Impact of comorbid conditions and race/ethnicity on glycemic control among the US population with type 2 diabetes, 1988-1994 to 1999-2004.
OBJECTIVE
To measure trends in glycemic control in type 2 diabetes in the United States from 1988-1994 to 1999-2004 and to identify factors influencing glycemic control, including the presence of comorbid conditions and race/ethnicity.


METHODS
Participants in the National Health and Nutrition Examination Surveys (1988-1994 and 1999-2004) aged ≥30 years with diagnosed type 2 diabetes were identified. Outcome measures included glycemic control [glycosylated hemoglobin (A1C) <7%] and pharmacologic treatment rate. Comorbid conditions assessed included obesity, hyperlipidemia, and hypertension.


RESULTS
Prevalence of type 2 diabetes increased from 5.8% in 1988-1994 to 7.1% in 1999-2004. Rates of treatment for type 2 diabetes improved, from 72.3% to 82.2%. The proportion of patients who achieved A1C <7% did not change significantly (44.4% to 50.1%, P=.06); however, blood pressure and cholesterol level both improved. During 1999-2004, only 14% of persons treated for type 2 diabetes did not have an additional comorbid condition; 21% had all three comorbid conditions. During 1999-2004, among treated patients, non-Hispanic blacks were 0.43 times as likely (95% CI 0.29-0.63), and Mexican Americans were 0.47 times as likely (95% CI 0.32-0.68), to have A1C <7% compared to non-Hispanic whites.


CONCLUSIONS
Despite improved treatment rates, one in two individuals with type 2 diabetes has A1C of ≥7%. Most type 2 diabetic subjects also suffer from hypertension, hyperlipidemia, and/or obesity, and glycemic control rates were lowest for those with all three conditions. Non-Hispanic blacks and Mexican Americans are less likely to achieve glycemic control as compared to non-Hispanic whites.
Suh
Dong-Churl
DC
Rutgers University School of Pharmacy, Piscataway, NJ 08854, USA. dsuh@rci.rutgers.edu
Choi
In-Sun
IS
Plauschinat
Craig
C
Kwon
Jinweon
J
Baron
Michelle
M
D000328:Adult; D000368:Aged; D044383:Black People; D001786:Blood Glucose / Q000032:analysis*; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology*; D005006:Ethnicity; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006630:Hispanic or Latino; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D009765:Obesity / Q000453:epidemiology; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin