Controlling Diabetes: Black-White Gap

Aug. 25, 2006 -- Blacks with diabetesdiabetes are more likely than whites to have a major health risk: uncontrolled blood sugar.

Wake Forest University's Julienne Kirk, PharmD, CDE, and colleagues report that news in September's edition of Diabetes Care.

"This lower level of [blood sugar] control may partly explain why blacks have disproportionately higher rates of death and complications from diabetes," Kirk says, in a Wake Forest news release.

In fact, the black-white gap could mean that whites are about 15% less likely than blacks to have diabetes-related circulation problems compared with blacks, the researchers note.

For people with diabetes, good blood sugar control is essential.

Uncontrolled high blood sugar ups the risk of serious diabetes complications, including:

• Heart diseaseHeart disease
• Kidney failureKidney failure
• Diabetic retinopathy (an eye disease that can cause blindness)
• Foot or leg amputation
• Nerve problems

Kirk's team reviewed 11 studies from 1993-2005 on blacks and whites with diabetes. All together, the studies included about 45,000 whites and more than 15,000 blacks.

The average age of patients in most studies was over 50. Most patients had type 2 diabetes, the most common type of diabetes. None had gestational diabetesgestational diabetes.

Data included patients' hemoglobin A1c test scores. The hemoglobin A1c test measures the average amount of sugar in your blood over the last three months; higher scores on the blood test mean poor blood sugar control.

Average A1C scores were about 0.65% higher for blacks than whites across the studies, write Kirk and colleagues.

That may sound like a tiny difference. But it could have a big impact.

A previous study showed a 21% drop in diabetes-related circulation problems for every 1% drop in A1c. So a 0.65% gap translates into a 15% difference, Kirk's team notes.

What's the reason for the black-white A1C gap? This study doesn't settle that question.

Many factors -- including access to medical care and intensity of treatment -- are likely involved, the researchers write.

They call for more studies to understand and close the black-white gap in diabetes blood sugar control.