Retirement and Management of Diabetes in Medically Under-served Patients with Type 2 Diabetes: Preliminary Findings and Literature Review

Abstract

Background: Studies have found that diagnosis of Type 2 diabetes increases the risk of early retirement in the high-income countries. In this study, we examined the levels of glycated hemoglobin (HbA1c) by employment status to determine if early retirement confers a benefit to managing diabetes. Methods: The data was from a primary care center serving the uninsured and medically underserved in the greater Williamsburg area in the State of Virginia. Plasma concentration of HbA1c (%) from the last visit was used to measure the average level of blood glucose and as an assessment test for glycemic control in people with diabetes. Data analyses were carried out using general linear regression with HbA1c as the dependent variable and employment status, gender and age as the independent variables; and the interaction of gender and employment status and interaction of age and employment status were assessed to control for potential confounding factors. Results: The results showed that males tended to have a higher level of HbA1c; overall age was negatively associated with the levels of HbA1c; there was a significant difference in the mean levels of HbA1c between the retired people and people working part-time (p=0.032). After controlling for age and gender in the multiple linear regression analysis, employment status became non-significantly associated with HbA1c levels. Post hoc analysis showed a difference in HbA1c between individuals working part-time (the highest HbA1c group) and the full-time employed at a marginal significance (p=0.0823). While almost 20 years older, the retired people had the lowest level of HbA1c. However, the mean level of HbA1c was no longer significantly different from that in other groups, probably because age explained much of this variation in the levels of HbA1c among employment status. Multiple regression analysis showed that age was negatively associated with the levels of HbA1c (The retired people mainly derived Beta=-0.046, p<0.0001). Conclusion: In this underserved population, the HbA1c level is the lowest in people after retirement, even though they are older. Our study indicates that retirement may be a beneficial factor for the management of diabetes, which warrants further investigation.