Diabetes, diabetes complications, and their consequences in Mexican-American elders
Max Elias Otiniano
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The purpose of this study is to describe the epidemiology of diabetes, diabetes complications and their consequences over an 11-year period in Mexican-American elders. Design: This is an 11-year prospective cohort study (1993-1994 to 2004-2005). Setting: This study was conducted among residents of five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. Participants: This is a population-based sample of 3050 non-institutionalized Mexican American men and women aged 65 or older from the Hispanic Established Population for Epidemiologic Studies of the Elderly (H EPESE). Measures: A number of measures were developed that include socio demographic indicators; categories of health behaviors; and self-reports of diabetes, diabetes complications, functional disability, medical conditions, health service utilization, and depressive symptoms. Self-reported heart attack, self-reported stroke, mortality, and HbA1c measure were used as independent variables over the 11-year period. Results: 1) The estimated prevalence of diabetes was 22%. 2) The estimated prevalence of diabetic complications was 60% (retinopathy: 38%, nephropathy: 14%, peripheral vascular disease: 40%, and amputations: 8%). 3) Self-reported heart attack and self-reported stroke are significantly associated with diabetes at 7-year follow-up. 4) At 7-year follow-up, heart attack accounted for 45% of deaths in diabetics. 5) At 11-year follow-up, glycemic control was associated with low education, duration of disease, and severity of disease. Conclusions: These findings suggest that Mexican American elders with diabetes are at high risk of developing diabetes complications, primarily heart attack, stroke, and premature mortality. It is important to promote educational programs aimed at developing healthy lifestyle changes beginning in early adulthood as a preventive measure to delay the onset of disease in this high risk population.