Prevalence and control of diabetes and impaired fasting glucose in New York City

Abstract

Objective: To determine the prevalence of diabetes and impaired fasting glucose (IFG) and to assess clinical management indicators among adults with diabetes in a representative sample of New York City adults.

Research design and methods: In 2004, New York City implemented the first community-level Health and Nutrition Examination Survey (NYC HANES), modeled after the National Health and Nutrition Examination Survey (NHANES). We used an interview to determine previously diagnosed diabetes and measured fasting plasma glucose to determine undiagnosed diabetes and IFG in a probability sample of 1,336 New York City adults. We assessed glycemic control and other clinical indicators using standardized NHANES protocols.

Results: The prevalence of diabetes among New York City adults was 12.5% (95% CI 10.3-15.1): 8.7% diagnosed and 3.8% undiagnosed. Nearly one-fourth (23.5%) of adults had IFG. Asians had the highest prevalence of impaired glucose metabolism (diabetes 16.1%, IFG 32.4%) but were significantly less likely to be obese. Among adults with diagnosed diabetes, less than one-half (45%) had A1C levels <7%; one-half (50%) had elevated blood pressure measures at interview, 43% of whom were not on antihypertensive medications; nearly two-thirds (66%) had elevated LDL levels, and only 10% had their glucose, blood pressure, and cholesterol all at or below recommended levels. Most adults (84%) with diagnosed diabetes were on medication, but only 12% were receiving insulin.

Conclusions: In New York City, diabetes and IFG are widespread. Policies and structural interventions to promote physical activity and healthy eating should be prioritized. Improved disease management systems are needed for people with diabetes.

Figure 1

Prevalence of diagnosed and undiagnosed diabetes among New Yorkers aged 20 years and older: NYC HANES 2004.

Figure 2

Adjusted prevalence (predicted marginals) for diabetes (A) and diabetes and IFG (B) by BMI category and race/ethnicity. Both models control for sex, age, place of birth, income, and physical activity. A: ^aEstimate is higher than that for whites at P < 0.05. B: ^aEstimate is higher than those for all other normal-weight racial/ethnic groups at P = 0.05. ^bEstimate is higher than that for overweight whites at P < 0.05. ^cEstimate is higher than that for overweight whites (P <0.001) and Hispanics (P < 0.05). ^dEstimate is higher than that for obese blacks at P < 0.05. Non Hisp, non-Hispanic.