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Bullock A, Sheff K, Hora I, Burrows NR, Benoit SR, Saydah SH, Hardin CL, Gregg EW. Prevalence of diagnosed diabetes in American Indian and Alaska Native adults, 2006-2017. BMJ Open Diabetes Res Care 2020; 8:e001218. [PMID: 32312721 PMCID: PMC7199144 DOI: 10.1136/bmjdrc-2020-001218] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/02/2020] [Accepted: 03/28/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The objective of this study was to examine recent trends in diagnosed diabetes prevalence for American Indian and Alaska Native (AI/AN) adults aged 18 years and older in the Indian Health Service (IHS) active clinical population. RESEARCH DESIGN AND METHODS Data were extracted from the IHS National Data Warehouse for AI/AN adults for each fiscal year from 2006 (n=729 470) through 2017 (n=1 034 814). The prevalence of diagnosed diabetes for each year and the annual percentage change were estimated for adults overall, as well as by sex, age group, and geographic region. RESULTS After increasing significantly from 2006 to 2013, diabetes prevalence for AI/AN adults in the IHS active clinical population decreased significantly from 2013 to 2017. Prevalence was 14.4% (95% CI 13.9% to 15.0%) in 2006; 15.4% (95% CI 14.8% to 16.0%) in 2013; and 14.6% (95% CI 14.1% to 15.2%) in 2017. Trends for men and women were similar to the overall population, as were those for all age groups. For all geographic regions, prevalence either decreased significantly or leveled off in recent years. CONCLUSIONS Diabetes prevalence in AI/AN adults in the IHS active clinical population has decreased significantly since 2013. While these results cannot be generalized to all AI/AN adults in the USA, this study documents the first known decrease in diabetes prevalence for AI/AN people.
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Affiliation(s)
- Ann Bullock
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, Maryland, USA
| | - Karen Sheff
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, Maryland, USA
| | - Israel Hora
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nilka Rios Burrows
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen R Benoit
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sharon H Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carmen Licavoli Hardin
- Division of Diabetes Treatment and Prevention, Indian Health Service, Rockville, Maryland, USA
| | - Edward W Gregg
- Epidemiology and Biostatistics, Imperial College London, London, UK
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Schmittdiel JA, Steiner JF, Adams AS, Dyer W, Beals J, Henderson WG, Desai J, Morales LS, Nichols GA, Lawrence JM, Waitzfelder B, Butler MG, Pathak RD, Hamman RF, Manson SM. Diabetes care and outcomes for American Indians and Alaska natives in commercial integrated delivery systems: a SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) Study. BMJ Open Diabetes Res Care 2014; 2:e000043. [PMID: 25452877 PMCID: PMC4246918 DOI: 10.1136/bmjdrc-2014-000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/23/2014] [Accepted: 10/14/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare cardiovascular disease risk factor testing rates and intermediate outcomes of care between American Indian/Alaska Native (AI/AN) patients with diabetes and non-Hispanic Caucasians enrolled in nine commercial integrated delivery systems in the USA. RESEARCH DESIGN AND METHODS We used modified Poisson regression models to compare the annual testing rates and risk factor control levels for glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure (SBP); number of unique diabetes drug classes; insulin use; and oral diabetes drug medication adherence between insured AI/AN and non-Hispanic white adults with diabetes aged ≥18 in 2011. RESULTS 5831 AI/AN patients (1.8% of the cohort) met inclusion criteria. After adjusting for age, gender, comorbidities, insulin use, and geocoded socioeconomic status, AI/AN patients had similar rates of annual HbA1c, LDL-C, and SBP testing, and LDL-C and SBP control, compared with non-Hispanic Caucasians. However, AI/AN patients were significantly more likely to have HbA1c >9% (>74.9 mmol/mol; RR=1.47, 95% CI 1.38 to 1.58), and significantly less likely to adhere to their oral diabetes medications (RR=0.90, 95% CI 0.88 to 0.93) compared with non-Hispanic Caucasians. CONCLUSIONS AI/AN patients in commercial integrated delivery systems have similar blood pressure and cholesterol testing and control, but significantly lower rates of HbA1c control and diabetes medication adherence, compared with non-Hispanic Caucasians. As more AI/ANs move to urban and suburban settings, clinicians and health plans should focus on addressing disparities in diabetes care and outcomes in this population.
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Affiliation(s)
- Julie A Schmittdiel
- Division of Research , Kaiser Permanente Northern California , Oakland, California , USA
| | - John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado , Denver, Colorado , USA
| | - Alyce S Adams
- Division of Research , Kaiser Permanente Northern California , Oakland, California , USA
| | - Wendy Dyer
- Division of Research , Kaiser Permanente Northern California , Oakland, California , USA
| | - Janette Beals
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA
| | - William G Henderson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA
| | - Jay Desai
- HealthPartners Institute for Education and Research , Minneapolis, Minnesota , USA
| | - Leo S Morales
- Group Health Research Institute , Seattle, Washington , USA
| | - Gregory A Nichols
- Kaiser Permanente Center for Health Research , Portland, Oregon , USA
| | - Jean M Lawrence
- Department of Research & Evaluation , Kaiser Permanente Southern California , Pasadena, California , USA
| | | | - Melissa G Butler
- Kaiser Permanente Georgia Center for Health Research-Southeast , Atlanta , Georgia , USA
| | | | - Richard F Hamman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Denver, Colorado , USA
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