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Treister-Goltzman Y, Liberty IF, Peleg R. Ethnicity Affects A1C Levels in Patients With Diagnosed Type 2 Diabetes in Southern Israel. Diabetes Spectr 2023; 37:86-94. [PMID: 38385090 PMCID: PMC10877214 DOI: 10.2337/ds23-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Purpose To assess whether ethnicity affects the association between A1C and fasting glucose in people with type 2 diabetes. Methods This investigation was an epidemiological, cross-sectional study based on computerized medical records of the Southern District of Clalit Health Services. The study population comprised patients ≥40 years of age with type 2 diabetes who underwent blood tests between 8 August 2015 and 20 July 2020. A normal-error multiple linear regression model was used to assess differences in associations among ethnic groups (i.e., Arabs, Ethiopian Jews, and non-Ethiopian Jews) and A1C. Results A total of 59,432 patients with type 2 diabetes were included in the study. Of these, 1,804 were Jews of Ethiopian origin, 49,296 were non-Ethiopian Jews, and 8,332 were Arabs. Compared with non-Ethiopian Jews, A1C levels were increased by 0.1% (1 mmol/mol) among Ethiopian Jews and by 0.3% (3 mmol/mol) among Arabs. Ethnicity was a strong predictor of A1C, explaining 0.6% of its variance. An A1C level of 7% (53 mmol/mol) correlated with fasting glucose levels of 141, 136, and 126 mg/dL in non-Ethiopian Jews, Ethiopian Jews, and Arabs, respectively. Conclusion Ethnic differences in A1C should be considered by clinicians, researchers, and policymakers.
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Affiliation(s)
- Yulia Treister-Goltzman
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Haim Doron Division of Community Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clalit Health Services, Southern District, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idit F. Liberty
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Diabetes Clinic, Soroka University Medical Center, Beer-Sheva, Israel
| | - Roni Peleg
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Haim Doron Division of Community Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Clalit Health Services, Southern District, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Joseph JJ, Rajwani A, Roper D, Zhao S, Kline D, Odei J, Brock G, Echouffo-Tcheugui JB, Kalyani RR, Bertoni AG, Effoe VS, Sims M, Wu WC, Wand GS, Golden SH. Associations of Cardiometabolic Multimorbidity With All-Cause and Coronary Heart Disease Mortality Among Black Adults in the Jackson Heart Study. JAMA Netw Open 2022; 5:e2238361. [PMID: 36282500 PMCID: PMC9597394 DOI: 10.1001/jamanetworkopen.2022.38361] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE A combination of diabetes, coronary heart disease (CHD), and stroke has multiplicative all-cause mortality risk compared with any individual morbidity in White populations, but there is a lack of studies in Black populations in the US. OBJECTIVE To examine the association of cardiometabolic multimorbidity (diabetes, stroke, and CHD) individually and collectively with all-cause and CHD mortality. DESIGN, SETTING, AND PARTICIPANTS This cohort study included Black adults in the Jackson Heart Study followed over a median of 15 years. Baseline examinations were performed between 2000 and 2004, with follow-up on all-cause and CHD mortality through May 31, 2018. Participants were categorized into mutually exclusive groups at baseline: (1) free of cardiometabolic morbidity, (2) diabetes, (3) CHD, (4) stroke, (5) diabetes and stroke, (6) CHD and stroke, (7) diabetes and CHD, and (8) diabetes, stroke, and CHD. Data were analyzed from 2019 to 2021. EXPOSURE Cardiometabolic disease alone or in combination. MAIN OUTCOMES AND MEASURES The main outcomes were all-cause mortality and CHD mortality. Cox models estimated hazard ratios (HRs) with 95% CIs adjusted for sociodemographic and cardiovascular risk factors. RESULTS Among 5064 participants (mean [SD] age, 55.4 [12.8] years; 3200 [63%] women) in the Jackson Heart Study, 897 (18%) had diabetes, 192 (4%) had CHD, and 104 (2%) had a history of stroke. Among participants with cardiometabolic morbidities, the crude all-cause mortality rates were lowest for diabetes alone (24.4 deaths per 1000 person-years) and highest for diabetes, CHD, and stroke combined (84.1 deaths per 1000 person-years). For people with only 1 cardiometabolic morbidity, risk for all-cause mortality was highest for people with stroke (HR, 1.74; 95% CI, 1.24-2.42), followed by CHD (HR, 1.59 (95% CI, 1.22-2.08) and diabetes (HR, 1.50; 95% CI, 1.22-1.85), compared with no cardiometabolic morbidities. There were also increased risks of mortality with combinations of diabetes and stroke (HR, 1.71; 95% CI, 1.09-2.68), CHD and stroke (HR, 2.23; 95% CI, 1.35-3.69), and diabetes and CHD (HR, 2.28; 95% CI, 1.65-3.15). The combination of diabetes, stroke, and CHD was associated with the highest all-cause mortality (HR, 3.68; 95% CI, 1.96-6.93). Findings were similar for CHD mortality, but with a larger magnitude of association (eg, diabetes, stroke, and CHD: HR, 13.52; 95% CI, 3.38-54.12). CONCLUSIONS AND RELEVANCE In this cohort study, an increasing number of cardiometabolic multimorbidities was associated with a multiplicative increase in risk of all-cause mortality among Black adults, with a greater magnitude of association for CHD mortality.
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Affiliation(s)
- Joshua J. Joseph
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Aakash Rajwani
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Daniel Roper
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Songzhu Zhao
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - David Kline
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - James Odei
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus
| | - Guy Brock
- Department of Medicine, The Ohio State University Wexner Medical Center, Columbus
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| | - Rita R. Kalyani
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| | - Alain G. Bertoni
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Valery S. Effoe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Wen-Chi Wu
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Gary S. Wand
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
| | - Sherita H. Golden
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Massachusetts
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Xu Y, Bergenstal RM, Dunn TC, Ram Y, Ajjan RA. Interindividual variability in average glucose-glycated haemoglobin relationship in type 1 diabetes and implications for clinical practice. Diabetes Obes Metab 2022; 24:1779-1787. [PMID: 35546274 PMCID: PMC9546041 DOI: 10.1111/dom.14763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/22/2022] [Accepted: 05/08/2022] [Indexed: 12/25/2022]
Abstract
AIM Glycated haemoglobin (HbA1c) can fail to reflect average glucose levels, potentially compromising management decisions. We analysed variability in the relationship between mean glucose and HbA1c in individuals with diabetes. MATERIALS AND METHODS Three months of continuous glucose monitoring and HbA1c data were obtained from 216 individuals with type 1 diabetes. Universal red blood cell glucose transporter-1 Michaelis constant KM and individualized apparent glycation ratio (AGR) were calculated and compared across age, racial and gender groups. RESULTS The mean age (range) was 30 years (8-72) with 94 younger than 19 years, 78 between 19 and 50 years, and 44 were >50 years. The group contained 120 women and 96 men with 106 white and 110 black individuals. The determined KM value was 464 mg/dl and AGR was (mean ± SD) 72.1 ± 7 ml/g. AGR, which correlated with red blood cell lifespan marker, was highest in those aged >50 years at 75.4 ± 6.9 ml/g, decreasing to 73.2 ± 7.8 ml/g in 19-50 years, with a further drop to 71.0 ± 5.8 ml/g in the youngest group (p <0 .05). AGR differed between white and black groups (69.9 ± 5.8 and 74.2 ± 7.1 ml/g, respectively; p < .001). In contrast, AGR values were similar in men and women (71.5 ± 7.5 and 72.5 ± 6.6 ml/g, respectively; p = .27). Interestingly, interindividual AGR variation within each group was at least four-fold higher than average for between-group variation. CONCLUSIONS In this type 1 diabetes cohort, ethnicity and age, but not gender, alter the HbA1c-glucose relationship with even larger interindividual variations found within each group than between groups. Clinical application of personalized HbA1c-glucose relationships has the potential to optimize glycaemic care in the population with diabetes.
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Affiliation(s)
- Yongjin Xu
- Abbott Diabetes CareAlamedaCaliforniaUSA
| | | | | | | | - Ramzi A. Ajjan
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
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Venkatesh KK, Fareed N, Kiefer MK, Ware CA, Buschur E, Landon MB, Thung SF, Costantine MM, Gabbe SG, Joseph JJ. Differences in Hemoglobin A1c during Pregnancy between Non-Hispanic Black versus White Women with Prepregnancy Diabetes. Am J Perinatol 2022; 39:1279-1287. [PMID: 35253121 DOI: 10.1055/a-1788-5600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The objective of this was to determine whether the change in hemoglobin A1c (HbA1c) from early to late pregnancy differs between non-Hispanic Black and White women with prepregnancy diabetes. STUDY DESIGN A retrospective analysis was performed from an integrated prenatal and diabetes care program from 2012 to 2016. We compared HbA1c as a continuous measure and secondarily, HbA1c <6.5%, cross-sectionally, and longitudinally in early (approximately 10 weeks) and late (approximately 31 weeks) pregnancies. Linear and logistic regression were used and adjusted for age, body mass index, White diabetes class, medication use, diabetes type, gestational age at baseline HbA1c measurement, and baseline hemoglobin. RESULTS Among 296 non-Hispanic Black (35%) and White pregnant women (65%) with prepregnancy diabetes (39% type 1 and 61% type 2), Black women were more likely to experience increased community-level social determinants of health as measured by the Social Vulnerability Index (SVI) and were less likely to have type 1 diabetes and have more severe diabetes versus White women (p < 0.05). Black women had higher mean HbA1c (7.8 vs. 7.4%; beta: 0.75; 95% confidence interval [CI]: 0.30-1.19) and were less likely to have HbA1c < 6.5% at 10 weeks compared with White women (24 vs. 35%; adjusted odds ratio: 0.45; 95% CI: 0.24-0.81) but not after adjusting for SVI. At 31 weeks, both groups had similar mean HbA1c (both 6.5%) and were equally as likely to have HbA1c < 6.5% (57 vs. 54%). From early to late pregnancy, Black women had a higher percentage decrease in HbA1c (1.3 vs. 0.9%; beta = 0.63; 95% CI: 0.27-0.99) and were equally as likely to have an improvement or stable HbA1C < 6.5% from 10 to 31 weeks, with both groups having a similar mean HbA1c (6.5%) at 31 weeks. CONCLUSION Despite experiencing greater community-level social determinants of health, Black women with pregestational diabetes had a larger reduction in HbA1c and were able to equally achieve the target of HbA1c < 6.5% by late pregnancy compared with White women as part of an integrated diabetes and prenatal care program. KEY POINTS · An integrated diabetes and pregnancy care program may decrease racial and ethnic disparities in glycemic control.. · Black women had a larger reduction in HbA1c versus White women.. · Black women were able to equally achieve the target of HbA1c < 6.5% by late pregnancy versus White women..
