Associations of Four Community Factors With Longitudinal Change in Hemoglobin ALevels in Patients With Type 2 Diabetes.
To evaluate associations of community factors with glycated hemoglobin (HbA).
RESEARCH DESIGN AND METHODS
We identified patients with type 2 diabetes who had an HbA≥7.5% (58 mmol/mol) and subsequent HbAtesting 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 HbAchange over 6 and 24 months, controlling for demographics, HbA, BMI, and time with evidence of type 2 diabetes. We evaluated whether community domains modified associations of TI with HbAchange using cross product terms.
There were 15,308 patients with 69,818 elevated HbAmeasures. The average reduction in HbAover 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 HbAin townships with the best food availability (versus worst). HbAreductions 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 HbAchange 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 HbAchange 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).
Community domains were associated with HbAchange and blunted TI effectiveness.
Hirsch, Annemarie G
Durden, T Elizabeth
Schwartz, Brian S