There is limited information on whether recent improvements in the control of cardiovascular disease (CVD) risk factors among individuals with diabetes have been concentrated in particular sociodemographic groups. This article estimates racial/ethnic- and education-related disparities and examines trends in uncontrolled CVD risk factors among adults with diabetes. The main racial/ethnic comparisons made are with African Americans versus non-Latino whites and Mexican Americans versus non-Latino whites.
The analysis samples include adults aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 1988-1994 and the NHANES 1999-2008 who self-reported having diabetes (n = 1,065, NHANES 1988-1994; n = 1,872, NHANES 1999-2008). By use of logistic regression models, we examined the correlates of binary indicators measuring 1) high blood glucose, 2) high blood pressure, 3) high cholesterol, and 4) smoking.
Control of blood glucose, blood pressure, and cholesterol improved among individuals with diabetes between the NHANES 1988-1994 and the NHANES 1999-2008, but there was no change in smoking prevalence. In the NHANES 1999-2008, racial/ethnic minorities and individuals without some college education were more likely to have poorly controlled blood glucose compared with non-Latino whites and those with some college education. In addition, individuals with diabetes who had at least some college education were less likely to smoke and had better blood pressure control compared with individuals with diabetes without at least some college education.
Trends in CVD risk factors among individuals with diabetes improved over the past 2 decades, but racial/ethnic- and education-related disparities have emerged in some areas.
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"Demographic background characteristics including gender (female = 1, male = 0), marital status (married = 1, other status = 0), and education received in their country of origin and/or in the United States (years); acculturation indicated by time living in the United States (years); diabetes severity indicated by time since diagnosis (years), diabetes treatment method (diet and exercise; medications; insulin) and number of comorbidities were used as control variables. We selected these variables because prior research demonstrated their role in shaping health or diabetes outcomes (American Diabetes Association, 2013; Chatterji et al., 2012; Chun, Chesla, & Kwan, 2011; Kalyani, Saudek, Brancati, & Selvin, 2010; Kiecolt-Glaser & Newton, 2001). Although the literature suggests associations between socioeconomic status and health, we did not control for household income, a measure of socioeconomic status, to avoid problems of multicollinearity. "
[Show abstract][Hide abstract] ABSTRACT: This study examined whether social relationships were linked to health among Chinese Americans with diabetes, and whether age moderated these links given the norm of respect for the elderly. Chinese American immigrants with type 2 diabetes (n= 163) provided questionnaire and laboratory data. Relationships were assessed with diabetes family instrumental support, emotional support, and conflicts, as well as general support. Health was assessed with subjective health, depressive symptoms, and glucose regulation. When relationship predictors were examined simultaneously, more conflicts and less general support were associated with more depressive symptoms, after adjusting for covariates. More emotional support was associated with better glucose regulation only for midlife, not older, participants. Findings underscore cultural and life-stage considerations in studying social determinants of health.
"Thus, the American Diabetes Association (ADA) releases updated clinical practice recommendations annually, including those related to the management of the risk factors of diabetes8. As a result, a significant number of physicians manage diabetes according to the ADA clinical practice recommendations9. "
[Show abstract][Hide abstract] ABSTRACT: Aims/Introduction
We investigated the prevalence, treatment and control of diagnosed diabetes in Korean adults from 1998 to 2010.
Materials and Methods
The Korean Ministry of Health and Welfare carried out the Korean National Health and Nutrition Examination Survey (KNHANES) in the years 1998 (I), 2001 (II), 2005 (III), 2007–2009 (IV) and 2010 (V). We estimated the prevalence of diagnosed diabetes in Korean adults and the proportions of well‐controlled diabetes, as defined by having glycosylated hemoglobin <7.0%, blood pressure <130/80 mmHg and low density lipoprotein (LDL) cholesterol <100 mg/dL according to the American Diabetes Association.
The prevalence of diagnosed diabetes increased significantly from 3.2% in 1998 to 6.4% in 2010 (P < 0.0001). The prevalence of adults with diagnosed diabetes achieving blood pressure and LDL cholesterol target levels increased from 23.8% to 54.2% (P < 0.0001), and 25.7% to 47.7% (P<0.0001), respectively. However, the percentage of patients achieving glycemic goals did not increase significantly from 42.5% to 49.1% (P = 0.3034). Furthermore, there were significant increases in the proportions of individuals achieving all three target levels, from 2.7% in 2005 to 8.7% in 2010 (P < 0.0001).
The prevalence of diagnosed diabetes in Korea increased significantly from 1998 to 2010. The percentages of those achieving all recommendations of the American Diabetes Association have increased, but are still not satisfactory.
"Possible mechanisms linking type 2 diabetes to dementia and cognitive impairment include chronic hyperglycemia or hypoglycemia, hyperinsulinemia or insulin resistance, effects of inflammatory cytokines and oxidative stress, and β-amyloid deposition in the brain (14,15). The type 2 diabetes–dementia association has not been evaluated among Mexican Americans, a population with a high prevalence of type 2 diabetes (16), poor glycemic control among those with diabetes (17), and higher rates of complications compared with non-Hispanic whites (18). "
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE
Type 2 diabetes has been linked with increased risk of dementia and cognitive impairment among older adults and with premature mortality in young and middle-aged adults. No studies have evaluated the association between diabetes and dementia among Mexican Americans, a population with a high burden of diabetes. We evaluated the association of diabetes with incidence of dementia and cognitive impairment without dementia (CIND) among older Mexican Americans while accounting for competing risk from death.RESEARCH DESIGN AND METHODS
This study included 1,617 participants 60-98 years of age from the Sacramento Area Latino Study on Aging followed up to 10 years from 1998. We evaluated the association between diabetes and dementia/CIND with competing risk regression models.RESULTSParticipants free of dementia/CIND at baseline (n = 1,617) were followed annually up to 10 years. There were 677 (41.9%) participants with diabetes, 159 (9.8%) incident dementia/CIND cases, and 361 (22.3%) deaths. Treated and untreated diabetes (hazard ratio 2.12 [95% CI 1.65-2.73] and 2.15 [1.58-2.95]) and dementia/CIND (2.48 [1.75-3.51]) were associated with an increased risk of death. In models adjusted for competing risk of death, those with treated and untreated diabetes had an increased risk of dementia/CIND (2.05 [1.41-2.97] and 1.55 [0.93-2.58]) compared with those without diabetes.CONCLUSIONS
These findings provide evidence that the association between type 2 diabetes and dementia/CIND among Mexican Americans remains strong after accounting for competing risk of mortality. Treatments that modify risk of death among those with diabetes may change future dementia risk.