title: Factors associated with poor glycemic control or wide glycemic variability among diabetes patients in Hawaii, 2006-2009.
abstract: BACKGROUND
  Although glycemic control is known to reduce complications associated with diabetes, it is an elusive goal for many patients with diabetes. The objective of this study was to identify factors associated with sustained poor glycemic control, some glycemic variability, and wide glycemic variability among diabetes patients over 3 years.
  
  
  METHODS
  This retrospective study was conducted among 2,970 diabetes patients with poor glycemic control (hemoglobin A1c [HbA1c] >9%) who were enrolled in a health plan in Hawaii in 2006. We conducted multivariable logistic regressions to examine factors related to sustained poor control, some glycemic variability, and wide glycemic variability during the next 3 years. Independent variables evaluated as possible predictors were age, sex, type of insurance coverage, morbidity, diabetes duration, history of cardiovascular disease, and number of medications.
  
  
  RESULTS
  Longer duration of diabetes, being under age 35, and taking 15 or more medications were significantly associated with sustained poor glycemic control. Preferred provider organization and Medicare (vs health maintenance organization) enrollees and patients with high morbidity were less likely to have sustained poor glycemic control. Wide glycemic variability was significantly related to being younger than age 50, longer duration of diabetes, having coronary artery disease, and taking 5 to 9 medications per year.
  
  
  CONCLUSIONS
  Results indicate that duration of diabetes, age, number of medications, morbidity, and type of insurance coverage are risk factors for sustained poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Patients younger than age 50 and those with a history of coronary heart disease should be warned of the health risks of wide glycemic variability.
authors.affiliation: College of Pharmacy, University of Hawaii, 677 Ala Moana Blvd, Ste 1025, Honolulu, HI 96813, USA. dtjuarez@hawaii.edu
authors.forename: Deborah Taira
authors.initials: DT
authors.lastname: Juarez
authors.forename: Tetine
authors.initials: T
authors.lastname: Sentell
authors.forename: Sheri
authors.initials: S
authors.lastname: Tokumaru
authors.forename: Roy
authors.initials: R
authors.lastname: Goo
authors.forename: James W
authors.initials: JW
authors.lastname: Davis
authors.forename: Marjorie M
authors.initials: MM
authors.lastname: Mau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D048909:Diabetes Complications / Q000097:blood / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006254:Hawaii / Q000453:epidemiology; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin