Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

Influence of Age, Biological Sex, and Ethnicity on HbA1C Levels and Glycemic Control Disparities in Adults with Type II Diabetes Sydney Ball, OMS III, BS, Elias Bouyounes, OMS III, BS, Grace Cush, OMS III, BS, Naina Kohli, OMS III, BS, Erin McCoy, OMS III, BS Edward Via College of Osteopathic Medicine (VCOM) - Carolinas, Spartanburg, SC Dr. Lisa Carroll, M.D., David Redden, Statistician. Introduction Results Discussion

Statistical Analysis: • Summarizing categorical demographic variables, such as race, sex, and preferred language. • Summarizing continuous demographic variables using sample mean and standard deviation to measure central location and spread Comparison of A1c levels across sex, preferred language, and race began using t-tests and Analysis of Variance. • Examination of the residuals indicated violation of the normality assumption, therefore non-parametric tests (Wilcoxon Rank Sum, Kruskal Wallis) to conduct the tests was used. • To test an association between age and A1c level, we used Spearman’s correlation.

• There is a statistically significant pattern where older individuals tend to have lower A1c levels. • The study revealed no statistical significance that biological sex or ethnicity influenced HBA1C levels in adults diagnosed with type 2 diabetes nor did it show significant disparities in glycemic control between different ethnic groups. • Future research is warranted to address why age alone influences HbA1c levels. • Questions for future research may focus on individual health behaviors or lifestyle factors (i.e. regimented diet and medication schedules at home or in skilled nursing facilities). • The study highlights disparities in glycemic control across different ethnic groups. • Future studies should focus on other underlying factors contributing to poor glycemic control. • Research should also be done on the impact of different intervention plans and their effectiveness in lowering HbA1c. • Furthermore, this study should be expanded to other communities to get a more comprehensive understanding of the disparities that exist. Conclusions

Type 2 diabetes mellitus is a chronic and costly disease that affects many patients across the United States. Multiple studies have shown that the burden of type 2 diabetes is not shared equally between different ethnic and age groups. Rural communities also carry the highest risks for diabetes related mortality. Treatment for type 2 diabetes often requires a combination of behavioral changes and medications while tracking disease severity using Hemoglobin A1C levels. These treatments vary between individuals and adequate glycemic control is not always acquired. Studying the demographics of patients with poorly controlled diabetes in rural communities may provide better insight into the disparities present and lead to improvements in the care delivered. Studying de identified data sets obtained from a free clinic in rural South Carolina, focusing on patients with type 2 diabetes, is important to understand potential disparities in glycemic control across different ethnic groups. This study aimed to determine if sex, biological age, or ethnicity influenced HBA1C levels in adults diagnosed with type 2 diabetes and if there were significant disparities in glycemic control between different ethnic groups. Does age, biological sex, and ethnicity influence HbA1c levels in adults diagnosed with Type 2 Diabetes, and are there significant disparities in glycemic control across different ethnic groups? • Using a random day generator, a patient population with a previous diagnosis of type 2 diabetes at St. Luke’s Free Medical Clinic in Spartanburg, SC was created. • Patients were deidentified and their most previous A1C value and date were recorded, as well as their birth year, biological sex, race, and preferred language. • This data was then analyzed by a statistician who extrapolated patterns and insights regarding the study’s objectives. Methods

Table 1. P values assessing the association between different demographics and their A1c levels.

Results: Sample of 69 individuals • A1c ranged from 5.6 mmol/L to 13.60 mmol/L with a mean of 7.80 mmol/L, standard deviation 1.83 mmol/L. • Age ranged from 30 to 77 with mean of 55.31, standard deviation of 9.84. • Using a 0.05 Type I error

References

rate, we do not observe a statistically significant difference based upon sex (p = 0.0965), preferred language (p = 0.1161), or race (p = 0.3571).

Figure 1. Scatterplot and Spearman Correlation between A1c Rank and Age Rank

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• However, using a 0.05 Type I error rate, we observe a significant negative Spearman correlation between age and A1c level (p = 0.0135).

2025 Research Recognition Day

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