The potentially poor response to outpatient diabetes care in urban African-Americans

OBJECTIVE- HbA(1c) levels can be reduced in populations of diabetic patient s, but some individuals may exhibit little improvement. To search for reaso ns underlying differences in HbA(1c) outcome, we analyzed patients managed in an outpatient diabetes clinic. RESEARCH DESIGN AND METHODS- African-Americans with type 2 diabetes were ca tegorized as responders, intermediate responders or poor responders accordi ng to their HbA(1c) level after 1 year of care. Logistical regression was u sed to determine baseline characteristics that distinguished poor responder s from responders. Therapeutic strategies were examined for each of the res ponse categories. RESULTS- The 447 patients had a mean age and disease duration of 58 and 5 y ears, respectively, and BMI of 32 kg/m(2). Overall, the mean HbA(1c) level fell from 9.6 to 8.1% after 12 months. Mean HbA(1c) levels improved from 8. 8 to 6.2% in responders, and from 9.5 to 7.9% in intermediate responders. I n poor responders, the average HbA(1c) level was 10.8% on presentation and 10.9% at 1 year. The odds of being a poor responder were significantly incr eased with longer disease duration, higher initial HbA(1c) level, and great er BMI. Although doses of oral agents and insulin were significantly higher among poor responders at most visits, the acceleration of insulin therapy did not occur until late in the follow-up period. CONCLUSIONS- Clinical diabetes programs need to devise methods to identify patients who are at risk for persistent hyperglycemia. Whereas patient char acteristics explain some heterogeneity of HbA(1c) outcome (and may aid in e arlier identification of patients who potentially may not respond to conven tional treatment), insufficient intensification of therapy may also be a co mponent underlying the failure to achieve glycemic goals.