Changes in the Diagnosis and Management of Diabetes in Mexico City Between 1998-2004 and 2015-2019
Por:
Aguilar-Ramirez, Diego, Alegre-Diaz, Jesus, Gnatiuc, Louisa, Ramirez-Reyes, Raul, Wade, Rachel, Hill, Michael, Collins, Rory, Peto, Richard, Emberson, Jonathan R., Herrington, William G., Kuri-Morales, Pablo, Tapia-Conyer, Roberto
Publicada:
1 abr 2021
Resumen:
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
HbA(1c) >= 6.5%. Controlled diabetes was defined as HbA(1c) <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 HbA(1c) 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.
Filiaciones:
Aguilar-Ramirez, Diego:
Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England
Alegre-Diaz, Jesus:
Univ Nacl Autonoma Mexico, Fac Med, Mexico City, DF, Mexico
Gnatiuc, Louisa:
Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England
Ramirez-Reyes, Raul:
Univ Nacl Autonoma Mexico, Fac Med, Mexico City, DF, Mexico
Wade, Rachel:
Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, MRC Populat Hlth Res Unit, Oxford, England
Hill, Michael:
Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, MRC Populat Hlth Res Unit, Oxford, England
Collins, Rory:
Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England
Peto, Richard:
Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England
Emberson, Jonathan R.:
Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, MRC Populat Hlth Res Unit, Oxford, England
Herrington, William G.:
Univ Oxford, Nuffield Dept Populat Hlth, Clin Trial Serv Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, Epidemiol Studies Unit, Oxford, England
Univ Oxford, Nuffield Dept Populat Hlth, MRC Populat Hlth Res Unit, Oxford, England
Kuri-Morales, Pablo:
Univ Nacl Autonoma Mexico, Fac Med, Mexico City, DF, Mexico
Tapia-Conyer, Roberto:
Univ Nacl Autonoma Mexico, Fac Med, Mexico City, DF, Mexico
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