Fayfman Maya, Vellanki Priyathama, Alexopoulos Anastasia-Stefania, Buehler Lauren, Zhao Liping, Smiley Dawn, Haw Sonya, Weaver Jeff, Pasquel Francisco J, Umpierrez Guillermo E
Division of Endocrinology (M.F., P.V., A.-S.A., L.B. D.S., S.H., F.J.P., G.E.U.), Department of Medicine, Department of Biostatistics and Bioinformatics (L.Z.), Rollins School of Public Health, Research & Woodruff Health Sciences IT (J.W.), Data Management Group, Emory University, Atlanta, Georgia 30322.
J Clin Endocrinol Metab. 2016 Mar;101(3):1144-50. doi: 10.1210/jc.2015-3220. Epub 2016 Jan 6.
A higher prevalence of diabetes-related complications is reported in minority populations; however, it is not known if there are racial disparities in diabetes care and outcomes in hospitalized patients.
Our objective was to determine the association between hyperglycemia, in patients with and without diabetes mellitus (non-DM), and complications among different racial groups.
This observational study compared the frequency of hyperglycemia (blood glucose ≥ 180 mg/dL; 10 mmol/L) and DM and hospital complications between Black and White patients hospitalized patients between January 2012 and December 2013.
Adults admitted to medical and surgery services in two academic hospitals were included in this study.
Among 35 866 patients, there were 14 387 Black (40.1%) and 21 479 White patients (59.9%). Blacks had a higher prevalence of hyperglycemia (42.3% vs 36.7%, P < .0001) and DM (34.5% vs 22.8%, P < .0001) and a higher admission rate and mean daily blood glucose (P < .001). Blacks also had higher rates of complications (22.2% vs 19.2%, P < .0001), both in patients with DM (24.7 vs 22.9%, P = .0413) and non-DM with hyperglycemia (41.2% vs 37.2%, P = .0019). Using sequential modelling adjusted for age, gender, body mass index, comorbidities, and insurance coverage, non-DM Blacks with normoglycemia (odds ratio, 1.22; 95% confidence interval, 1.10-1.35) and non-DM Blacks with hyperglycemia (odds ratio, 1.18; 95% confidence interval, 1.04-1.33) had higher number of complications compared to Whites.
Black patients have higher rates of hyperglycemia and diabetes, worse inpatient glycemic control, and greater frequency of hospital complications compared to Whites. Non-DM Blacks with hyperglycemia are a particularly vulnerable group. Further investigation is needed to better understand factors contributing the racial disparities in the hospital.
据报道，少数族裔人群中与糖尿病相关的并发症患病率较高；然而，尚不清楚住院患者在糖尿病护理和治疗结果方面是否存在种族差异。
我们的目的是确定患有和未患有糖尿病（非糖尿病）患者的高血糖与不同种族群体并发症之间的关联。
这项观察性研究比较了2012年1月至2013年12月期间住院的黑人和白人患者高血糖（血糖≥180mg/dL；10mmol/L）、糖尿病及医院并发症的发生频率。
本研究纳入了两家学术医院内科和外科服务收治的成年人。
在35866例患者中，有14387例黑人（40.1%）和21479例白人患者（59.9%）。黑人的高血糖患病率（42.3%对36.7%，P<.0001）和糖尿病患病率（34.5%对22.8%，P<.0001）更高，入院率和每日平均血糖也更高（P<.001）。黑人的并发症发生率也更高（22.2%对19.2%，P<.0001），糖尿病患者（24.7%对22.9%，P=.0413）和非糖尿病高血糖患者（41.2%对37.2%，P=.0019）均如此。通过对年龄、性别、体重指数、合并症和保险覆盖情况进行调整的序贯模型分析，血糖正常的非糖尿病黑人（比值比，1.22；95%置信区间，1.10 - 1.35）和高血糖的非糖尿病黑人（比值比，1.18；95%置信区间，1.04 - 1.33）与白人相比，并发症数量更多。
与白人相比，黑人患者的高血糖和糖尿病发生率更高，住院期间血糖控制更差，医院并发症发生频率更高。高血糖的非糖尿病黑人是一个特别脆弱的群体。需要进一步调查以更好地了解导致医院中种族差异的因素。
