Diabetes risk, diagnosis, and control: Do psychosocial factors predict hemoglobin A1C defined outcomes or accuracy of self-reports?

Objective: To evaluate the accuracy of self-reported diabetes among multi-ethnic older adults by psychosocial factors and assess predictors of diabetes risk, diagnosis, and control. Design and Methods: The 2006 Health and Retirement Study (N=5,594) was used to determine agreement between self-reported diabetes and measured diabetes (HbA1c = 6.5 ) by age, sex, race/ethnicity, nativity, education, health insurance coverage, body mass index, depressive symptoms, and prior report of racial discrimination. We also examined associations between these factors and pre-diabetes (HbA1c = 6.0- 6.5 ) among individuals without diabetes, and those with undiagnosed and poorly controlled (HbA1c = 8.0 ) diabetes. Results: Accuracy of self-reported diabetes was good (ie, sensitivity = 80 and specificity = 95 ) among all demographic subgroups and across most social strata. Among those who reported racial discrimination, sensitivity of self-reported diabetes was lower among Blacks who reported racial discrimination in comparison to Blacks who did not report racial discrimination (82.7 vs 89.0 ) an association that was marginally statistically significant (P=.05). Blacks and Hispanics had higher odds of pre-diabetes, undiagnosed diabetes, and poor glycemic control. Conclusions: Self-reported diabetes corresponded well with HbA1c assessed disease for all social strata examined in this sample of multi-ethnic older adults. Blacks with a history of racial discrimination may be less likely to know diabetes status.

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Diabetes/Self-report/Accuracy/Race/ethnicity/Racial Discrimination

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