The Prevalence and Impact of Diabetes Mellitus among Undocumented Immigrants in an Indigent Care Program in Riverside, California

Abstract

Background: Acculturated undocumented immigrants (UI) in the U.S. with sedentary lifestyle and poor eating habits are at risk for diabetes mellitus (DM). UI also face adverse social, economic, and psychological stressors that may lead to poor clinical outcomes. No study to date has assessed DM prevalence and clinical outcomes among UI. Methods: Riverside University Health System, a county health system, provides medical care for indigent patients including UI. Of 8,466 UI receiving indigent care as of March, 2017, 500 UI were randomly selected to assess DM prevalence and clinical outcomes. Results: The mean age was 46.2 with more females (59%) accessing medical care. Over 95% were Hispanics and 74% were born in Mexico. Most were married and only 11% worked full time. A majority of UI never smoked (67%), and only 18% consumed alcohol. The prevalence of DM was 27%, and diabetics were older than nondiabetics (52.2 vs. 43.9, p<0.001) with comparable BMIs (29.9 vs. 28.9, p=0.12). The mean hemoglobin A1c was 8.3 and insulin and oral anti-hyperglycemic medication use was 8% and 19%, respectively. The total clinic visits among diabetics was 19 compared to 13 in nondiabetics (p=0.018) while total emergency department visits were comparable between two groups (2 vs. 2, p=0.100). The use of prescription medications was higher in diabetics than nondiabetics (7 vs. 4, p=<0.001). Diabetics had a higher rate of hypertension compared to nondiabetics (57% vs. 20%, p<0.001), but other clinical conditions were similar [congestive heart failure (1% vs. 3%), cancer (4% vs. 3%), depression (6% vs. 3%), chronic kidney disease (7% vs. 3%)]. Conclusions: The prevalence of DM among UI is high with poor glycemic control. Diabetics had more clinic visits than nondiabetics and were taking more prescription medications. Despite high prevalence of DM, diabetes-related complication and comorbidity rates were low, which may be due to medical care access through the indigent care program. Disclosure H. Lee: None. B.L. Zakhary: None. M.A. Firek: None. H. Lange: None. C.A. Gomez: None. A. Firek: None.