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Affiliation(s)
- Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Naleef Fareed
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Miranda K Kiefer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Courtney A Ware
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Elizabeth Buschur
- Division of Endocrinology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Mark B Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Stephen F Thung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Maged M Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Steven G Gabbe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Joshua J Joseph
- Department of Bioinformatics, The Ohio State University, Columbus, Ohio
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5
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Marcondes FO, Cheng D, Alegria M, Haas JS. Are racial/ethnic minorities recently diagnosed with diabetes less likely than white individuals to receive guideline-directed diabetes preventive care? BMC Health Serv Res 2021; 21:1150. [PMID: 34689778 PMCID: PMC8543926 DOI: 10.1186/s12913-021-07146-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes mellitus has reached epidemic proportions in the United States. As the prevalence of diabetes continues to rise, the burden of disease is divided unevenly among different populations. Racial/ethnic disparities in diabetes care are pervasive, including the provision of care for prevention of complications. Prevention efforts should be focused on the time that immediately follows a diagnosis of diabetes. The aim of this study was to assess racial/ethnic differences in the receipt of guideline-directed diabetes care for complication prevention by individuals recently diagnosed with diabetes. METHODS We used repeated cross-sections of individuals recently diagnosed with diabetes (within the past 5 years) from the National Health Interview Survey from 2011 to 2017. Multivariate regression was used to estimate the associations between race/ethnicity (non-Hispanic White, non-Hispanic Black and Hispanic) and guideline-directed process measures for prevention of diabetes complications (visits to an eye and foot specialist, and blood pressure and cholesterol checks by a health professional - each in the prior year). We assessed effect modification of these associations by socioeconomic status (SES). RESULTS In a sample of 7,341 participants, Hispanics had lower rates of having any insurance coverage (75.9 %) than Non-Hispanic Whites (93.2 %) and Blacks (88.1 %; p<0.001). After adjustment for demographics, total comorbidities, SES, and health insurance status, Hispanics were less likely to have an eye exam in the prior year (OR 0.80; (95 % CI 0.65-0.99); p=0.04) and a blood pressure check (OR 0.42; (95 % CI 0.28-0.65); p<0.001) compared to Non-Hispanic Whites. There was no significant effect modification of race/ethnicity by SES. CONCLUSIONS Hispanics recently diagnosed with diabetes were less likely to receive some indicators of guideline-directed care for the prevention of complications. Lack of insurance and SES may partially explain those differences. Future work should consider policy change and providers' behaviors linked to racial/ethnic disparities in diabetes care.
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Affiliation(s)
- Felippe O Marcondes
- Division of General Internal Medicine, Massachusetts General Hospital, MA, Boston, USA
| | - David Cheng
- Biostatistics Center, Massachusetts General Hospital, MA, Boston, USA
| | - Margarita Alegria
- Disparities Research Unit, Massachusetts General Hospital, MA, Boston, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, MA, Boston, USA.
- Division of General Internal Medicine, MGH, 100 Cambridge St, Suite 1600, MA, 02114, Boston, USA.
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6
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Au XY, Kola S, Mohan V. The Effect of Diabetes Self-Management Education on Glycemic Control in Minority Patients With Diabetes Mellitus. Cureus 2021; 13:e16888. [PMID: 34367841 PMCID: PMC8341211 DOI: 10.7759/cureus.16888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/05/2022] Open
Abstract
Background Diabetes self-management education (DSME) plays a vital role in diabetes control yet is highly underutilized, especially in the minority population. The efficacy of DSME on glycemic control among the Hispanic and non-Hispanic black population is not as well established as it is compared to the non-Hispanic White population. Methodology In this retrospective cohort study, patients who participated in both group and one-to-one DSME classes at Saint Francis Medical Center, Trenton, New Jersey, from 2017 to 2019 were identified. Mean hemoglobin A1c levels before DSME and after DSME were compared using paired t-test. Results A total of 344 patients were included in the study. Out of 344 patients, 200 (58%) patients were Hispanic and 97 (28%) were non-Hispanic black, 42 (12%) were Caucasian, and five (2%) were from other races. The mean hemoglobin A1c was reduced by an average of 1.08% among patients who participated in group DSME (DSME done in group settings) and by an average of 1.95% among patients who participated in one-to-one DSME (DSME done in individualized settings). Conclusion DSME is effective in reducing hemoglobin A1c levels in Hispanic and non-Hispanic black majority patients. One-to-one DSME is more effective than group DSME in reducing hemoglobin A1c in this patient population.
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Affiliation(s)
- Xiu Ying Au
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | - Sneha Kola
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | - Vinuta Mohan
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
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7
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Lang M, Rosselli M, Greig MT, Torres VL, Vélez-Uribe I, Arruda F, Barker WW, Garcia P, Loewenstein DA, Curiel RE, Duara R. Depression and the Diagnosis of MCI in a Culturally Diverse Sample in the United States. Arch Clin Neuropsychol 2021; 36:214-230. [PMID: 31729523 PMCID: PMC7881973 DOI: 10.1093/arclin/acz043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 04/10/2019] [Accepted: 07/30/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To analyze (1) whether there are ethnic differences in the severity of depressive symptoms between groups of elders classified as cognitively normal (CN) or amnestic mild cognitive impairment (aMCI) and (2) the influence of depressive symptoms on specific cognitive performance by ethnicity across diagnoses, controlling for covariates. METHODS 164 Hispanics residing in the United States (HAs) and European Americans (EAs) (100 women; Mage = 72.1, SD = 8.0) were diagnosed as either CN or aMCI. Depressive symptoms were measured with the Geriatric Depression Scale (GDS-15). Cognition was assessed using the Loewenstein-Acevedo Scales for Semantic Interference and Learning (semantic memory), Multilingual Naming Test (confrontation naming), and the Stroop Test (Color-Word condition; executive function). A 2 × 2 univariate ANCOVA as well as linear and logistic regressions explored differences in depressive symptoms among diagnostic and ethnic groups. RESULTS Higher depression was seen in aMCI compared to the CN group for both ethnicities, after controlling for age, education, gender, and Mini-Mental State Examination score. Greater levels of depression also predicted lower scores in confrontation naming and semantic memory for only the EA group and marginally in scores of executive function for HA participants. GDS-15 scores of ≤ 4 also predicted less likelihood of aMCI diagnosis. CONCLUSIONS Severity of depressive symptoms was associated with greater cognitive impairment, independent of ethnicity. Significant results suggest detrimental effects of depression on clinical diagnoses most evidently for subjects from the EA group.
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Affiliation(s)
- Merike Lang
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Mónica Rosselli
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
| | - Maria T Greig
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Valeria L Torres
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Idaly Vélez-Uribe
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Fernanda Arruda
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Warren W Barker
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Patricia Garcia
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - David A Loewenstein
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
- Center for Cognitive Neuroscience and Aging and the Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Rosie E Curiel
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
- Center for Cognitive Neuroscience and Aging and the Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjan Duara
- Florida Alzheimer’s Disease Research Center, Miami Beach, FL, USA
- Wien Center for Alzheimer’s Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, USA
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Racial/Ethnic Differences in Glycemic Control in Older Adults with Type 2 Diabetes: United States 2003-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030950. [PMID: 32033032 PMCID: PMC7036954 DOI: 10.3390/ijerph17030950] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/14/2020] [Accepted: 01/31/2020] [Indexed: 01/03/2023]
Abstract
The aim of this study was to determine whether racial differences in HbA1c persist in older adults (≥65 years) living with type 2 diabetes. Data from The National Health and Nutrition Examination Survey (NHANES) 2003–2014 were used to examine the association between HbA1c and older adults (≥65 years) over time. Compared to non-Hispanic Whites, Mexican Americans had the greatest difference in average HbA1c among minority groups, followed by those with unspecified/mixed ethnicities and non-Hispanic Blacks. In the adjusted linear model, racial minorities had a statistically significant relationship with HbA1c. There was no relationship between HbA1c and older age and insulin use. Trends in mean HbA1c over time increased for non-Hispanic Blacks and Mexican Americans and decreased for non-Hispanic Whites. The findings suggest that racial differences in HbA1c persist into older age and compared to non-Hispanic Whites, non-Hispanic Blacks and Mexican Americans are at an increased risk of morbidity, mortality, and disability due to high HbA1c. Furthermore, alternate measures of glycemic control may be needed to screen and manage T2DM in racial minorities.
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Wiss DA. The Relationship Between Alcohol and Glycohemoglobin: A Biopsychosocial Perspective. Biores Open Access 2019; 8:146-154. [PMID: 31588381 PMCID: PMC6776959 DOI: 10.1089/biores.2019.0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
With the rising prevalence of type 2 diabetes mellitus (T2DM), there is debate regarding biological and psychosocial risk factors. While it is well established that alcohol lowers glycohemoglobin (HbA1c) levels, it is less clear whether alcohol consumption is protective of T2DM. It is also unclear how gender and ethnicity influence the utility of HbA1c screening as a tool for T2DM diagnosis, particularly in the context of alcohol use. This cross-sectional study utilized the National Health and Nutrition Examination Survey 2013–2014 dataset and was restricted to adults 20 years and older, nonpregnant, and not on antihypertensive medication (n = 4299) to evaluate the relationship between alcohol use and HbA1c. A multilinear regression model controlled for gender, ethnicity, education level, body mass index, and age. After controlling for covariates, both moderate (β = −0.073; p = 0.033) and heavy drinking (β = −0.167; p < 0.001) are associated with reduced HbA1c levels. Additionally, female gender is a significant negative predictor of HbA1c (β = −0.052; p = 0.024) and all ethnic groups have higher levels of HbA1c compared with non-Hispanic whites. Plausible biological mechanisms are discussed. The clinical utility of HbA1c as a screening tool for T2DM without considering alcohol use, gender, and ethnicity may lead to diagnostic errors. Individualized approaches and focused efforts toward health equity are needed to address rising rates of T2DM.
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Affiliation(s)
- David A. Wiss
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California
- Address correspondence to: David A. Wiss, MS, RDN, Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, 650 Young Drive South, Los Angeles, CA 90025
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Glantz NM, Duncan I, Ahmed T, Fan L, Reed BL, Kalirai S, Kerr D. Racial and Ethnic Disparities in the Burden and Cost of Diabetes for US Medicare Beneficiaries. Health Equity 2019; 3:211-218. [PMID: 31289781 PMCID: PMC6608694 DOI: 10.1089/heq.2019.0004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose: To examine the burden and cost of diabetes among fee-for-service Medicare beneficiaries. Methods: Medicare 5% File data for type 1 diabetes (T1D) and type 2 diabetes (T2D) consisting of 1,397,933 enrollees in fee-for-service without Medicare Advantage during the period 2012-2013 were analyzed by race and ethnicity. Results: Although non-Hispanic whites (nHWs) comprised most of this population (86%), prevalence of T1D and T2D was higher for Hispanics than nHWs (3.4% vs. 1.8%, p=0.0006, for T1D and 33.4% vs. 21.9%, p<0.0001, for T2D). Hispanics also had more acute hospital admissions (p=0.0235 for T1D and p=0.0009 for T2D) and longer lengths of stay (7.5 vs. 6.9 days for T1D, p=0.0105, and 6.7 vs. 6.2 days for T2D, p<0.0001) compared with nHWs. Allowed and paid costs per member per month adjusted for confounding were higher for Hispanics than nHWs for T2D (both p<0.0001) and lower for those with T1D (both p<0.0001). Mean number of chronic diseases in patients with diabetes was higher in Hispanics than nHWs (both T1D and T2D, p<0.0000). For T2D, Hispanics were more likely to have glycated hemoglobin (HbA1c) and lipid testing as well as nephropathy screening (all p<0.0001). Hispanics with T1D were also more likely to have HbA1c and lipid tests (p=0.0014 and p=0.0011, respectively); retinopathy and nephropathy screening rates did not differ significantly from rates among nHWs. Conclusion: Diabetes disproportionately impacts US seniors, with Hispanics almost twice as likely as nHWs to be diagnosed. Racial and ethnic disparities exist in the burden and cost of diabetes care for Medicare recipients.
