Diabetes Complications Vary Little by Ethnicity

March 4, 2015

Examining ethnic patterns of prevalent geriatric conditions in diabetes may help ensure culturally competent, patient-centered care in an increasingly diverse population.

Although there may be noticeable differences in the prevalence of diabetes mellitus (DM) across ethnic groups, the prevalence of diabetic complications and geriatric conditions does not vary significantly among these groups, according to a new study.

“For patients with diabetes, geriatric conditions such as chronic pain, depression or dementia become increasingly common with age, yet it has been unknown to what extent these conditions vary across ethnic groups,” said lead author Andrew J. Karter, PhD, Senior Research Scientist at the Kaiser Permanente Division of Research, Oakland, Calif. “We found that geriatric conditions were more common than diabetic complications. The welcome news was that the prevalence of these conditions varied relatively little by ethnicity.”

The researchers conducted an observational study of an ethnically diverse population of more than 115,000 patients with DM, age 60 years or older, who were Kaiser Permanente members in Northern California.

About one-third of the patients had a diagnosis of at least 1 DM-related complication in the past 2 years. More common complications included advanced diabetic eye disease (21%) and heart failure (13%). Less common complications included myocardial infarction, stroke, end-stage renal disease, serious hypoglycemic events, and amputation (all less than 2%).

The vast majority of patients (88%) had at least 1 geriatric condition recorded in the previous 2 years. The most common conditions were chronic pain (74%), polypharmacy (57%), and depression (17%). Other conditions were relatively uncommon; they included urinary incontinence (7%), falls (7%), dementia (2%), and underweight (less than 1%).

“Compared with Whites, Asians and Filipinos were more likely to be underweight but had substantively lower prevalence of falls, urinary incontinence, polypharmacy, depression, and chronic pain, and were least likely of all groups to have at least 1 geriatric condition,” the researchers stated. “African Americans had significantly lower prevalence of incontinence and falls, but higher prevalence of dementia; Latinos had a lower prevalence of falls. Except for end-stage renal disease, Whites tended to have the highest rates of prevalent diabetic complications.”

There is considerable variation in the prevalence of DM across ethnicities nationwide, from Whites (7%), Chinese (8%), Japanese (10%), African Americans and Latinos (14%), and Filipinos and South Asians (16%) to Pacific Islanders (18%).

The rate of having at least 1 diabetic complication was not markedly different across ethnic groups-38% of African Americans and those of mixed-race ethnicity, 32% of Latinos, 31% of Whites, 29% of Filipinos, and 28% of Asians.

In addition, the prevalence of having any geriatric condition did not differ markedly by ethnicity. More than 80% of patients in ethnic groups had at least 1 geriatric condition, ranging from 89% of African Americans and Whites to 81% of Asians. 

“Geriatric conditions can have a greater impact on health-related quality of life than diabetic complications,” said senior author Elbert S. Huang, MD, of the University of Chicago. “Examination of ethnic patterns of prevalent geriatric conditions in diabetes is important for our efforts to reduce disparities and assure culturally competent and patient-centered care among an increasingly diverse population of older patients with diabetes."

The researchers published their results online February 10, 2015, in the Journal of Aging and Health.