Race/Ethnic Difference in Diabetes and Diabetic Complications.
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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ABSTRACT: Disparate vascular outcomes in diabetes by race and/or ethnicity may reflect differential risk factor control, especially pre-Medicare. Assess concurrent target attainment for glycohemoglobin <7%, non-high density lipoprotein-cholesterol <130 mg/dL, and blood pressure <140/<90 mm Hg in white, black, and Hispanic diabetics <65 years and ≥65 years of age. The National Health and Nutrition Examination Surveys 1999-2010 data were analyzed on diagnosed and undiagnosed diabetics ≥18 years old. Concurrent target attainment was higher in whites (18.7%) than blacks (13.4% [P = .02] and Hispanics [10.3%, P < .001] <65 years but not ≥65 years of age; 20.0% vs. 15.9% [P = .13], 19.5% [P = .88]). Disparities in health care insurance among younger whites, blacks, and Hispanics, respectively, (87.4% vs. 81.1%, P < .01; 68.0%, P < .001) and infrequent health care (0-1 visits/y; 14.3% vs. 15.0%, P = not significant; 32.0%, P < .001) declined with age. Cholesterol treatment predicted concurrent control in both age groups (multivariable odds ratio >2, P < .001). Risk factor awareness and treatment were lower in Hispanics than whites. When treated, diabetes and hypertension control were greater in whites than blacks or Hispanics. Concurrent risk factor control is low in all diabetics and could improve with greater statin use. Insuring younger adults, especially Hispanic, could raise risk factor awareness and treatment. Improving treatment effectiveness in younger black and Hispanic diabetics could promote equitable risk factor control.Journal of the American Society of Hypertension (JASH) 06/2014; 8(6):394-404. DOI:10.1016/j.jash.2014.03.323 · 2.68 Impact Factor
Article: Beyond "ethnicity" in dermatology.Dermatologic clinics 04/2014; 32(2):ix-xii. DOI:10.1016/j.det.2014.01.001 · 1.43 Impact Factor
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ABSTRACT: Pioglitazone is one of the antidiabetic agents used in the management of type 2 diabetes mellitus (DM). The effect of pioglitazone on blood glucose, lipid profile, liver enzymes and weight has been shown with conflicting results. In this study we aim to evaluate the effect of pioglitazone on the weight, lipid profile and liver enzymes in patients with DM. In this single-arm clinical trial, 110 poorly controlled diabetic type 2 patients (63.6% female with mean age of 54.26 ± 8.96 years) who were on maximal dosage of metformin and glibenclamide were enrolled. Patients were treated with pioglitazone for 3 months and laboratory. Fasting blood sugar (FBS), haemoglobin A1C (HbA1C), cholesterol, triglyceride, low-density lipoprotein (LDL) and high-density lipoprotein (HDL), alkaline phosphatase (ALK-P), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and weight changes were measured before and at the end of the study. The levels of FBS (p < 0.001), HbA1c (p < 0.001), triglyceride (p = 0.001), ALT (p = 0.005) and ALK-P (p = 0.001) were significantly decreased, but weight was significantly increased (p < 0.001) after the intervention. There were no significant difference in cholesterol, LDL and HDL values before and after study. Although pioglitazone causes a significant decrease in FBS, HbA1C and triglyceride levels, it is associated with weight gain, which would limit its utility. IRCT registration code: IRCT201209276712N2.Therapeutic advances in endocrinology and metabolism 04/2015; 6(2):56-60. DOI:10.1177/2042018815574229