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Affiliation(s)
- Namino M Glantz
- Sansum Diabetes Research Institute, Santa Barbara, California
| | - Ian Duncan
- Department of Statistics and Applied Probability, University of California Santa Barbara, Santa Barbara, California
| | - Tamim Ahmed
- Santa Barbara Actuaries, Inc., Santa Barbara, California
| | - Ludi Fan
- Eli Lilly and Company, Indianapolis, Indiana
| | | | | | - David Kerr
- Sansum Diabetes Research Institute, Santa Barbara, California
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Kannan S, Jaipalreddy C, Annapandian VM, Murali Mohan BV, Damodar S, Khadilkar KS, Shivaprasad KS. Impact of Anemia and Red Cell Indices on the Diagnosis of Pre-Diabetes and Diabetes in Indian Adult Population: Is there a Cut-off Guide for Clinicians? Indian J Endocrinol Metab 2019; 23:91-96. [PMID: 31016161 PMCID: PMC6446692 DOI: 10.4103/ijem.ijem_190_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is well known that anemia and red cell turn over affects the HbA1c value. Iron deficiency anemia increases the HbA1c and haemolytic anemia lowers it. However, the cut-off of haemoglobin (Hb) or red-cell indices when the HbA1c value becomes unreliable is not known. AIM We sought to find out values of HbA1c and red-cell indices where there is considerable discordance between HbA1c and plasma glucose (PG) values in the diagnosis of diabetes (DM) and pre-diabetes (Pre-DM) making HbA1c values unreliable. METHODS A cross-sectional study of 237 non-diabetic subjects who attended our out-patient division of preventive health check-up clinics, between November 2016 and December 2017. Data was collected only from relatively healthy subjects who had voluntarily opted for undergoing a preventative health check-up (including a diabetes screening). Patients were classified as concordant (fasting and 2-hr post meal glucose values are in agreement with HbA1c) and discordant (values are not in agreement with HbA1c). RESULTS A total of 237 patients (73% males) with mean age was 47.2±9.7 years (range 25-75) were included in the study. The HbA1c definition group had more diagnosis of DM (153 vs 96) and but lesser numbers of pre-DM (66 vs 102) compared to the PG group. Out of 237 patients, 133 (56%) showed concordance and 104 (44%) were discordant. The FPG, 2h-PPBG and HbA1c are significantly higher in the concordant group. The Hb value and MCV were significantly higher (p<0.05) in concordant group whereas, RDW and platelets are significantly higher (p<0.05) in discordant group. The highest rate of discordance was noted in the HbA1c strata of 6.5-7% (72%) followed by HbA1c of 5-6.4% (42%) and least in the HbA1c strata >7% (20%). While no single Hb or MCV value could predict discordance, a RDW value >17 was consistently associated with discordance across all the HbA1c strata. CONCLUSION A HbA1c below 7% is significantly influenced by red-cell turn over indices and clinicians need to perform additional testing using plasma glucose levels to confirm the presence of diabetes or pre-diabetes. In patients whose RDW >17, HbA1c should be replaced by 75gm OGTT as a test of choice for diagnosis of diabetes or pre-diabetes.
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Affiliation(s)
- Subramanian Kannan
- Department of Endocrinology, Diabetes and Metabolism, Mazumdar Shaw Medical Center, Narayana Health City, Bangalore, Karnataka, India
| | - Chinthala Jaipalreddy
- Department of Internal Medicine and Pulmonary Medicine, Mazumdar Shaw Medical Center, Narayana Health City, Bangalore, Karnataka, India
| | | | | | - Sharat Damodar
- Department of Hematology and Medical Oncology, Mazumdar Shaw Medical Center, Narayana Health City, Bangalore, Karnataka, India
| | - Kranti Shreesh Khadilkar
- Department of Endocrinology, Diabetes and Metabolism, Mazumdar Shaw Medical Center, Narayana Health City, Bangalore, Karnataka, India
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12
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Al Zahrani S, Al Mutairi AA. Crestal Bone Loss Around Submerged and Non-Submerged Dental Implants in Individuals with Type-2 Diabetes Mellitus: A 7-Year Prospective Clinical Study. Med Princ Pract 2019; 28:75-81. [PMID: 30396170 PMCID: PMC6558320 DOI: 10.1159/000495111] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 11/05/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE In establishing an evidence-based rationale for the optimal use of implant therapy in patients with type 2 diabetes mellitus (T2DM), it is essential to first understand the impact of glycemic control on early healing and the success of dental implants. The objective of this study was to evaluate crestal bone loss (CBL) and stability around submerged and non-submerged dental implants in Saudi patients with well- and poorly controlled T2DM. SUBJECT AND METHODS Thirty-five patients with well-controlled T2DM (24 males and 11 females) and 32 poorly controlled T2DM patients (19 males and 13 females) were included. CBL was measured on digital radiographs; resonance frequency analysis (RFA) measurements were made for each implant at the time of fixture placement and at 3 months in both the groups. A p value less than 0.05 was considered statistically significant. RESULTS A total of 124 dental implants were placed. Mean RFA values between baseline and 3 months in poorly controlled T2DM patients was statistically significant (p = 0.048). CBL at first year (p = 0.047), second year (p = 0.041), third year (p = 0.046), and seventh year (p = 0.035) was significantly worse in poorly controlled T2DM. CBL around non-submerged dental implants showed statistically significant differences at all time-intervals (p < 0.05). CONCLUSION Poorly controlled T2DM patients present worse peri-implant bone outcomes as compared to patients with well-controlled T2DM. We suggest that the predictability of successful dental implant therapy outcomes depends on the maintenance of optimal haemoglobin A1c levels.
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Affiliation(s)
- Saeed Al Zahrani
- Division of Prosthodontics, Department of Dental Services, Central Region, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia,
| | - Abdullah A Al Mutairi
- Division of Advanced Education in General Dentistry, Department of Dental Services, Central Region, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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13
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Munkhaugen J, Hjelmesæth J, Otterstad JE, Helseth R, Sollid ST, Gjertsen E, Gullestad L, Perk J, Moum T, Husebye E, Dammen T. Managing patients with prediabetes and type 2 diabetes after coronary events: individual tailoring needed - a cross-sectional study. BMC Cardiovasc Disord 2018; 18:160. [PMID: 30075751 PMCID: PMC6091110 DOI: 10.1186/s12872-018-0896-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/24/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Understanding the determinants associated with prediabetes and type 2 diabetes in coronary patients may help to individualize treatment and modelling interventions. We sought to identify sociodemographic, medical and psychosocial factors associated with normal blood glucose (HbA1c < 5.7%), prediabetes (HbA1c 5.7-6.4%), and type 2 diabetes. METHODS A cross-sectional explorative study applied regression analyses to investigate the factors associated with glycaemic status and control (HbA1c level) in 1083 patients with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records at the index event and from a self-report questionnaire and clinical examination with blood samples at 2-36 months follow-up. RESULTS In all, 23% had type 2 diabetes, 44% had prediabetes, and 33% had normal blood glucose at follow-up. In adjusted analyses, type 2 diabetes was associated with larger waist circumference (Odds Ratio 1.03 per 1.0 cm, p = 0.001), hypertension (Odds Ratio 2.7, p < 0.001), lower high-density lipoprotein cholesterol (Odds Ratio 0.3 per1.0 mmol/L, p = 0.002) and insomnia (Odds Ratio 2.0, p = 0.002). In adjusted analyses, prediabetes was associated with smoking (Odds Ratio 3.3, p = 0.001), hypertension (Odds Ratio 1.5, p = 0.03), and non-participation in cardiac rehabilitation (Odds Ratio 1.7, p = 0.003). In patients with type 2 diabetes, a higher HbA1c level was associated with ethnic minority background (standardized beta [β] 0.19, p = 0.005) and low drug adherence (β 0.17, p = 0.01). In patients with prediabetes or normal blood glucose, a higher HbA1c was associated with larger waist circumference (β 0.13, p < 0.001), smoking (β 0.18, p < 0.001), hypertension (β 0.08, p = 0.04), older age (β 0.16, p < 0.001), and non-participation in cardiac rehabilitation (β 0.11, p = 0.005). CONCLUSIONS Along with obesity and hypertension, insomnia and low drug adherence were the major modifiable factors associated with type 2 diabetes, whereas smoking and non-participation in cardiac rehabilitation were the factors associated with prediabetes. Further research on the effect of individual tailoring, addressing the reported significant predictors of failure, is needed to improve glycaemic control. TRIAL REGISTRATION Retrospectively registered at ClinicalTrials.gov: NCT02309255 , December 5th 2014.
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Affiliation(s)
- John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Health Trust, Dronninggata 41, 3004, Drammen, Norway. .,Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jøran Hjelmesæth
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Ragnhild Helseth
- Centre for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Erik Gjertsen
- Department of Medicine, Drammen Hospital Trust, Drammen, Norway
| | - Lars Gullestad
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Torbjørn Moum
- Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Einar Husebye
- Department of Medicine, Drammen Hospital Trust, Drammen, Norway
| | - Toril Dammen
- Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Oslo, Norway
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14
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AL ZAHRANI S, AL MUTAIRI AA. Stability and bone loss around submerged and non-submerged implants in diabetic and non-diabetic patients: a 7-year follow-up. Braz Oral Res 2018; 32:e57. [DOI: 10.1590/1807-3107bor-2018.vol32.0057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 05/10/2018] [Indexed: 11/22/2022] Open
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15
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Yamada E, Namiki Y, Takano Y, Takamine H, Inazumi K, Sasaki H, Yamada M, Ito S, Iwasaki T, Mantani N, Minami T, Osada UN, Terauchi Y, Nakajima A. Clinical factors associated with the symptoms of constipation in patients with diabetes mellitus: A multicenter study. J Gastroenterol Hepatol 2018; 33:863-868. [PMID: 29048762 DOI: 10.1111/jgh.14022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/13/2017] [Accepted: 10/11/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIM Changes in treatment protocols for patients with diabetes mellitus (DM) may influence the functions of the digestive tract. This study examined possible clinical factors associated with the symptoms of constipation in patients with DM. METHODS This was a multicenter study. Participants were consecutive Japanese patients undergoing treatment for type 1 or type 2 DM. Constipation was evaluated using the gastrointestinal symptom rating scale. Diabetic neuropathy was evaluated by the presence or absence of peripheral neuropathy of the lower limbs. RESULTS Of 419 participants, 258 were men and 161 women (ratio: 1.6:1), with a mean age of 63.6 ± 12.5 years. In multivariate analysis, symptoms of constipation were significantly associated with age (odds ratio [OR] = 1.02, 95% confidence interval [CI]: 1.01-1.04, P = 0.032), lower mental component summary (OR = 3.31, 95% CI: 1.69-6.48, P < 0.001), diabetic retinopathy (OR = 1.99, 95% CI: 1.14-3.45, P = 0.015), and diabetic neuropathy (OR = 1.86, 95% CI: 1.10-3.16, P = 0.021). In patients with peripheral neuropathy of the lower limbs, regardless of the presence of other complications (diabetic nephropathy and diabetic retinopathy), the prevalence of symptoms of constipation was twice that of patients without peripheral neuropathy (40.0-49.1% vs 22.0%). Diabetic drugs were not associated with symptoms of constipation. CONCLUSIONS Diabetic neuropathy, defined as peripheral neuropathy of the lower limbs, was significantly associated with symptoms of constipation. Peripheral neuropathy of the lower limbs is not a direct risk factor for constipation but may be a useful criterion when assessing whether constipation is associated with DM.
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Affiliation(s)
- Eiji Yamada
- Gastroenterology Division, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Yulia Namiki
- Diabetes and Endocrinology Division, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan
| | - Yuya Takano
- Diabetes and Endocrinology Division, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan
| | - Hikaru Takamine
- Diabetes and Endocrinology Division, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan
| | - Koji Inazumi
- Endocrinology and Diabetes Division, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroto Sasaki
- Endocrinology and Metabolism Division, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Masayo Yamada
- Endocrinology and Metabolism Division, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Satoshi Ito
- Diabetes and Endocrinology Division, Machida Municipal Hospital, Machida, Japan
| | | | | | - Taichi Minami
- Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Uru Nezu Osada
- Diabetes and Endocrinology Division, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan.,Bayside Clinic, Yokohama, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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16
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Davidson JA, Jones-Leone A, Wilson TH, Nino A, Forero-Schwanhaeuser S, Reinhardt RR. Albiglutide efficacy and safety in the Latino/Hispanic subpopulation for the integrated phase III program. Postgrad Med 2017; 129:849-857. [PMID: 29083275 DOI: 10.1080/00325481.2017.1387473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE to evaluate the efficacy and safety of albiglutide compared with placebo and active comparators from an integrated trial subpopulation of Latino/Hispanic patients whose type 2 diabetes mellitus (T2DM) was inadequately controlled on their current regimen of diet and exercise, with or without oral antidiabetic drugs (OADs) and/or insulin. METHODS Latino/Hispanic patient subpopulations (N = 1204) across 7 phase III albiglutide studies (N = 4400) were evaluated post-hoc for efficacy and safety. Comparators were placebo, sulfonylureas, insulin, thiazolidinediones, and dipeptidyl peptidase-4 inhibitors. Glycatedhemoglobin (HbA1c) change from baseline to the time of the primary endpoint assessment (from 26 to 104 weeks) was evaluated in patients on diet and exercise and/or OADs, with or without insulin. Patients were allowed to continue in the study if hyperglycemic rescue was required, according to a prespecified algorithm and at the discretion of the investigator. RESULTS At baseline in the Latino/Hispanic subpopulation, the mean HbA1c was 8.3%, mean age was 53 years, mean body mass index was 32 kg/m2, and mean duration of T2DM was 8.0 years. The primary endpoint of mean HbA1c difference (albiglutide - placebo) was -0.94% for the Latino/Hispanic subpopulation and -0.86% (p < 0.001) for the overall phase III population. Changes in fasting plasma glucose mirrored those of HbA1c. Weight loss with albiglutide was numerically greater than with OADs and insulin in both populations, but it was smaller than with liraglutide. Within the Latino/Hispanic subpopulation, more injection-site reactions were reported with albiglutide vs all comparators, while gastrointestinal and hypoglycemic adverse events were comparable between the two groups, and the latter was uncommon when used without insulin and/or a sulfonylurea. CONCLUSIONS In the Latino/Hispanic population, albiglutide resulted in effective lowering of glucose and modest weight loss, and it was generally well tolerated.
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Affiliation(s)
- Jaime A Davidson
- a Touchstone Diabetes Center , UT Southwestern Medical Center , Dallas , TX , USA
| | | | | | - Antonio Nino
- d Research and Development, GlaxoSmithKline , Collegeville , PA , USA
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Rouyard T, Kent S, Baskerville R, Leal J, Gray A. Perceptions of risks for diabetes-related complications in Type 2 diabetes populations: a systematic review. Diabet Med 2017; 34:467-477. [PMID: 27864886 PMCID: PMC5363347 DOI: 10.1111/dme.13285] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/23/2016] [Accepted: 11/11/2016] [Indexed: 11/28/2022]
Abstract
AIM In Type 2 diabetes, there is no clear understanding of how people perceive their risk of experiencing diabetes-related complications. To address this issue, we undertook an evidence-based synthesis of how people with Type 2 diabetes perceive their risk of complications. METHODS We performed a systematic search of nine electronic databases for peer-reviewed articles published on or before 1 March 2016. Data from 18 studies reporting lay perceptions of risks for complications in Type 2 diabetes populations were included. Publication year ranged between 2002 and 2014. RESULTS Methods used to assess risk perceptions were heterogeneous, ranging from questionnaires measuring the accuracy of perceived risks to semi-structured and focus group interviews. We found evidence of low risk awareness in most dimensions of risk perceptions measured and the existence of optimistic bias. CONCLUSIONS Perceptions were generally biased and varied according to the dimension of risk measured, the subpopulation concerned and the type of complications considered. Future work is needed to identify the best practical ways of correcting for biased risk perceptions so as to encourage self-care behaviours and treatment adherence.
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Affiliation(s)
- T. Rouyard
- Health Economics Research CentreNuffield Department of Population HealthOxfordUK
| | - S. Kent
- Health Economics Research CentreNuffield Department of Population HealthOxfordUK
| | - R. Baskerville
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - J. Leal
- Health Economics Research CentreNuffield Department of Population HealthOxfordUK
| | - A. Gray
- Health Economics Research CentreNuffield Department of Population HealthOxfordUK
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18
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Daley CM, Hale JW, Berryhill K, Bointy S, Clark L, Chase B, LeMaster J, He J. Diabetes Self-Management Behaviors among American Indians in the Midwestern United States. ACTA ACUST UNITED AC 2017; 3:34-41. [PMID: 30637353 PMCID: PMC6329453 DOI: 10.20431/2455-5983.0301005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to understand if American Indian adults with diabetes in the Midwest are similar to American Indian adults nationally in their self-management behaviors. This cross-sectional survey was conducted from May 2009 to April 2010 at powwows, health fairs, and other community events. The convenience sample self-selected into the study and answered questions via touch screen computer about diabetes self-management. Participants were significantly below the national average for American Indians in their adherence to self-management recommendations in daily foot checks (p=0.0035) and having had a dilated eye exam in the previous year (p=0.0002), despite being significantly more likely to have taken a diabetes self-management class (p<0.0001). They were similar to the national average for daily glucose checks and having had one or more hemoglobin A1C tests in the previous year. Participants were less likely to eat 5 or more servings of fruits or vegetables per day (p=0.0001), but more likely to achieve 150 minutes or more of physical activity per week (p=0.0001). Programs addressing self-care issues should be developed to help improve the self-management habits of American Indian adults with diabetes, with particular attention to activities outside of monitoring blood glucose and hemoglobin A1C levels.
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Affiliation(s)
- Christine M Daley
- Professor of Family Medicine and Preventive Medicine & Public Health Director, Center for American Indian Community Health, USA
| | - Jason W Hale
- Research Instructor of Family Medicine, Assistant Director, Center for American Indian Community Health, USA
| | - Kelly Berryhill
- Research Associate, Center for American Indian Community Health, USA
| | - Shelley Bointy
- Project Director, Center for American Indian Community Health, USA
| | - Lauren Clark
- Graduate Research Associate, Department of Biostatistics Member, Center for American Indian Community Health, USA
| | - Brian Chase
- Graduate Research Associate, Department of Biostatistics Member, Center for American Indian Community Health, USA
| | - Joseph LeMaster
- Associate Professor of Family Medicine Member, Center for American Indian Community Health, USA
| | - Jianghua He
- Associate Professor of Biostatistics Member, Center for American Indian Community Health, USA
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19
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The Lifestyle Intervention for the Treatment of Diabetes study (LIFT Diabetes): Design and baseline characteristics for a randomized translational trial to improve control of cardiovascular disease risk factors. Contemp Clin Trials 2016; 53:89-99. [PMID: 27940180 DOI: 10.1016/j.cct.2016.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 11/18/2016] [Accepted: 12/03/2016] [Indexed: 01/07/2023]
Abstract
The prevalence of type 2 diabetes continues to increase in minority and underserved patients, who are also more likely to have poorer control of diabetes and related risk factors for complications. Although the Look AHEAD trial has demonstrated improved risk factor control among overweight or obese diabetes patients who received an intensive lifestyle intervention, translating such findings into accessible programs is a major public health challenge. The purpose of this paper is to report the design and baseline characteristics of the Lifestyle Interventions for the Treatment of Diabetes study (LIFT Diabetes). The overall goal is to test the impact of a community-based lifestyle weight loss (LWL) intervention adapted from Look AHEAD on cardiovascular disease risk at 12-months and 24-months among minority and lower income diabetes patients. Secondary outcomes include body weight, physical activity, medication use, cost, resource utilization, and safety. The primary hypothesis being tested is that the LWL will result in 10% relative reduction in CVD risk compared to the DSM. We have randomized 260 overweight or obese adults with diabetes one of two 12-month interventions: a LWL condition delivered by community health workers or a diabetes self-management (DSM) education condition. The baseline demographic characteristics indicate that our sample is predominantly female, obese, low income, and ethnic minority. Translating evidence-based, lifestyle strategies, and targeting minority and underserved patients, will yield, if successful, a model for addressing the burden of diabetes and may favorably impact health disparities.
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20
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Pinchevsky Y, Shukla VJ, Butkow N, Chirwa T, Raal F. Multi-ethnic differences in HbA 1c, blood pressure, and low-density-lipid cholesterol control among South Africans living with type 2 diabetes, after a 4-year follow-up. Int J Gen Med 2016; 9:419-426. [PMID: 27895508 PMCID: PMC5117891 DOI: 10.2147/ijgm.s119965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Our study set out to examine if disparities in control of glycated hemoglobin (HbA1c), blood pressure (BP), and low-density-lipoprotein cholesterol (LDL-C) existed among an urban multi-ethnic cohort of South Africans, living with type 2 diabetes mellitus (T2DM). Patients and methods This longitudinal, retrospective study consisted of 261 men and women with previously diagnosed T2DM who attended Charlotte Maxeke Johannesburg Academic Hospital, South Africa across two time periods 2009 and 2013. Demographic and clinical data were extracted from consecutive medical records. The primary outcome was to determine achievements in HbA1c, BP, and LDL-C among ethnic groups using evidence-based goals. Results The mean age of the cohort was 64 (±10.6) years, females represented 55%, and the self-reported diabetes duration was 16 (±10.6) years as at 2013. Black Africans (42.9%, n=112 of 261) were more likely to reach the HbA1c target (<7%) and less likely to have had retinopathy, nephropathy, or cardiovascular disease. Over two-thirds of mixed-ancestry patients attained the BP target (<140/80 mmHg), while 90.2% of Caucasians achieved LDL-C goals (<2.5 mmol/L). Overall, across the ethnic groups studied, we found that HbA1c control deteriorated over time, although BP levels remained the same and LDL-C levels drastically improved. Conclusion There was poor control of HbA1c, BP, and LDL-C across all ethnic groups. Although a minority achieved recommended targets, some ethnic groups appeared to have worse control than others. Timely aggressive actions in particularly high-risk ethnic groups will prevent/delay the complications commonly associated with T2DM.
