Morkos Michael, Tahsin Bettina, Fogg Louis, Fogelfeld Leon
Division of Endocrinology and Diabetes, John H. Stroger, Jr. Hospital of Cook County and Rush University Medical Center, Chicago, Illinois, USA.
Community, Systems, and Mental Health Nursing, Rush University College of Nursing, Chicago, Illinois, USA.
BMJ Open Diabetes Res Care. 2018 Oct 11;6(1):e000568. doi: 10.1136/bmjdrc-2018-000568. eCollection 2018.
To characterize the clinical presentation of newly diagnosed type 2 diabetes of ethnic minority adults in Chicago and compare with other populations.
Cross-sectional study examining the data of 2280 patients newly diagnosed with type 2 diabetes treated between 2003 and 2013 in a large Chicago public healthcare system.
Mean age of the patients was 49±11.3 years, men 54.4%, African-Americans 48.1%, Hispanics 32.5%, unemployed 69.9%, uninsured 82.2%, English-speaking 75.1%, and body mass index was 32.8±7.4 kg/m. Microvascular complications were present in 50.1% and macrovascular complications in 13.4%. There was a presence of either macrovascular or microvascular complications correlated with older age, hypertension, dyslipidemia, inactivity, speaking English, and being insured (p<0.01). Glycosylated hemoglobin A (HbA) at presentation did not correlate with diabetes complications. In our cohort, when compared with a diverse population in the UK and insured population in the USA, HbA at presentation was 10.0% (86 mmol/mol), 6.6% (49 mmol/mol), and 8.2% (66 mmol/mol); nephropathy was 22.2%, 16.7%, and 5.7%; retinopathy was 10.7%, 7.9%, and 1.4%; and neuropathy was 27.7%, and 6.7% in the UK (p<0.001). There were no significant differences between groups in the prevalence of macrovascular complications.
These results show the vulnerability of underserved and underinsured patients for developing diabetes complications possibly related to a delayed diagnosis.
描述芝加哥少数民族成年新诊断2型糖尿病患者的临床表现,并与其他人群进行比较。
横断面研究,分析2003年至2013年在芝加哥一个大型公共医疗系统中接受治疗的2280例新诊断2型糖尿病患者的数据。
患者平均年龄为49±11.3岁,男性占54.4%,非裔美国人占48.1%,西班牙裔占32.5%,失业者占69.9%,未参保者占82.2%,说英语者占75.1%,体重指数为32.8±7.4kg/m²。微血管并发症发生率为50.1%,大血管并发症发生率为13.4%。存在大血管或微血管并发症与年龄较大、高血压、血脂异常、缺乏运动、说英语和参保相关(p<0.01)。就诊时糖化血红蛋白A(HbA)与糖尿病并发症无关。在我们的队列中,与英国的多样化人群和美国的参保人群相比,就诊时HbA分别为10.0%(86mmol/mol)、6.6%(49mmol/mol)和8.2%(66mmol/mol);肾病发生率分别为22.2%、16.7%和5.7%;视网膜病变发生率分别为10.7%、7.9%和1.4%;神经病变发生率在英国分别为27.7%和6.7%(p<0.001)。各组大血管并发症患病率无显著差异。
这些结果表明,未得到充分服务和未参保的患者易发生可能与诊断延迟相关的糖尿病并发症。