Intersection of Gender-Race/Color and Glycemic Control in Diabetes in Nine Years of Follow-up of the ELSA-Brazil Cohort

This study investigated how social categories defined by the intersection of gender-race/color influence the trajectory of glycemic control in adults with type 2 diabetes mellitus (T2DM). Guided by intersectionality and ecossocial theories, the study analyzed 1,009 individuals with T2DM who participated in three in-person study visits of the ELSA-Brazil cohort. Glycemic control at each visit was defined by glycated hemoglobin (HbA1C) < 7%. Four glycemic control trajectories were established (glycemic control at all visits; inadequate control at one visit; inadequate control at two visits; inadequate control at three visits). Six intersectional categories of gender-race/color were created (white woman, brown woman, black woman, white man, brown man, and black man). The associations between the intersectional categories and the glycemic control trajectory were estimated by multinomial logistic regression adjusted for sociodemographic, behavioral, health, and insulin use factors. The prevalence of adequate glycemic control decreased over visits in all intersectional categories and was lowest among Black women. Compared to white women, all intersectional categories except white men had higher odds of inadequate glycemic control at all three visits after adjusting for age, especially black men (OR: 3.04; 95% CI: 1.58-5.85), followed by black women (OR: 2.99; 95% CI: 1.65-5.43), brown women (OR: 2.47; 95% CI: 1.36-4.46), and brown men (OR: 2.47; 95% CI: 1.40-4.39). These results reveal persistent inequalities in glycemic control among the most socially vulnerable intersectional groups of gender and race, suggesting that the distinct life experiences of these groups affect the control of their disease.