Diabetes Mellitus in Hopi and Navajo Indians: Prevalence of Microvascular Complications

Rate, Robert G.; Knowler, William C.; Morse, Harold G.; Bonnell, Mark D.; McVey, Jan; Chervenak, Carol L; Smith, Mike G; Pavanich, Gary

doi:10.2337/diab.32.10.894

Cited by 34 publications

(4 citation statements)

References 5 publications

(7 reference statements)

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“…The prevalence of DR in these earlier studies was higher than that reported here, i.e., in Pima Indians with type 2 diabetes [ 3 ], Navajo and Hopi Indians [ 4 ], and Sioux Indian tribes [ 5 ], the prevalence of NPDR was 37.8%, 40%, and 45.3% respectively. The prevalence of PDR was 2.7% (Pima), and prevalence of vision-threatening retinopathy was 8.2% (Navajo and Hopi).…”

Section: Discussioncontrasting

confidence: 59%

Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaskan Natives

Bursell

Fonda²,

Lewis³

et al. 2018

PLoS ONE

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BackgroundDiabetes and its complications are more common in American Indians and Alaska Natives (AI/AN) than other US racial/ethnic populations. Prior reports of diabetic retinopathy (DR) prevalence in AI/AN are dated, and research on diabetic macular edema (DME) is limited. This study characterizes the recent prevalence of DR and DME in AI/AN using primary care-based teleophthalmology surveillance.MethodsThis is a multi-site, clinic-based, cross-sectional study of DR and DME. The sample is composed of AI /AN patients with diabetes (n = 53,998), served by the nationally distributed Indian Health Service-Joslin Vision Network Teleophthalmology Program (IHS-JVN) in primary care clinics of US Indian Health Service (IHS), Tribal, and Urban Indian health care facilities (I/T/U) from 1 November 2011 to 31 October 2016. Patients were recruited opportunistically for a retinal examination using the IHS-JVN during their regular diabetes care. The IHS-JVN used clinically validated, non-mydriatic, retinal imaging and retinopathy assessment protocols to identify the severity levels of non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), DME, and sight threatening retinopathy (STR; a composite measure). Key social-demographic (age, gender, IHS area), diabetes-related health (diabetes therapy, duration of diabetes, A1c), and imaging technology variables were examined. The analysis calculated frequencies and percentages of severity levels of disease.ResultsPrevalence of any NPDR, PDR, DME, and STR among AI/AN patients undergoing DR teleophthalmology surveillance by IHS-JVN was 17.7%, 2.3%, 2.3%, and 4.2%, respectively. Prevalence was lowest in Alaska and highest among patients with A1c >/ = 8%, duration of diabetes > 10 years, or using insulin.ConclusionsPrevalence of DR in this cohort was approximately half that in previous reports for AI/AN, and prevalence of DME was less than that reported in non-AI/AN populations. A similar reduction in diabetes related end-stage renal disease in the same population and time period has been reported by other researchers. Since these two diabetic complications share a common microvasculopathic mechanism, this coincident change in prevalence may also share a common basis, possibly related to improved diabetes management.

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Section: Discussioncontrasting

confidence: 59%

Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaskan Natives

Bursell

Fonda²,

Lewis³

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Prevalence rates in various studies from around the world show considerable variation as a result of variations in study design, detection methods, the examination of patients at different stages in the natural history of diabetes, or in the definition of PN, and the study of selected populations, from as low as 1.5% to as high as 100% (7,(11)(12)(13)(14)(15)(16) making comparisons between studies of limited value. Our clinic-based prevalence is higher than the values reported in studies undertaken in developed nations (4,8,12,15,17,(23)(24)(25)(26)(27). In a Turkish study the overall prevalence of neuropathy in patients with type 2 diabetes was 60% (25).…”

Section: Discussioncontrasting

confidence: 53%

Peripheral neuropathy in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors

et al. 2006

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“…Mean duration of diabetes in our population was 11.2 years. One study of north-eastern Arizona found neuropathy in 21% of people with diabetes with more than 10-year duration of disease [30]. Consistent with the other studies our study confirms the association between the incidence rate of neuropathy, age and duration of diabetes [31].…”

Section: Discussionsupporting

confidence: 91%

The cost of diabetes chronic complications among Iranian people with type 2 diabetes mellitus

Farshchi

Esteghamati

Sari

et al. 2014

J Diabetes Metab Disord

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BackgroundTo evaluate the cost of diabetes related micro- and macrovascular complications in Iranian people with type 2 diabetes mellitus.MethodsIn routine clinical practice, people with type 2 diabetes mellitus were assessed for 10 years at a diabetes care center. The type of medications and clinical data were extracted from patients’ documents. Mortality rate and the incidence of micro- and macrovascular complications recorded in patients’ documents were analyzed. Cost analysis was comprised of 1) para clinic costs as well as laboratory, medications, clinical visits and nonmedical costs 2) inpatient costs as well as hospital admission costs, disability, and mortality costs.ResultsFrom 1562 people with type 2 diabetes mellitus, a total of 1000 patients with mean duration disease of 11.2 years, who had completed information in their documents, were studied. All people were free from complications at baseline. Mean cumulative incidence of diabetes-related complications over 10 years were 10.9 ± 3.5%, 8.0 ± 3.1%, 4.6 ± 1.7%, 9.1 ± 3.6% and 2.3 ± 0.9% for peripheral neuropathy and diabetic foot ulcer, nephropathy, ophthalmic complications, cardiovascular disease and death, respectively. People with better glycemic control had less complication and also related expenditures. Average para clinic cost per patient was 393.6 ± 47.8 and average inpatient cost per patient was 1520.7 ± 104.5 USD.ConclusionsOur findings demonstrate considerable incidence of diabetes chronic complications and also high health care expenditure for related complications among our patients. As the number of people with diabetes continues to rise, early detection of the disease and implementation of timely and appropriate therapeutic strategies could decrease the burden of diabetes chronic complications and also huge related expenditures.

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Diabetes Mellitus in Hopi and Navajo Indians: Prevalence of Microvascular Complications

Cited by 34 publications

References 5 publications

Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaskan Natives

Prevalence of diabetic retinopathy and diabetic macular edema in a primary care-based teleophthalmology program for American Indians and Alaskan Natives

Peripheral neuropathy in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors

The cost of diabetes chronic complications among Iranian people with type 2 diabetes mellitus

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