 ± 2.30. In univariate analysis, higher baseline Hb1Ac was observed in patients with REALM score below 7 vs. above 7, (9.30%±2.36 vs. 8.49% ± 2.27, p-value = 0.01), unemployed vs. unemployed (9.17%± 2.46 vs. 8.56%± 2.23, p-value = 0.08), and high school or lower vs. college and above (9.08% ± 2.36 vs. 8.7%± 2.28, p-value = 0.10). Single and divorced patients had higher baseline HbA1C (8.94 ± 2.4 and 8.90 ± 2.4 respectively) compared to their married counterpart (8.65%±2.4)Adjusting for baseline Hb1Ac level, gender, race marital status, employment status and educational level, multivariable regression analysis showed that higher educational level was significantly associated with change in HbA1c values. Patients with college education and above showed significant reduction in HbA1C (regression coefficient -0.75, 95% CI -1.27 to -0.230, p=0.005) compared to those with high school attainment and lower.
Conclusion: In this prospective study involving predominantly African Americans, higher educational attainment was independently associated with better glycemic control.
K.M. Folawewo: None. M.U. Hodge: None. G. Nunlee-Bland: None. N. Osman: None. A. Zenebe: None. W. Odonkor: None. V. Ganta: None. R. Ogunti: None.