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Changes in the Diagnosis and Management of Diabetes in Mexico City Between 1998–2004 and 2015–2019

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posted on 10.02.2021, 22:34 by Diego Aguilar-Ramirez, Jesus Alegre-Díaz, Louisa Gnatiuc, Raúl Ramirez-Reyes, Rachel Wade, Michael Hill, Rory Collins, Richard Peto, Jonathan R Emberson, William G Herrington, Pablo Kuri-Morales, Roberto Tapia-Conyer
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: In 1998-2004, 159,755 adults from Mexico City were recruited into a prospective study and in 2015-2019 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 standardised for age, sex and residential district. Cox models explored the relevance of controlled and inadequately controlled diabetes to cause-specific mortality.

Results: 99,623 participants in 1998-2004 and 8986 participants in 2015-2019 were aged 45-84 years. Diabetes prevalence increased from 26% in 1998-2004 to 35% by 2015-2019. Of those with diabetes, the proportion previously-diagnosed increased from 76% to 89%, and glucose-lowering medication use among them increased from 80% to 94%. Median HbA1c among all with diabetes decreased from 8.2% to 7.3%, and the proportion of them with controlled diabetes increased from 16% to 37%. Use of blood pressure lowering medication among all with previously-diagnosed diabetes increased from 35% to 51% and their use of lipid-lowering therapy 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.

Funding

This study was supported by grants from the Wellcome Trust, Mexican Health Ministry, Mexican National Council of Science and Technology, Cancer Research UK, British Heart Foundation, and UK Medical Research Council. Dr Aguilar-Ramirez acknowledges support from the BHF Centre of Research Excellence, Oxford (grant code RE/13/1/30181). Dr Herrington is funded by an MRC–Kidney Research UK Professor David Kerr Clinician Scientist Award.

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