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Affiliation(s)
- Yacob Pinchevsky
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences
| | - Varada J Shukla
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences
| | - Neil Butkow
- Department of Pharmacy and Pharmacology, School of Therapeutic Sciences
| | - Tobias Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health
| | - Frederick Raal
- Carbohydrate and Lipid Metabolism Research Unit, Division of Endocrinology and Metabolism, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Buffarini R, Restrepo-Méndez MC, Silveira VM, Miranda JJ, Gonçalves HD, Oliveira IO, Horta BL, Gigante DP, Menezes AM, Assunção MCF. Distribution of Glycated Haemoglobin According to Early-Life and Contemporary Characteristics in Adolescents and Adults without Diabetes: The 1982 and 1993 Pelotas Birth Cohorts. PLoS One 2016; 11:e0162614. [PMID: 27626274 PMCID: PMC5023185 DOI: 10.1371/journal.pone.0162614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/25/2016] [Indexed: 12/23/2022] Open
Abstract
Aim Glycated haemoglobin (HbA1c), a marker of glucose control in individuals with diabetes mellitus, is also related with the incidence of cardiometabolic risk in populations free of disease. The aim of this study was to describe the distribution of HbA1c levels according to early-life and contemporary factors in adolescents and adults without diabetes mellitus. Methods HbA1c was measured in adults aged 30 years and adolescents aged 18 years who are participants in the 1982 and 1993 Pelotas Birth Cohorts, respectively. Bivariate and multivariate analyses were performed to describe the HbA1c mean values according to early-life and contemporary characteristics collected prospectively since birth. Results The distribution of the HbA1c was approximately normal in both cohorts, with a mean (SD) 5.10% (0.43) in the 1982 cohort, and 4.89% (0.50) in the 1993 cohort. HbA1c mean levels were significantly higher in individuals self-reported as black/brown skin color compared to those self-reported as white in both cohorts. Parental history of diabetes was associated with higher HbA1c mean in adults, while stunting at one year old presented an inverse relation with the outcome in adolescents. No other early and contemporary factors were associated with HbA1c levels in adults or adolescents. Conclusions We found a consistent relationship between HbA1c and skin color in both cohorts. Further research is needed to understand the role of genomic ancestry on levels of HbA1c concentrations which may inform policies and preventive actions for diabetes mellitus and cardiometabolic risk.
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Affiliation(s)
- Romina Buffarini
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
- * E-mail:
| | - María Clara Restrepo-Méndez
- International Center for Equity in Health, Federal University of Pelotas, Rua Marechal Deodoro, 1160 3rd floor, 96020–220, Pelotas, Brazil
| | - Vera M. Silveira
- Clinical Medical Department, Faculty of Medicine, Federal University of Pelotas, Rua Félix da Cunha 614, Centro, 96010–000, Pelotas, Brazil
| | - Jaime J. Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Department of Medicine, School of Medicine, Lima, Peru
| | - Helen D. Gonçalves
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Isabel O. Oliveira
- Department of Physiology and Pharmacology, Federal University of Pelotas, Campus Universitário s/n, Capão do Leão, 96010–900, Pelotas, Brazil
| | - Bernardo L. Horta
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Denise P. Gigante
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Ana Maria Menezes
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, 96020–220, Pelotas, Brazil
| | - Maria Cecília F. Assunção
- Department of Nutrition, School of Nutrition, Federal University of Pelotas, Campus Anglo, Gomes Carneiro 1, 96010–900, Pelotas, Brazil
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Hitt JM, Velasquez-Mieyer P, Neira C, Cowan P. Factors Affecting Hemoglobin A1C in the Diagnosis of Diabetes and Prediabetes in Youth. J Pediatr Nurs 2016; 31:511-8. [PMID: 27132801 DOI: 10.1016/j.pedn.2016.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED We sought to examine the correlation between variables and A1C levels to determine if prediction modeling could be used in the screening and diagnosis of diabetes and prediabetes in youth. We also sought to test relationships between A1C levels to insulin sensitivity indices and β-cell function indices. DESIGN AND METHODS We performed a retrospective review of 904 medical records from youth deemed at-risk for the disease. We performed Pearson correlation, multiple regression, and simple regression testing to determine the relationship between variables and A1C levels. In addition, we performed Pearson correlation testing on insulin sensitivity indices and β-cell function indices to determine the strength of correlation to A1C levels. RESULTS Statistical analysis did not show a strong relationship between the variables tested and the A1C. When racial and ethnic groups were tested together, the results from African American participants resulted in bias estimates, and as a result, a statistical model for the entire sample could not be performed. Results indicate that A1C is correlated with all β-cell function proxy measurements and correlated to the corrected insulin level at 30minutes, but not the fasting insulin or insulinogenic index. DISCUSSION The results from this study underline the multi-dimensional causes of diabetes and prediabetes and further stress the difficulties in predicting the diseases. The causes of diabetes and prediabetes are multifaceted, often individualized, and often difficult to ascertain. PRACTICE IMPLICATIONS Clinicians should continue to examine a variety of variables prior to determining the need for diabetes diagnostic testing.
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Affiliation(s)
| | | | | | - Patricia Cowan
- University of Tennessee Health Science Center, Memphis, TN
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Puranik NV, Puntambekar HM, Srivastava P. Antidiabetic potential and enzyme kinetics of benzothiazole derivatives and their non-bonded interactions with α-glucosidase and α-amylase. Med Chem Res 2016. [DOI: 10.1007/s00044-016-1520-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Heidemann DL, Joseph NA, Kuchipudi A, Perkins DW, Drake S. Racial and Economic Disparities in Diabetes in a Large Primary Care Patient Population. Ethn Dis 2016; 26:85-90. [PMID: 26843800 DOI: 10.18865/ed.26.1.85] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We sought to determine if, after adjusting for economic status, race is an independent risk factor for glycemic control among diabetic patients in a large primary care patient population. DESIGN SETTING PARTICIPANTS We performed a retrospective chart review of 264,000 primary care patients at our large, urban academic medical center to identify patients with a diagnosis of diabetes (n=25,123). Zip code was used to derive median income levels using US Census Bureau demographic information. Self-reported race was extracted from registration data. MAIN OUTCOME MEASURES The prevalence of diabetes, average glycated hemoglobin (A1c), and prevalence of uncontrolled diabetes of White and Black patients at all income levels were determined. RESULTS White patients had a lower average A1c level and a lower prevalence of diabetes than Black patients in all income quartiles (P<.001). Among White patients, the prevalence of diabetes (P<.001), uncontrolled diabetes (P<.001), and A1c level (P=.014) were inversely proportional to income level. No significant difference in the prevalence of diabetes (P=.214), A1c level (P=.282), or uncontrolled diabetes related to income was seen in Black patients (P=.094). CONCLUSIONS Race had an independent association with diabetes prevalence and glycemic control. Our study does not support two prominent theories that economic and insurance status are the main factors in diabetes disparities, as we attempted to control for economic status and nearly every patient had insurance. It will be important for future analysis to explore how health care system factors affect these observed gaps in quality.
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Affiliation(s)
| | | | | | | | - Sean Drake
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI
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25
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Abstract
Globally, the incidence of diabetes mellitus is rising at an alarming rate and has become a health crisis that threatens the economies of all nations. Therefore, diagnosing diabetes has become an important issue in the management of diabetes. Glycated hemoglobin (HbA1c) is now recommended as a means to diagnose diabetes, but its use still has limitations. In this article, the biology, measurement, standardization, and opportunities and challenges of the use of HbA1c to diagnose diabetes are reviewed. More specifically, its use in China and the Asian region is discussed in detail.
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Affiliation(s)
- Weiping Jia
- a Department of Endocrinology and Metabolism , Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease , Shanghai , China
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Janghorbani M, Papi B, Amini M. Current status of glucose, blood pressure and lipid management in type 2 diabetes clinic attendees in Isfahan, Iran. J Diabetes Investig 2015; 6:716-25. [PMID: 26543547 PMCID: PMC4627550 DOI: 10.1111/jdi.12349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/12/2015] [Accepted: 03/02/2015] [Indexed: 01/22/2023] Open
Abstract
AIMS/INTRODUCTION To estimate the prevalence of meeting American Diabetes Association clinical practice recommendations for hemoglobin A1c (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) among Iranian type 2 diabetes clinic attendees, and to identify the factors associated with therapeutic target achievement. MATERIALS AND METHODS A total of 2,640 patients with type 2 diabetes (944 men and 1,696 women) from Isfahan Endocrine and Metabolism Research Center outpatient clinics, Iran, were examined. The main outcome measures were HbA1c, BP and LDLC, in accordance with the American Diabetes Association recommendations. The mean (standard deviation) age of participants was 49.6 years (9.3 years) with a mean (standard deviation) duration of diabetes of 5.0 years (4.9 years) at initial registration. RESULTS The percentages of patients who had HbA1c <7%, BP <140/90 mmHg and LDLC <100 mg/dL was 37.4% (95% confidence interval [CI] 35.6-39.3), 35.3% (95% CI 33.5-37.3) and 48.9% (95% CI 47.0-50.8), respectively. The proportion of patients meeting all three goals was 7.7% (95% CI 6.7-8.8). Lower BP, cholesterol level and higher education at registration, and higher follow up but lower number of follow-up visits affected achievement of all three goals. CONCLUSIONS The present study highlights that a substantial proportion of Iranian type 2 diabetes clinic attendees did not meet the American Diabetes Association clinical practice recommendations, and shows the difficult challenges physicians face when treating patients with type 2 diabetes.
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Affiliation(s)
- Mohsen Janghorbani
- School of Public Health, Isfahan University of Medical SciencesIsfahan, Iran
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical SciencesIsfahan, Iran
| | - Bahman Papi
- School of Public Health, Isfahan University of Medical SciencesIsfahan, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical SciencesIsfahan, Iran
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Seawell AH, Hurt TR, Shirley MC. The Influence of Stress, Gender, and Culture on Type 2 Diabetes Prevention and Management Among Black Men: A Qualitative Analysis. Am J Mens Health 2015; 10:149-56. [PMID: 25862692 DOI: 10.1177/1557988315580132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study used focus-group methodology to seek understanding about the unique influence of stress, gender, and culture on type 2 diabetes mellitus (t2dm) prevention and management among Black men. Twenty men from Iowa were recruited from a larger longitudinal study on Black families; each of these men participated in one of three focus groups. Ninety-five percent of the men in the sample were Black and all were either diagnosed with t2dm (n = 10), were prediabetic (n = 1), or had experience with t2dm through family and friends (n = 9). Our results revealed the existence of significant stress and some pessimism with respect to perceived ability to prevent and manage t2dm. The participants made it clear that, while their families are primary sources of support for managing stress, including t2dm, they can also be a source of stress, particularly with respect to parenting. Black men had mixed opinions on their relationships with respect to their health care providers; some had positive, long-standing relationships while others reported little or no relationship with their providers. In response to life stress, Black men reported experiencing inadequate and disrupted sleep as well as consuming too much alcohol at times. Some of the participants reported engaging in physical activity to manage their stress. The study concluded that, as researchers develop t2dm prevention and management programs, they should continue to consider the unique role that stress in its various forms, plays in the lives of Black men.
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Ghiraldini B, Conte A, Casarin RC, Casati MZ, Pimentel SP, Cirano FR, Ribeiro FV. Influence of Glycemic Control on Peri-Implant Bone Healing: 12-Month Outcomes of Local Release of Bone-Related Factors and Implant Stabilization in Type 2 Diabetics. Clin Implant Dent Relat Res 2015; 18:801-9. [PMID: 25825337 DOI: 10.1111/cid.12339] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The poor glycemic status seems to be an important factor affecting implant complication rates, including peri-implant bone loss. PURPOSE This trial evaluated the influence of glycemic control of type 2 diabetes mellitus (T2DM) patients on implant stabilization and on the levels of bone markers in peri-implant fluid during the healing. MATERIALS AND METHODS Systemically healthy patients (SH,n = 19), better-controlled T2DM (BCDM,n = 16), and poorly controlled T2DM (PCDM,n = 16) indicated for implant therapy were recruited. The implant stability quotient (ISQ) was determined at implant placement, 3, 6, and 12 months. Levels of transforming growth factor- β (TGF-β), fibroblast growth factor (FGF), osteopontin (OPN), osteocalcin (OC), and osteoprotegerin (OPG) in the peri-implant fluid were quantified at 15 days, and 3, 6, and 12 months, using the Luminex assay. RESULTS OPG and OPN levels were higher in SH at 12 months than at15 days (p < .05), whereas OC and TGF-β were lower in PCDM at 12 months compared with the 15-day and 3-month follow-ups, respectively (p < .05). Inter-group analyses showed lower OPN levels in PCDM compared with SH at 12 months (p < .05). The ISQ was higher at 12 months when compared with baseline and 3 months in SH (p < .05), whereas no differences were observed during follow-up in diabetics, regardless of glycemic control (p > .05). No difference in ISQ was observed among groups over time (p > .05). CONCLUSION Poor glycemic control negatively modulated the bone factors during healing, although T2DM, regardless of glycemic status, had no effect on implant stabilization.
