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Public Health and Clinical Implications of High Hemoglobin A1c Levels and Weight in Younger Adult Native American People With Diabetes
Janette S. Carter, MD;
Susan S. Gilliland, MPH;
Georgia E. Perez;
Betty Skipper, PhD;
Frank D. Gilliland, MD, PhD
Arch Intern Med. 2000;160:3471-3476.
Background Type 2 diabetes mellitus is a major public health issue for Native American people. Because glycemic levels are predictive of diabetes outcome, understanding determinants of high hemoglobin A1c (HbA1c) levels may provide targets for prevention efforts.
Objectives To investigate determinants of high HbA1c levels in Native American people.
Methods We conducted a population-based, cross-sectional study of 206 participants with diabetes from 8 Native American communities in New Mexico. We used linear regression to assess the relationship of HbA1c level with age, body mass index (BMI), treatment type, duration of diabetes, physical activity, and diet.
Results Age, dietary pattern, and treatment type were determinants of HbA1c levels. Participants younger than 55 years had the highest adjusted HbA1c levels at 9.5% and those 65 years and older had the lowest levels at 7.8%. According to a participant's dietary intake, HbA1c levels were highest for those who consumed the most fat and sugar, and high consumption of fat and sugar affected HbA1c levels most among those younger than 55 years. Participants treated with insulin had the highest hemoglobin A1c levels. Physical activity was not associated with HbA1c level.
Conclusions We found an increasing severity of diabetes among younger people. To avoid increased morbidity and mortality in the future, young Native American adults with diabetes need vigorous therapy to maintain tight glucose control.
From the Veterans Affairs Medical Center, Albuquerque, NM (Dr Carter), and the Departments of Medicine (Mss Gilliland and Perez) and Family and Community Medicine (Dr Skipper), University of New Mexico School of Medicine, Albuquerque, and the Department of Preventive Medicine, University of Southern California, Los Angeles (Dr Gilliland).
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