RT Journal Article
SR Electronic
T1 Changes in the Diagnosis and Management of Diabetes in Mexico City Between 1998–2004 and 2015–2019
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP dc202276
DO 10.2337/dc20-2276
A1 Aguilar-Ramirez, Diego
A1 Alegre-Díaz, Jesus
A1 Gnatiuc, Louisa
A1 Ramirez-Reyes, Raúl
A1 Wade, Rachel
A1 Hill, Michael
A1 Collins, Rory
A1 Peto, Richard
A1 Emberson, Jonathan R.
A1 Herrington, William G.
A1 Kuri-Morales, Pablo
A1 Tapia-Conyer, Roberto
YR 2021
UL http://care.diabetesjournals.org/content/early/2021/02/09/dc20-2276.abstract
AB OBJECTIVE To investigate the trends in diabetes prevalence, diagnosis, and management among Mexican adults who were participants in a long-term prospective study.RESEARCH DESIGN AND METHODS From 1998 to 2004, 159,755 adults from Mexico City were recruited to a prospective study, and from 2015 to 2019, 10,144 survivors were resurveyed. Diabetes was defined as self-reported diagnosis, glucose-lowering medication use, or HbA1c ≥6.5%. Controlled diabetes was defined as HbA1c <7%. Prevalence estimates were uniformly standardized for age, sex, and residential district. Cox models explored the relevance of controlled and inadequately controlled diabetes to cause-specific mortality.RESULTS During 1998–2004 and 2015–2019, 99,623 and 8,986 participants were aged 45–84 years. Diabetes prevalence had increased from 26% in 1998–2004 to 35% by 2015–2019. Of those with diabetes, the proportion previously diagnosed had increased from 76 to 89%, and glucose-lowering medication use among them had increased from 80 to 94%. Median HbA1c among those with diabetes had decreased from 8.2 to 7.3%, and the proportion of participants with controlled diabetes had increased from 16 to 37%. Use of blood pressure–lowering medication among those with previously diagnosed diabetes had increased from 35 to 51%, and their use of lipid-lowering therapy had increased from 1 to 14%. The excess mortality risk associated with diabetes accounted for 34% of deaths at ages 35–74 years, of which 5% were attributable to controlled and 29% to inadequately controlled diabetes.CONCLUSIONS Inadequately controlled diabetes is a leading cause of premature adult death in Mexico. Improvements in diabetes management have increased diagnosis and control, but substantial opportunities remain to improve treatment, particularly with lipid-lowering therapy.