Liu Longjian, Wang Fengge, Gracely Edward J, Moore Kari, Melly Steven, Zhang Fengqing, Sato Priscila Y, Eisen Howard J
Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA.
Department of Family, Community & Preventive Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Health Equity. 2020 Dec 30;4(1):525-532. doi: 10.1089/heq.2020.0076. eCollection 2020.
To examine the burden of uncontrolled hyperglycemia in patients with diabetes mellitus (DM) and their characteristics in a large urban city. 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. 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 (<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, <0.001), and with prevalent coronary heart disease (OR=1.39, 95% CI: 1.16-1.67, =0.001). Patients living in neighborhoods with lower socioeconomic status (SES) had significantly higher uncontrolled hyperglycemia rates across the city (=0.52, =0.27, =0.03). 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.
为研究大城市中糖尿病（DM）患者未控制的高血糖负担及其特征。对在费城一所大型大学教学医院接受常规医疗保健的4993名年龄≥18岁的DM患者进行随机抽样分析。未控制的高血糖被定义为糖化血红蛋白A1c>8%。采用单因素和多因素分析方法分析未控制的高血糖与社会人口统计学和心血管因素之间的关联。结果显示，18 - 54岁患者未控制的高血糖患病率最高（36.0%），其次是55 - 64岁（30.9%）、65 - 74岁（22.9%）和≥75岁（20.6%）的患者（<0.0001）。未经调整的高血糖与总胆固醇与高密度脂蛋白比值升高的患者显著相关（比值比[OR]=1.59，95%置信区间[CI]：1.33 - 1.90，<0.001），与冠心病患病率也显著相关（OR=1.39，95% CI：1.16 - 1.67，=0.001）。在全市范围内，生活在社会经济地位（SES）较低社区的患者未控制的高血糖率显著更高（=0.52，=0.27，=0.03）。本研究结果是最早表明年轻成年人未控制的高血糖率较高的研究之一。应进一步关注年轻成年人以及生活在SES较低社区的患者在控制糖尿病方面所面临的挑战。
