Racial and ethnic differences in cardio-metabolic risk in individuals with undiagnosed diabetes: National Health and Nutrition Examination Survey 1999-2008.

Hunt KJ, Gebregziabher M, Egede LE. Racial and ethnic differences in cardio-metabolic risk in individuals with undiagnosed diabetes: National Health and Nutrition Examination Survey 1999-2008. Journal of general internal medicine. 2012 Aug 1; 27(8):893-900.

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• IIR 06-219 – Ethnic Differences in Medication Adherence and Cost for Elderly Veterans with DM

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Abstract:

BACKGROUND: Although early recognition and treatment of diabetes may be essential to prevent complications, roughly one-fifth of diabetes remains undiagnosed. OBJECTIVE: Examine cardio-metabolic risk factors and their control in non-Hispanic white (NHW), non-Hispanic black (NHB) and Mexican American (MA) individuals with undiagnosed diabetes. DESIGN: Nationally representative cross-sectional study of participants in the National Health and Nutrition Examination Survey (NHANES) continuous cycles conducted 1999 through 2008. PARTICIPANTS: Of 22,621 non-pregnant individuals aged = 20 years, 2521 had diagnosed diabetes. Of the remaining 20,100 individuals, 17,963 had HbA1c measured, 551 of whom were classified as having undiagnosed diabetes and comprise the study population. MAIN MEASURES: Undiagnosed diabetes was defined as HbA1c? = 6.5% without a self-report of physician diagnosed diabetes. Cardio-metabolic risk factor control was examined using regression methods for complex survey data. KEY RESULTS: Among individuals with undiagnosed diabetes, mean HbA1c level was 7.7% (95% CI: 7.5, 7.9), 19.3% (95% CI: 14.2, 24.3) smoked, 59.7% (95% CI: 54.5, 64.8%) had hypertension and 96.5% (95% CI: 94.6, 98.4%) had dyslipidemia. Lipid profiles were remarkably different across racial-ethnic groups: NHB had the highest LDL- and HDL-cholesterol, but the lowest triglycerides, while MA had the highest triglycerides and the lowest LDL-cholesterol. After adjusting for age, sex, NHANES examination cycle and use of either blood pressure or lipid medication, the odds of having blood pressure = 130/80 mmHg was higher in NHB [1.92 (95% CI: 1.09, 3.55)] than NHW, while the odds of having LDL-cholesterol > 100 mg/dl was higher in NHW[2.93 (95% CI: 1.37, 6.24)] and NHB[3.34 (95% CI: 1.08, 10.3)] than MA. CONCLUSIONS: In a nationally representative sample of individuals with undiagnosed diabetes, cardio-metabolic risk factor levels were high across all racial/ethnic groups, but NHB and MA had poorer control compared to NHW. Interventions that target identification of diabetes and treatment of cardio-metabolic risk factors are needed.