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Guerrero N, Mendes de Leon CF, Evans DA, Jacobs EA. Determinants of trust in health care in an older population. J Am Geriatr Soc 2015; 63:553-7. [PMID: 25752478 PMCID: PMC4373974 DOI: 10.1111/jgs.13316] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore differences in sociodemographic and psychological correlates of institutional trust in health care in an aging population of African Americans and non-Hispanic whites. DESIGN Cross-sectional survey data from the longitudinal Chicago Health and Aging Project. SETTING Population-based study of three communities in the Chicago area. PARTICIPANTS African Americans (n=2,284) and non-Hispanic whites (1,354) with a mean age of 79.3. MEASUREMENTS Demographic factors, socioeconomic status (SES), healthcare access, cynical hostility, perceived discrimination, depression, and institutional trust in health care. RESULTS African Americans reported substantially lower healthcare trust than non-Hispanic whites (P<.001). After adjustment for demographic variables and SES, only race (P<.001) and age (P=.008) were significantly associated with healthcare trust scores. The association between race and healthcare trust was slightly attenuated after adjusting for cynical hostility, depressive symptoms, and perceived discrimination (P<.001). Each of these variables was negatively associated with healthcare trust, and together these accounted for approximately 15% of racial differences in healthcare trust. CONCLUSION Psychological factors, not demographic characteristics, SES, or healthcare factors, appear to contribute the most to disparities in healthcare trust between older African Americans and non-Hispanic whites.
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Affiliation(s)
- Natalie Guerrero
- University of Wisconsin School of Medicine and Public Health; Madison, WI
| | | | - Denis A. Evans
- Department of Medicine & Rush Institute for Aging, Rush University Medical School; Chicago, IL
| | - Elizabeth A. Jacobs
- University of Wisconsin School of Medicine and Public Health; Madison, WI
- Division of General Internal Medicine & Departments of Medicine and Population Health Sciences; Madison, WI
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Raghav A, Ahmad J. Glycated serum albumin: a potential disease marker and an intermediate index of diabetes control. Diabetes Metab Syndr 2014; 8:245-251. [PMID: 25311816 DOI: 10.1016/j.dsx.2014.09.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Glycation is a non-enzymatic spontaneous process in proteins which has remarkable impact on its physical and functional aspect. This alteration with addition of carbohydrate residue to human serum albumin leads to several pathological events such as diabetic nephropathy, neuropathy, retinopathy and cardiovascular complications. Human serum albumin is the major protein and is most susceptible to non-enzymatic glycation. Structural and biological properties of functional albumin alter due to the addition of reducing carbohydrate to free amino terminal residues vivo. These irreversible changes in functional albumin are stable which makes this modified albumin as new gold standard future diagnostic marker in diabetes associated complications. Glycated albumin can be used to determine the glycemic control due to short half life than erythrocytes which makes it an alternate reliable disease marker in diabetes. In this review, Human serum albumin glycation has been overviewed, stating concept of glycation and sites that are prone to this modifications. Impact of non-enzymatic addition of carbohydrate to albumin's structural and biological properties has also been elaborated. Accurate measurements of glycated albumin with implications of new highly sensitive techniques have also been described briefly. Interestingly human serum albumin imposed glycation can serve as future tool not for diagnosing diabetes but also its potential in assessment of diabetes associated complications.
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Affiliation(s)
- Alok Raghav
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh 202002, UP, India
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Aligarh Muslim University, Aligarh 202002, UP, India.
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Gribble MO, Around Him DM. Ethics and Community Involvement in Syntheses Concerning American Indian, Alaska Native, or Native Hawaiian Health: A Systematic Review. AJOB Empir Bioeth 2014; 5:1-24. [PMID: 25089283 DOI: 10.1080/21507716.2013.848956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of the research was to review reporting of ethical concerns and community involvement in peer-reviewed systematic reviews or meta-analyses concerning American Indian, Alaska Native, or Native Hawaiian (AI/AN/NH) health. METHODS Text words and indexed vocabulary terms were used to query PubMed, Embase, Cochrane Library, and the Native Health Database for systematic reviews or meta-analyses concerning AI/AN/NH health published in peer-reviewed journals, followed by a search through reference lists. Each article was abstracted by two independent reviewers; results were discussed until consensus was reached. RESULTS We identified 107 papers published from 1986-2012 that were primarily about AI/AN/NH health or presented findings separately for AI/AN/NH communities. Two reported seeking indigenous reviewer feedback; none reported seeking input from tribes and communities. Approximately 7% reported on institutional review board (IRB) approval of included studies, 5% reported on tribal approval, and 4% referenced the sovereignty of AI/AN tribes. Approximately 63% used evidence from more than one AI/AN/NH population study, and 28% discussed potential benefits to communities from the synthesis research. CONCLUSIONS Reporting of ethics and community involvement are not prominent. Systematic reviews and meta-analyses making community-level inferences may pose risks to communities. Future systematic reviews and meta-analyses should consider ethical and participatory dimensions of research.
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Affiliation(s)
- Matthew O Gribble
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Deana M Around Him
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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Abstract
Population management is increasingly invoked as an approach to improve the quality and value of diabetes care. Recent emphasis is driven by increased focus on both costs and measures of care as the US moves from fee for service to payment models in which providers are responsible for costs incurred, and outcomes achieved, for their entire patient population. The capacity of electronic health records (EHRs) to create patient registries, apply analytic tools, and facilitate provider- and patient-level interventions has allowed rapid evolution in the scope of population management initiatives. However, findings on the efficacy of these efforts for diabetes are mixed, and work remains to achieve the full potential of an-EHR based population approach. Here we seek to clarify definitions and key domains, provide an overview of evidence for EHR-based diabetes population management, and recommend future directions for applying the considerable power of EHRs to diabetes care and prevention.
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Affiliation(s)
- Emma M Eggleston
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 133 Brookline Avenue, Boston, MA, 02215, USA,
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Gómez-Moreno G, Aguilar-Salvatierra A, Rubio Roldán J, Guardia J, Gargallo J, Calvo-Guirado JL. Peri-implant evaluation in type 2 diabetes mellitus patients: a 3-year study. Clin Oral Implants Res 2014; 26:1031-5. [PMID: 24684438 DOI: 10.1111/clr.12391] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the changes produced in peri-implant tissues in type 2 diabetes mellitus patients with different glycemia levels, measured by monitoring glycated hemoglobin A1c (HbA1c), over a period of 3 years following dental implant placement. MATERIALS AND METHODS Sixty-seven patients were divided into four groups according to their HbA1c levels: 21 patients in Group 1 (<6); 24 patients in Group 2 (6.1-8); and 11 patients in Group 3 (8.1-10) and Group 4 (>10.1). Each patient received one implant. All implants were placed in the anterior zone of the maxilla. The variables selected to assess the general state of patients' peri-implant health were as follows: probing depth, bleeding on probing, and marginal bone loss. RESULTS Marginal bone loss was found to increase in relation to increases in HbA1c levels. Bleeding on probing showed statistically significant differences between groups. When the peri-implant area was probed, mean levels of bleeding varied from 0.43 in Group 1 at 1 year after implant surgery to 0.62 in Group 4 (P = 0.042 between the four study groups). After the second year, greater bleeding on probing was observed in Group 4 (0.63) in comparison with groups with lower HbA1c levels. Peri-implant pocket depths presented values that were too low to be considered pathological and without statistically significant differences between the study groups. CONCLUSION Implant therapies for diabetic patients can be predictable, providing these patients fall within controlled ranges of glycemia over time, assessed by monitoring HbA1c levels.
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Affiliation(s)
- Gerardo Gómez-Moreno
- Department of Special Care in Dentistry, Pharmacological Research in Dentistry, Periodontology and Implant Dentistry, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Antonio Aguilar-Salvatierra
- Department of Pharmacological Research in Dentistry, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Jerónimo Rubio Roldán
- Periodontology and Implant Dentistry, Faculty of Dentistry, Universidad de Granada, Granada, Spain
| | - Javier Guardia
- Department of Pharmacological Research in Dentistry, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Jordi Gargallo
- Department of Dentistry, Faculty of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - José Luis Calvo-Guirado
- Department of Implant Dentistry, Implant Dentistry and Biomaterials, School of Medicine and Dentistry, University of Murcia, Murcia, Spain
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Diabetes epidemic in the Asia Pacific region: has hemoglobin A1C finally earned its place as a diagnostic tool? Asian Pac J Trop Biomed 2014; 4:85-9. [DOI: 10.1016/s2221-1691(14)60214-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/25/2014] [Indexed: 11/19/2022] Open
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Mook-Kanamori MJ, El-Din Selim MM, Takiddin AH, Al-Mahmoud KAS, Al-Homsi H, McKeon C, Al Muftah WA, Kader SA, Mook-Kanamori DO, Suhre K. Elevated HbA1c levels in individuals not diagnosed with type 2 diabetes in Qatar: a pilot study. Qatar Med J 2014; 2014:106-13. [PMID: 25745600 PMCID: PMC4344984 DOI: 10.5339/qmj.2014.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 11/05/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes (T2D) in Qatar and the Middle East is one of the highest in the world. It is estimated that about one quarter of the individuals with tbl2D are undiagnosed. Elevated HbA1c levels are an indicator of tbl2D or a pre-diabetic state. In this study we set out to examine which factors, such as anthropometric and socio-demographic risk factors, are associated with elevated HbA1c levels in a population without tbl2D. METHODS We examined 191 subjects with no record of tbl2D. Anthropometrics and HbA1c were measured. Socio-demographic (age, gender, ethnicity and educational level) and health information were assessed through questionnaires. Elevated HbA1c levels were defined as >6.0% (>42 mmol/mol). Individual risk factors were examined in relationship to having elevated HbA1c levels using logistic regression. RESULTS Thirty-eight (20%) study participants had elevated HbA1c levels. Participants from South Asian and Filipino descent were more likely to present with elevated HbA1c levels than Arab participants (adjusted odds ratios (OR): 13.30 (95% confidence interval (CI): 4.24, 41.79), p < 0.001 for South Asian and 4.54 (95% CI: 1.04, 19.83), p = 0.04 for Filipinos). A body mass index of above 30 kg/m(2) was associated with elevated HbA1c levels (adjusted OR: 2.90 (95% CI: 1.29, 6.51), p = 0.01). Neither gender nor educational level was associated with elevated HbA1c levels. CONCLUSIONS Elevated HbA1c levels in individuals not diagnosed with diabetes were most frequently found in the South Asian and Filipino immigrant population. Special attention should therefore be given to the early identification of tbl2D in these subjects.
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Affiliation(s)
| | | | | | | | - Hala Al-Homsi
- Dermatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Cindy McKeon
- Department of Clinical Research, Weill Cornell Medical College - Qatar, Doha, Qatar
| | - Wadha A Al Muftah
- Department of Physiology and Biophysics, Weill Cornell Medical College - Qatar, Doha, Qatar
| | - Sara Abdul Kader
- Department of Physiology and Biophysics, Weill Cornell Medical College - Qatar, Doha, Qatar
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Abstract
Health disparities in diabetes and its complications and comorbidities exist globally. A recent Endocrine Society Scientific Statement described the Health Disparities in several endocrine disorders, including type 2 diabetes. In this review, we summarize that statement and provide novel updates on race/ethnic differences in children and adults with type 1 diabetes, children with type 2 diabetes, and in Latino subpopulations. We also review race/ethnic differences in the epidemiology of diabetes, prediabetes, and diabetes complications and mortality in the United States and globally. Finally, we discuss biological, behavioral, social, environmental, and health system contributors to diabetes disparities to identify areas for future preventive interventions.
