397-P: Relationship between HbA1c and Declines in Racial Differences of Serious Hypoglycemia in the Veteran Health Administration (VHA) 2004-2015

Abstract

Annual rates of emergency department visits or hospitalizations for hypoglycemia (HYPO) were evaluated using a serial cross-sectional study design (2004-2015) of VHA/Medicare enrolled patients. Subjects were ≥65 years receiving secretagogues only (Secr), or insulin with or without Secr (Ins), and who had HbA1c value(s). Separately for Secr/Ins groups and by race/ethnicity, we assessed age/sex adjusted HYPO rates (per 1000 patients) and A1c values (from prior to an event or end of year for those without an event). In 2015, subjects were 99% men, 10% [B]lack, 6% [H]ispanic, and 75% [W]hite; 75% had major comorbidity categories; 24% had cardiovascular conditions only, and 9% advanced diabetes only. Ins use increased by 88%, similar among B/H/W. HYPO rates markedly declined for Ins and Secr in all races but remained higher for B. The percent of patients with A1c <7% decreased: 44.2%/32.9%[B], 51.0%/32.6%[W], and 41.3%/28.4%[H]; the percentage for A1c 7.0-7.9% increased: 28.6%/31.6%[B], 30.6%/35.8%[W], and 30.8%/32.4%[H]; the percentage for >9% also increased: 11.9%/15.8%% [B], 6.4/12.2%[W], and 12.0/17.6%[H]. Mean A1c values also increased in B/H/W, and were similar (difference ≤0.2%) between patients with and without HYPO. Guideline recommendations (post 2008) for individualized A1c goals may have mediated reductions in racial disparities for HYPO rates. Disclosure C. Tseng: None. O. Soroka: None. C.E. Myers: None. D.C. Aron: None. L.M. Pogach: None. Funding U.S. Department of Veterans Affairs (IIR14-082)