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Associations of Four Community Factors With Longitudinal Change in Hemoglobin A1c Levels in Patients With Type 2 Diabetes
Diabetes Care ( IF 16.2 ) Pub Date : 2018-03-01 , DOI: 10.2337/dc17-1200
Annemarie G. Hirsch 1, 2 , T. Elizabeth Durden 3 , Cara Nordberg 4 , Andrea Berger 4 , Brian S. Schwartz 1, 2
Affiliation  

OBJECTIVE To evaluate associations of community factors with glycated hemoglobin (HbA1c).

RESEARCH DESIGN AND METHODS We identified patients with type 2 diabetes who had an HbA1c ≥7.5% (58 mmol/mol) and subsequent HbA1c testing within 90–270 days. We used mixed-effect models to assess whether treatment intensification (TI) and community domains (community socioeconomic deprivation [CSD], food availability, fitness assets, and utilitarian physical activity favorability [quartiled]) were associated with HbA1c change over 6 and 24 months, controlling for demographics, HbA1c, BMI, and time with evidence of type 2 diabetes. We evaluated whether community domains modified associations of TI with HbA1c change using cross product terms.

RESULTS There were 15,308 patients with 69,818 elevated HbA1c measures. The average reduction in HbA1c over 6 months was 0.07% less in townships with a high level of CSD (third quartile versus the first). Reductions were 0.10% greater for HbA1c in townships with the best food availability (versus worst). HbA1c reductions were 0.17–0.19% greater in census tracts in the second and third quartiles of utilitarian physical activity favorability versus the first. The association of TI with 6-month HbA1c change was weaker in townships and boroughs with the worst CSD (versus best) and in boroughs with the best fitness assets (versus worst). The association of TI with 24-month HbA1c change was weaker in census tracts with the worst CSD (versus third quartile) and strongest in census tracts most favorable for utilitarian physical activity (versus worst).

CONCLUSIONS Community domains were associated with HbA1c change and blunted TI effectiveness.



中文翻译:

2型糖尿病患者中四个社区因素与血红蛋白A 1c水平的纵向变化的关系

目的评估社区因素与糖化血红蛋白(HbA 1c)的关系。

研究设计和方法我们确定患者的2型糖尿病谁了糖化血红蛋白1C ≥7.5%(58毫摩尔/摩尔)和后续HBA 1C内90-270天的测试。我们使用混合效应模型评估了治疗强化(TI)和社区领域(社区社会经济剥夺[CSD],食物供应,健身资产和功利体育活动的有利程度[四分位数])是否与6和24岁以上的HbA 1c变化相关个月,控制人口统计学,HbA 1c,BMI和2型糖尿病的证据。我们使用跨产品术语评估了社区域修饰的TI与HbA 1c的关联是否发生了变化。

结果15308例患者的HbA 1c指标升高了69,818例。在CSD较高的乡镇中,HbA 1c的平均减少量在6个月内减少了0.07%(第三四分位数与第一四分位数相比)。HbA 1c在食物可获得量最好(相对最差)的乡镇中降低了0.10%。在第二和第三四分位数的功利体育活动偏好中,普查区的HbA 1c降低幅度为0.17-0.19%。TI与6个月HbA 1c变化的关联在CSD最差的城镇和自治市镇(相对最佳)和健身资产最佳的自治市镇(相对最差)都较弱。TI与24个月HbA 1c的关联 CSD最差的普查区的变化较弱(相对于第三四分位数),最有利于功利体育活动的普查区的变化较之最差(最差)。

结论社区域与HbA 1c的改变和TI有效性的降低有关。

更新日期:2018-02-21
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