Characterization of Type 2 Diabetes Mellitus Burden by Age and Ethnic Groups Based on a Nationwide Survey

• Published in: Clinical therapeutics Vol. 36; no. 4; pp. 494 - 506
• Main Authors: Lopez, Janice M.S., PharmD, MPH, Bailey, Robert A., MD, Rupnow, Marcia F.T., PhD, Annunziata, Kathy, MA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2014; Elsevier Limited
• Subjects: Adult; African Americans - statistics & numerical data; age; Age Factors; Aged; Asian Continental Ancestry Group - statistics & numerical data; Blood Glucose - metabolism; Body Mass Index; Cardiovascular disease; Comorbidity; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - ethnology; Ethnic Groups; ethnicity; European Continental Ancestry Group - statistics & numerical data; Female; Glucose; Glycated Hemoglobin A - metabolism; Hispanic Americans - statistics & numerical data; Humans; Hypoglycemia - epidemiology; Internal Medicine; Male; Medical Education; Medical treatment; Medication Adherence - ethnology; Medication Adherence - statistics & numerical data; Middle Aged; Mortality; Obesity; Obesity - ethnology; Older people; patient perspective; Retrospective Studies; survey; Surveys and Questionnaires; type 2 diabetes; United States > US; survey; type 2 diabetes; ethnicity; patient perspective; age
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2013.12.016

Abstract Background Type 2 diabetes mellitus (T2DM) is the most common form of diabetes. Risk factors for its development include older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. Objective The purpose of this study was to characterize T2DM burden, from a patient perspective, with respect to age and race/ethnicity. Methods Adults aged ≥18 years with T2DM from a large, Internet-based, nationwide survey were retrospectively analyzed. Demographic and clinical characteristics (glycemic control, body mass index [BMI], comorbidities, and diabetes-related complications), hypoglycemic episodes, and medication adherence were used to assess diabetes burden. Degree of burden was compared across age (18–64, 65–74, and ≥75 years) and racial/ethnic (white, African American, Hispanic, Asian, and American Indian) groups. Results An apparent association was found between glycemic control and medication adherence. Hispanics had the lowest percentage of participants with a hemoglobin A1c (HbA1c ) level <7.0% (24.4%) and the highest percentage of those not knowing their HbA1c levels (55.4%) but also had the poorest medication adherence among racial/ethnic groups. Conversely, American Indians and whites had the best glycemic control, HbA1c knowledge, and medication adherence. The 18- to 64-year age group had the poorest glycemic control (28.8%), the most with unknown HbA1c levels (46.3%), and the poorest medication adherence of the age groups. Mean BMIs were high (>30 mg/kg2 ) for all racial/ethnic groups other than the Asian group (28.9 mg/kg2 ). Approximately 71% of Asians were obese or overweight compared with ≥90% in the other racial/ethnic groups. Mean BMIs decreased with increasing age group (34.5, 32.6, and 29.8 kg/m2 for the age groups of 18–64, 65–74, and ≥75 years, respectively). Regarding diabetes-related comorbidities, the Asian group had the lowest percentages of those with hypertension (39.1%) and hypercholesterolemia (46.6%). The Asian group had the lowest mean Charlson Comorbidity Index (CCI) score (score of 1.4); the American Indian group had the highest CCI score (score of 1.8). Of the age groups, the 65- to 74-year group had the highest percentages of those with hypertension (69.0%) and hypercholesterolemia (67.4%). The mean CCI scores in the 65- to 74-year and ≥75-year age groups (scores of 1.8 for both) were significantly higher than in the 18- to 64-year age group. The Asian group had the lowest percentage of participants reporting hypoglycemia (37.3%). The 18- to 64-year age group had the highest percentage of participants reporting hypoglycemia (52.7%). Limitations of this study include selection bias (Internet-based survey), recall bias, missing values, and descriptive analyses without adjustment for multiplicity. Conclusion There are many factors that contribute to diabetes burden and the complexity of diabetes management. The results of this study provide insight from a patient perspective regarding how these factors vary across age and race/ethnicity to aid in the individualization of diabetes treatment.