The epidemic of type 2 diabetes has had a disproportionate impact on African-Americans, who have increased risk of both the disorder and its complications. The risk of complications has been attributed to poor metabolic control, and our studies show that HbAlc levels are higher in African-Americans than in Non-Hispanic Whites. The mechanisms which underlie such disparities are poorly understood; socioecologic factors may play a role, but management by providers may also contribute - since we find that African-Americans receive lower dosages and less complex insulin regimens. (1) To identify socioecologic factors which contribute to poor control we will measure socioeconomic status and literacy, and assess health care access for African- Americans in a municipal diabetes clinic, and determine the impact of such factors on HbAIc levels both at presentation and after followup. (2) To determine whether diabetes control can be improved with an aggressive, physiologic regimen of insulin administration we will conduct a randomized, controlled trial comparing conventional regimens (beginning with 70/30 insulin twice daily) with a more physiologic regimen (insulin before meals and at bedtime), and assess HbAlc levels; potential adverse effects (hypoglycemia and weight gain); and patient acceptability, adherence, and satisfaction over one year of care. Information from these analyses will be critical to guide development of programs aimed at eliminating the health disparity of African-Armenians with diabetes.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Postdoctoral Individual National Research Service Award (F32)
Project #
1F32DK062668-01
Application #
6551307
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Hyde, James F
Project Start
2002-07-01
Project End
2004-06-30
Budget Start
2002-07-01
Budget End
2003-06-30
Support Year
1
Fiscal Year
2002
Total Cost
$50,116
Indirect Cost
Name
Emory University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Ziemer, David C; Kolm, Paul; Weintraub, William S et al. (2010) Glucose-independent, black-white differences in hemoglobin A1c levels: a cross-sectional analysis of 2 studies. Ann Intern Med 152:770-7
Chatterjee, Ranee; Narayan, K M Venkat; Lipscomb, Joseph et al. (2010) Screening adults for pre-diabetes and diabetes may be cost-saving. Diabetes Care 33:1484-90
Phillips, L S; Ziemer, D C; Kolm, P et al. (2009) Glucose challenge test screening for prediabetes and undiagnosed diabetes. Diabetologia 52:1798-807
Rhee, Mary K; Ziemer, David C; Caudle, Jane et al. (2008) Use of a uniform treatment algorithm abolishes racial disparities in glycemic control. Diabetes Educ 34:655-63
El Bassuoni, Eman A; Ziemer, David C; Kolm, Paul et al. (2008) The ""metabolic syndrome"" is less useful than random plasma glucose to screen for glucose intolerance. Prim Care Diabetes 2:147-53
Ziemer, David C; Kolm, Paul; Weintraub, William S et al. (2008) Age, BMI, and race are less important than random plasma glucose in identifying risk of glucose intolerance: the Screening for Impaired Glucose Tolerance Study (SIGT 5). Diabetes Care 31:884-6
Ziemer, David C; Kolm, Paul; Foster, Jovonne K et al. (2008) Random plasma glucose in serendipitous screening for glucose intolerance: screening for impaired glucose tolerance study 2. J Gen Intern Med 23:528-35
Phillips, Lawrence S; Weintraub, William S; Ziemer, David C et al. (2006) All pre-diabetes is not the same: metabolic and vascular risks of impaired fasting glucose at 100 versus 110 mg/dl: the Screening for Impaired Glucose Tolerance study 1 (SIGT 1). Diabetes Care 29:1405-7
Ziemer, David C; Doyle, Joyce P; Barnes, Catherine S et al. (2006) An intervention to overcome clinical inertia and improve diabetes mellitus control in a primary care setting: Improving Primary Care of African Americans with Diabetes (IPCAAD) 8. Arch Intern Med 166:507-13
Rhee, M K; Ziemer, D C; Kolm, P et al. (2006) Postchallenge glucose rises with increasing age even when glucose tolerance is normal. Diabet Med 23:1174-9

Showing the most recent 10 out of 16 publications