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Affiliation(s)
- Elias K. Spanakis
- Departments of Medicine, Johns Hopkins University School of Medicine
| | - Sherita Hill Golden
- Departments of Medicine, Johns Hopkins University School of Medicine
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health
- Corresponding author: Address correspondence and requests for reprints to: Dr. Sherita Hill Golden, Johns Hopkins University School of Medicine Division of Endocrinology and Metabolism, 1830 E. Monument Street, Suite 333 Baltimore, MD 21287 Tel: (410) 502-0993, Fax (410) 955-8172,
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Osborn CY, de Groot M, Wagner JA. Racial and ethnic disparities in diabetes complications in the northeastern United States: the role of socioeconomic status. J Natl Med Assoc 2013; 105:51-8. [PMID: 23862296 DOI: 10.1016/s0027-9684(15)30085-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The role of socioeconomic status (SES) in explaining racial/ ethnic disparities in diabetes remains unclear. We investigated disparities in self-reported diabetes complications and the role of macro (eg, income, education) and micro (eg, owning a home or having a checking account) SES indicators in explaining these differences. The sample included individuals with a diagnosis of diabetes (N=795) who were aged, on average, 55 years, and 55.6% non-Hispanic white, 25.0% African American, and 19.4% Hispanic. Approximately 8% reported nephropathy, 35% reported retinopathy, and 16% reported cardiovascular disease. There were significant disparities in the rates of complications among non-Hispanic white, African American, and Hispanic participants, with Hispanic participants having the highest rates of nephropathy, retinopathy, and cardiovascular disease. Macro SES indicators (eg, income) mediated racial differences (ie, non-Hispanic whites vs African Americans) in self-reported retinopathy, a combination of macro and more micro SES indicators (eg, education, income, and ownirg a home or having a checking account) mediated racial/ethnic differences (ie, non-Hispanic white vs Hispanic participants) in self-reported cardiovascular disease, and only micro SES indicators (eg, owning a home or having a checking account) mediated differences between lower-income SES racial/ethnic minority groups (ie, African American vs Hispanic participants) in self-reported retinopathy and cardiovascular disease. Findings underscore that indicators of SES must be sensitive to the outcome of interest and the racial/ethnic groups being compared.
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Affiliation(s)
- Chandra Y Osborn
- Department of Medicine, Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Davis NJ, Schechter CB, Ortega F, Rosen R, Wylie-Rosett J, Walker EA. Dietary patterns in Blacks and Hispanics with diagnosed diabetes in New York City's South Bronx. Am J Clin Nutr 2013; 97:878-85. [PMID: 23446901 PMCID: PMC3607660 DOI: 10.3945/ajcn.112.051185] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 01/09/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An understanding of dietary patterns in diverse populations may guide the development of food-based, rather than nutrient-based, recommendations. OBJECTIVE We identified and determined predictors of dietary patterns in low-income black and Hispanic adults with diagnosed diabetes. DESIGN A food-frequency questionnaire was used to assess dietary intake in 235 adults living in the South Bronx, New York City, NY. We used principal factor analysis with promax rotation to identify dietary patterns. Multivariate linear regression models were used to test associations between demographic variables and dietary pattern scores. RESULTS The following 5 dietary patterns were identified: pizza and sweets, meats, fried foods, fruit and vegetables, and Caribbean starch. The Caribbean starch and fruit and vegetables patterns were high in fruit and vegetables and low in trans fats. In multivariate analyses, sex, language spoken, years living in the United States, and region of birth were significant predictors of dietary patterns. Compared with English speakers, Spanish speakers were less likely to have high scores in pizza and sweets (P = 0.001), meat (P = 0.004), and fried food (P = 0.001) patterns. Participants who lived longer in the United States were less likely to have a meat (P = 0.024) or Caribbean starch pattern (P < 0.001). In Hispanics, the consumption of foods in the Caribbean starch pattern declined for each year that they lived in the United States. CONCLUSIONS In adults with diagnosed diabetes who were living in the South Bronx, a Caribbean starch pattern, which included traditional Hispanic and Caribbean foods, was consistent with a healthier dietary pattern. In developing dietary interventions for this population, one goal may be to maintain healthy aspects of traditional diets. This trial was registered at clinicaltrials.gov as NCT00797888.
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Abstract
Conditions that affect erythrocyte turnover influence HbA1c concentrations and the International Expert Committee has warned clinicians to be aware of any conditions that could affect the turnover of red blood cells. Although many forms of anemia are associated with lowering of HbA1c, iron deficiency has been shown to shift HbA1c slightly upward. The exact mechanism through which iron deficiency anemia affects HbA1c levels, however still remains unclear. The explanations provided above are merely speculations, warranting further studies to confirm and elucidate the role of these factors. As little work has been done in this field so future and large scale studies are required which may address HbA1c enhancing effect and the mechanism of increased HbA glycation in iron deficiency properly.
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Affiliation(s)
- Jamal Ahmad
- Centre for Diabetes and Endocrinology, Faculty of Medicine, JN Medical College, Aligarh Muslim University, Aligarh 202002, India.
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Ryan JG, Jennings T, Vittoria I, Fedders M. Short and Long-Term Outcomes from a Multisession Diabetes Education Program Targeting Low-Income Minority Patients: A Six-Month Follow Up. Clin Ther 2013; 35:A43-53. [DOI: 10.1016/j.clinthera.2012.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/10/2012] [Accepted: 12/13/2012] [Indexed: 10/27/2022]
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Gerber BS, Rapacki L, Castillo A, Tilton J, Touchette DR, Mihailescu D, Berbaum ML, Sharp LK. Design of a trial to evaluate the impact of clinical pharmacists and community health promoters working with African-Americans and Latinos with diabetes. BMC Public Health 2012; 12:891. [PMID: 23088168 PMCID: PMC3571948 DOI: 10.1186/1471-2458-12-891] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/16/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Given the increasing prevalence of diabetes and the lack of patients reaching recommended therapeutic goals, novel models of team-based care are emerging. These teams typically include a combination of physicians, nurses, case managers, pharmacists, and community-based peer health promoters (HPs). Recent evidence supports the role of pharmacists in diabetes management to improve glycemic control, as they offer expertise in medication management with the ability to collaboratively intensify therapy. However, few studies of pharmacy-based models of care have focused on low income, minority populations that are most in need of intervention. Alternatively, HP interventions have focused largely upon low income minority groups, addressing their unique psychosocial and environmental challenges in diabetes self-care. This study will evaluate the impact of HPs as a complement to pharmacist management in a randomized controlled trial. METHODS/DESIGN The primary aim of this randomized trial is to evaluate the effectiveness of clinical pharmacists and HPs on diabetes behaviors (including healthy eating, physical activity, and medication adherence), hemoglobin A1c, blood pressure, and LDL-cholesterol levels. A total of 300 minority patients with uncontrolled diabetes from the University of Illinois Medical Center ambulatory network in Chicago will be randomized to either pharmacist management alone, or pharmacist management plus HP support. After one year, the pharmacist-only group will be intensified by the addition of HP support and maintenance will be assessed by phasing out HP support from the pharmacist plus HP group (crossover design). Outcomes will be evaluated at baseline, 6, 12, and 24 months. In addition, program and healthcare utilization data will be incorporated into cost and cost-effectiveness evaluations of pharmacist management with and without HP support. DISCUSSION The study will evaluate an innovative, integrated approach to chronic disease management in minorities with poorly controlled diabetes. The approach is comprised of clinic-based pharmacists and community-based health promoters collaborating together. They will target patient-level factors (e.g., lack of adherence to lifestyle modification and medications) and provider-level factors (e.g., clinical inertia) that contribute to poor clinical outcomes in diabetes. Importantly, the study design and analytic approach will help determine the differential and combined impact of adherence to lifestyle changes, medication, and intensification on clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01498159.
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Affiliation(s)
- Ben S Gerber
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
- Jesse Brown VA Medical Center, 820 South Damen Ave., Chicago, IL, 60612, USA
| | - Lauren Rapacki
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
| | - Amparo Castillo
- Midwest Latino Health Research, Training and Policy Center, 1640 West Roosevelt Road- Suite 636, Chicago, IL, 60608, USA
| | - Jessica Tilton
- Department of Pharmacy Practice, 833 S. Wood St. M/C 886, Chicago, IL, 60612, USA
| | - Daniel R Touchette
- Department of Pharmacy Practice, 833 S. Wood St. M/C 886, Chicago, IL, 60612, USA
| | - Dan Mihailescu
- Section of Endocrinology, Diabetes and Metabolism, 1819 West Polk Street, M/C 640, Chicago, IL, 60612, USA
| | - Michael L Berbaum
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
| | - Lisa K Sharp
- Institute for Health Research and Policy, 1747 West Roosevelt Rd. M/C 275, Chicago, IL, 60608, USA
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Janghorbani M, Amini M. Patterns and predictors of long-term glycemic control in patients with type 2 diabetes. ISRN ENDOCRINOLOGY 2012; 2012:526824. [PMID: 23119180 PMCID: PMC3479977 DOI: 10.5402/2012/526824] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/26/2012] [Indexed: 11/23/2022]
Abstract
Aims/Introduction. To describe patterns of long-term glycemic control among patients with type 2 diabetes in Isfahan, Iran and identify factors associated with glycemic control. Methods. During the mean (standard deviation (SD)) follow-up period of 8.4 (4.2) (range 1-18) years, 4,582 patients with type 2 diabetes have been examined to determine glycemic changes. Their glycated hemoglobin (GHb) at the last clinic visit was compared with the initial visit data. The mean (SD) age of participants was 49.3 (9.6) years with a mean (SD) duration of diabetes of 5.0 (5.1) years at initial registration. Results. Mean (SD) GHb was 8.7% (2.3) at baseline and 7.9% (1.9) at the study end and decreased by mean of 0.8% (95% confidence interval (CI) 0.74, 0.87; P < 0.001) and varied by the severity of baseline GHb. 74.6% at the initial visit versus 64.4% at the last clinic visit had GHb values above the target level of 7.0%. Using a stepwise multiple regression models, age, higher GHb, FPG, follow-up period, and number of follow-up visits increased and higher systolic BP and female gender significantly decreased the percent glycemic change. Conclusions. This study highlights that more than 64.4% of the patients have GHb values higher than 7.0% at last clinic visit andindicatesthe difficult challenges physicians face when treating their patients with type 2 diabetes. Clinical efforts should focus on more effective methods for glycemic control in diabetic patients.
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Affiliation(s)
- Mohsen Janghorbani
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Amini
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Golden SH, Brown A, Cauley JA, Chin MH, Gary-Webb TL, Kim C, Sosa JA, Sumner AE, Anton B. Health disparities in endocrine disorders: biological, clinical, and nonclinical factors--an Endocrine Society scientific statement. J Clin Endocrinol Metab 2012; 97:E1579-639. [PMID: 22730516 PMCID: PMC3431576 DOI: 10.1210/jc.2012-2043] [Citation(s) in RCA: 271] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim was to provide a scholarly review of the published literature on biological, clinical, and nonclinical contributors to race/ethnic and sex disparities in endocrine disorders and to identify current gaps in knowledge as a focus for future research needs. PARTICIPANTS IN DEVELOPMENT OF SCIENTIFIC STATEMENT: The Endocrine Society's Scientific Statement Task Force (SSTF) selected the leader of the statement development group (S.H.G.). She selected an eight-member writing group with expertise in endocrinology and health disparities, which was approved by the Society. All discussions regarding the scientific statement content occurred via teleconference or written correspondence. No funding was provided to any expert or peer reviewer, and all participants volunteered their time to prepare this Scientific Statement. EVIDENCE The primary sources of data on global disease prevalence are from the World Health Organization. A comprehensive literature search of PubMed identified U.S. population-based studies. Search strategies combining Medical Subject Headings terms and keyword terms and phrases defined two concepts: 1) racial, ethnic, and sex differences including specific populations; and 2) the specific endocrine disorder or condition. The search identified systematic reviews, meta-analyses, large cohort and population-based studies, and original studies focusing on the prevalence and determinants of disparities in endocrine disorders. consensus process: The writing group focused on population differences in the highly prevalent endocrine diseases of type 2 diabetes mellitus and related conditions (prediabetes and diabetic complications), gestational diabetes, metabolic syndrome with a focus on obesity and dyslipidemia, thyroid disorders, osteoporosis, and vitamin D deficiency. Authors reviewed and synthesized evidence in their areas of expertise. The final statement incorporated responses to several levels of review: 1) comments of the SSTF and the Advocacy and Public Outreach Core Committee; and 2) suggestions offered by the Council and members of The Endocrine Society. CONCLUSIONS Several themes emerged in the statement, including a need for basic science, population-based, translational and health services studies to explore underlying mechanisms contributing to endocrine health disparities. Compared to non-Hispanic whites, non-Hispanic blacks have worse outcomes and higher mortality from certain disorders despite having a lower (e.g. macrovascular complications of diabetes mellitus and osteoporotic fractures) or similar (e.g. thyroid cancer) incidence of these disorders. Obesity is an important contributor to diabetes risk in minority populations and to sex disparities in thyroid cancer, suggesting that population interventions targeting weight loss may favorably impact a number of endocrine disorders. There are important implications regarding the definition of obesity in different race/ethnic groups, including potential underestimation of disease risk in Asian-Americans and overestimation in non-Hispanic black women. Ethnic-specific cut-points for central obesity should be determined so that clinicians can adequately assess metabolic risk. There is little evidence that genetic differences contribute significantly to race/ethnic disparities in the endocrine disorders examined. Multilevel interventions have reduced disparities in diabetes care, and these successes can be modeled to design similar interventions for other endocrine diseases.
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Affiliation(s)
- Sherita Hill Golden
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Herman WH, Cohen RM. Racial and ethnic differences in the relationship between HbA1c and blood glucose: implications for the diagnosis of diabetes. J Clin Endocrinol Metab 2012; 97:1067-72. [PMID: 22238408 PMCID: PMC3319188 DOI: 10.1210/jc.2011-1894] [Citation(s) in RCA: 201] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hemoglobin A1c (HbA1c) is widely used as an index of mean glycemia in diabetes, as a measure of risk for the development of diabetic complications, and as a measure of the quality of diabetes care. In 2010, the American Diabetes Association recommended that HbA1c tests, performed in a laboratory using a method certified by the National Glycohemoglobin Standardization Program, be used for the diagnosis of diabetes. Although HbA1c has a number of advantages compared to traditional glucose criteria, it has a number of disadvantages. Hemoglobinopathies, thalassemia syndromes, factors that impact red blood cell survival and red blood cell age, uremia, hyperbilirubinemia, and iron deficiency may alter HbA1c test results as a measure of average glycemia. Recently, racial and ethnic differences in the relationship between HbA1c and blood glucose have also been described. Although the reasons for racial and ethnic differences remain unknown, factors such as differences in red cell survival, extracellular-intracellular glucose balance, and nonglycemic genetic determinants of hemoglobin glycation are being explored as contributors. Until the reasons for these differences are more clearly defined, reliance on HbA1c as the sole, or even preferred, criterion for the diagnosis of diabetes creates the potential for systematic error and misclassification. HbA1c must be used thoughtfully and in combination with traditional glucose criteria when screening for and diagnosing diabetes.
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Affiliation(s)
- William H Herman
- University of Michigan, 1000 Wall Street, Room 6100/SPC 5714, Ann Arbor, Michigan 48105-1912, USA.
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Shah BR, Cauch-Dudek K, Anand SS, Austin PC, Manuel DG, Hux JE. Absence of disparities in the quality of primary diabetes care for South Asians and Chinese in an urban Canadian setting. Diabetes Care 2012; 35:794-6. [PMID: 22323411 PMCID: PMC3308276 DOI: 10.2337/dc11-1845] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 12/11/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether quality of diabetes care is equitable for South Asian and Chinese patients in an urban Canadian setting. RESEARCH DESIGN AND METHODS Process and intermediate measures of quality of care were compared between 246 South Asians, 170 Chinese, and 431 patients from the general population with type 2 diabetes selected from 45 family physicians' practices. RESULTS A total of 61% of Chinese achieved A1C ≤7.0% versus 45% of South Asians and 49% of the general population (P < 0.05). They were also more likely to achieve LDL cholesterol ≤2.0 mmol/L, while South Asians were more likely to achieve blood pressure ≤130/80. There was only one significant process of care deficiency: fewer foot examinations among South Asians (34 vs. 49% for the general population, P < 0.01). CONCLUSIONS Quality of diabetes care in a Canadian urban setting was equitable, with ethnic minorities somewhat more likely to achieve recommended targets than the general population.
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Affiliation(s)
- Baiju R Shah
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
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Affiliation(s)
- Hyun-Ae Seo
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - In-Kyu Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Abstract
During pregnancy, the glucose levels vary according to the hormonal changes and the metabolic needs necessary to maintain fetal nutrition but strict glycemic control is essential to minimize the maternal and fetal morbidity and mortality of pregnancies complicated by diabetes. Although considered the "gold standard" for diagnosis, measurement of glucose in the blood is subject to several limitations, many of which are not widely appreciated. Measurement of A1c for diagnosis is appealing as with one number, a total, integrated view of glycemia over time is derived though it has some inherent limitations. Thus, supplementation with HbA1c, as is common outside pregnancy, seems appropriate. Before pregnancy, the target for metabolic control in women with diabetes is HbA1c values near the normal range. However, the upper normal range of HbA1c during normal pregnancy is only sparsely investigated with different methods though recently a number of papers have been published regarding the determination of reference ranges for HbA1c in pregnancy. These changes may have clinical implications for the assessment and management of glycemic control in diabetic pregnancy and calls for establishment of separate reference limits of HbA1c levels in different trimesters as compared to general population.
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Affiliation(s)
- Dalia Rafat
- Department of Obstetrics and Gynecology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh 202002, India
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Van Rompay MI, Castaneda-Sceppa C, McKeown NM, Ordovás JM, Tucker KL. Prevalence of cardiovascular disease risk factors among older Puerto Rican adults living in Massachusetts. J Immigr Minor Health 2011; 13:825-33. [PMID: 21298483 DOI: 10.1007/s10903-011-9448-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There remains limited research on cardiovascular disease (CVD) risk factors in Puerto Rican adults. We compared lifestyle and CVD risk factors in Puerto Rican men and women with normal fasting glucose (NFG), impaired fasting glucose (IFG), or type 2 diabetes (T2D), and investigated achievement of American Diabetes Association (ADA) treatment goals in those with T2D. Baseline data from the Boston Puerto Rican Health Study were analyzed, which included 1,287 adults aged 45-75 years. Obesity, hyperglycemia, and dyslipidemia were prevalent and increased from NFG to IFG and T2D. In individuals without T2D, fasting insulin correlated significantly with body mass index. Achievement of ADA goals was poor; LDL cholesterol was most achieved (59.4%), followed by blood pressure (27.2%) and glycosylated hemoglobin (27.0%). Poverty, female sex, current alcohol use, and diabetes or anti-hypertensive medication use were associated with not meeting goals. Puerto Rican adults living in the Boston area showed several metabolic abnormalities and high CVD risk, likely due to pervasive obesity and socio-economic disparities.
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Affiliation(s)
- Maria I Van Rompay
- Nutrition and Genomics Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
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Forjuoh SN, Huber C, Bolin JN, Patil SP, Gupta M, Helduser JW, Holleman S, Ory MG. Provision of counseling on diabetes self-management: are there any age disparities? PATIENT EDUCATION AND COUNSELING 2011; 85:133-9. [PMID: 20863646 PMCID: PMC3021766 DOI: 10.1016/j.pec.2010.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 07/30/2010] [Accepted: 08/06/2010] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To determine whether there are any age-related disparities in the frequency of provision of counseling and education for diabetes care in a large HMO in Central Texas. METHODS EMR search from 13 primary care clinics on patients aged ≥18 years (n=1300) who had been diagnosed with type 2 diabetes. RESULTS There were no significant age differences in the frequency of provision of counseling about HBGM, diet, smoking or diabetes education. However, there were significant age differences in the provision of exercise counseling. Patients aged ≥75 were significantly less likely to have been provided exercise counseling than those aged <65 (adjusted OR=0.60; 95% CI=0.37-0.98). The mean HbA1c for patients aged ≥75 and 65-74 were significantly lower than that of patients aged <65 (8.9 vs. 9.0 vs. 9.7; P<0.001). CONCLUSION While age-related variations in self-management protocols were not found, the provision of formal diabetes education was low (29.4%). The persistence of key risk factors in later life (e.g., obesity) underscores the need for better self-management protocols for older adults. PRACTICE IMPLICATIONS Additional efforts on strategies to increase counseling about lifestyle habits and diabetes self-management care by appropriate health care providers is needed. Diabetes counseling should be individually tailored in older population.
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Affiliation(s)
- Samuel N Forjuoh
- Department of Family & Community Medicine, Scott & White, College of Medicine, Texas A&M Health Science Center, Temple, TX 76504, USA.
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Abstract
In the United States, the prevalence of adults who are overweight or obese is higher in Hispanics/Latinos compared with non-Hispanic whites. In addition, data from the National Health and Nutrition Examination Survey (NHANES) indicate that the prevalence of type 2 diabetes mellitus is consistently greater in racial/ethnic minority groups, such as Hispanics/Latinos, compared with non-Hispanic whites. In fact, data from the Centers for Disease Control and Prevention (CDC) from 2007 to 2009 suggest that the prevalence of type 2 diabetes is almost twice as high in Hispanics/Latinos compared with non-Hispanic whites (11.8% vs. 7.1%, respectively). Although genetics plays a role in the increased prevalence of type 2 diabetes in Hispanics/Latinos, cultural and environmental factors also contribute. In addition to the increased prevalence of type 2 diabetes in Hispanics/Latinos, evidence suggests that the patients in this population are often undertreated and, therefore, less likely to achieve control of their glucose, blood pressure, and lipid levels. Because individuals with type 2 diabetes have a 2- to 4-fold increased risk of cardiovascular disease compared with individuals with normal glucose levels, there is consensus that targeting environmental factors, particularly the development of obesity at an early age, is the most cost-effective approach to prevent the development of type 2 diabetes and its broad spectrum of complications, including cardiovascular disease. Cultural and socioeconomic barriers, such as language, cost, and access to goods and services, must be overcome to improve management of type 2 diabetes in this high-risk population. By increasing healthcare provider awareness and the availability of programs tailored to Hispanic/Latino individuals, the current treatment gap among ethnic minorities in the United States will progressively narrow, and eventually, disappear.
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