Abstract
Purpose: To examine the burden of uncontrolled hyperglycemia in patients with diabetes mellitus (DM) and their characteristics in a large urban city.Methods: A randomized sample of 4993 patients with DM ≥18 years old who received routine health care in a large university teaching hospital in the city of Philadelphia was analyzed. Uncontrolled hyperglycemia was classified as blood hemoglobin A1c >8%. The associations of uncontrolled hyperglycemia with sociodemographic and cardiovascular factors were analyzed using univariate and multivariate analysis methods.Results: The results show that patients 18–54 years had the highest prevalence of uncontrolled hyperglycemia (36.0%), followed by those at age 55–64 (30.9%), 65–74 (22.9%), and ≥75 (20.6%) years (p<0.0001). Unadjusted hyperglycemia was significantly associated with patients with increased total cholesterol to high-density lipoprotein ratio (odds ratio [OR]=1.59, 95% confidence interval [CI]: 1.33–1.90, p<0.001), and with prevalent coronary heart disease (OR=1.39, 95% CI: 1.16–1.67, p=0.001). Patients living in neighborhoods with lower socioeconomic status (SES) had significantly higher uncontrolled hyperglycemia rates across the city (r=0.52, R2=0.27, p=0.03).Conclusions: Findings of this study is one of the first studies to address that younger adults had higher rates of uncontrolled hyperglycemia. Further attention should be paid to the challenges of controlling DM in younger adults and patients who live in neighborhoods with lower SES.
Highlights
Diabetes mellitus (DM) is a major public health concern that is approaching a new epidemic in both developing and developed societies
Patients with lower socioeconomic status (SES) had significantly higher uncontrolled hemoglobin A1c (HbA1c) rates. It appears there were no significant differences in HbA1c control status by sex, race/ethnicity, and medical conditions of HTN, coronary heart disease (CHD), stroke, and heart failure (HF) (Table 1)
Uncontrolled HbA1c disproportionately affected participants who lived in neighborhoods with lower SES. (3) Uncontrolled HbA1c was significantly associated with serum dyslipidemia (TC/HDL ratio) and the prevalent CHD
Summary
Diabetes mellitus (DM) is a major public health concern that is approaching a new epidemic in both developing and developed societies. In the United States (U.S.), an estimated 30.2 million adults 18 years or older (12.2%) have DM. About 95% of people with DM are estimated to have type 2 DM (T2DM)[1] that affects all parts of the body. In the United States, of the largest 10 cities by population, the city of Philadelphia had the highest prevalence of DM (15.4%) in adults 18 years or older compared with the other nine largest cities (New York, Los Angeles, Chicago, Houston, Phoenix, San Antonio, San Diego, Dallas, and San Jose), all of which had DM rates below the U.S average of 12.2%.7.
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