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> or = 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 > or = 6.0-<6.5%) among individuals without diabetes, and those with undiagnosed and poorly controlled (HbA1c > or = 8.0%) diabetes. RESULTS Accuracy of self-reported diabetes was good (ie, sensitivity > or = 80% and specificity > or = 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 HbAlc 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.