September 9, 2025Journal of Racial and Ethnic Health Disparities1 citationsOpen Access

Risk Trajectories of Type 2 Diabetes–Related Microvascular Complications Across Racial/Ethnic Groups Among Older Adults

KPKaustubh V. ParabAurora St. Luke's Medical Center XGXiaotian GaoBaylor College of Medicine NGNeha P. GotheNortheastern University

Structured PICO

Do risk trajectories of type 2 diabetes-related microvascular complications differ across racial/ethnic groups among older adults?

Population

6,326 older adults with type 2 diabetes mellitus (HbA1c ≥ 7.5, aged 40-79 years with a history of cardiovascular diseases or 55-79 years with at least two risk factors for cardiovascular diseases) derived from the ACCORD trial. Subgroups included Black (n=1,099), White (n=4,071), and Other races (n=1,156).

Outcome

Composite microvascular complications (nephropathy based on serum creatinine >3.3 mg/dL, retinopathy based on vision loss, and neuropathy based on MNSI score >2) over 8 yearscomposite

Older adults of 'Other' races (predominantly Hispanic) with type 2 diabetes demonstrated a declining risk of microvascular complications over 8 years, whereas Black and White adults experienced an increasing risk over time.

Abstract

INTRODUCTION: Type 2 diabetes mellitus (T2DM) microvascular complications are a major public health issue that disproportionately affects racial/ethnic minorities in the US. We aimed to address the limited understanding of racial/ethnic disparities in the longitudinal natural history of microvascular complications over eight years among older adults with T2DM in the US and Canada. METHODS: From 10,251 participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) (2003-2009) trial, we derived 6323 participants. We examined racial/ethnic disparities of composite microvascular complications, nephropathy, neuropathy, and retinopathy outcomes among adults of Black (n = 1099), White (n = 4071), and Other races (n = 1156), over 8 years. We used linear mixed-effects model with random intercept to account for intra-person correlation. RESULTS: Our linear mixed-effects models displayed that the odds of composite microvascular complications for other race, which primarily consisted of Hispanic adults declined over a period of time OR: 0.95 (0.93-0.99). The odds increased over time for Black 1.06 (1.03-1.09) and White 1.11 (1.09-1.13) adults (P < 0.001). CONCLUSION: Other race adults had a declining risk of microvascular complications over time. This decline was not observed among Black and White adults.

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