Factors Associated With Poor Glycemic Control or Wide Glycemic Variability Among Diabetes Patients in Hawaii, 2006–2009

Deborah Taira Juarez; Tetine Sentell; Sheri Tokumaru; Roy Goo; James W. Davis; Marjorie M. Mau

Suggested citation for this article: Juarez DT, Sentell T, Tokumaru S, Goo R, Davis JW, Mau MM. Factors Associated With Poor Glycemic Control or Wide Glycemic Variability Among Diabetes Patients in Hawaii, 2006–2009. Prev Chronic Dis 2012;9:120065. DOI: http://dx.doi.org/10.5888/pcd9.120065

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Release date: September 26, 2012; Expiration date: September 26, 2013

Learning Objectives

Upon completion of this activity, participants will be able to:

Analyze risk factors for poor glycemic control among patients with diabetes
Evaluate risk factors for wide glycemic variability among patients with diabetes

CME EDITOR
Rosemarie Perrin, Editor; Camille Martin, Editor, Preventing Chronic Disease. Disclosure: Rosemarie Perrin and Camille Martin have disclosed no relevant financial relationships.
CME AUTHOR
Charles P. Vega, MD, Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine. Disclosure: Charles P. Vega, MD, has disclosed no relevant financial relationships.
AUTHORS AND CREDENTIALS
Disclosures: Deborah Taira Juarez, ScD; Tetine Sentell, PhD; Sheri Tokumaru, PharmD, BCPS; Roy Goo, PharmD; James W. Davis, PhD; Marjorie M. Mau, MD, MS have disclosed no relevant financial relationships.

Affiliations: Deborah Taira Juarez, College of Pharmacy, University of Hawaii, Honolulu, Hawaii; Sheri Tokumaru, Roy Goo, University of Hawaii at Hilo, Hawaii; Tetine Sentell, James W. Davis, Marjorie M. Mau, John A. Burns, School of Medicine, Honolulu, Hawaii

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Abstract

Introduction
Although glycemic control is known to reduce complications associated with diabetes, it is an elusive goal for many patients with diabetes. The objective of this study was to identify factors associated with sustained poor glycemic control, some glycemic variability, and wide glycemic variability among diabetes patients over 3 years.
Methods
This retrospective study was conducted among 2,970 diabetes patients with poor glycemic control (hemoglobin A1c [HbA1c] >9%) who were enrolled in a health plan in Hawaii in 2006. We conducted multivariable logistic regressions to examine factors related to sustained poor control, some glycemic variability, and wide glycemic variability during the next 3 years. Independent variables evaluated as possible predictors were age, sex, type of insurance coverage, morbidity, diabetes duration, history of cardiovascular disease, and number of medications.
Results
Longer duration of diabetes, being under age 35, and taking 15 or more medications were significantly associated with sustained poor glycemic control. Preferred provider organization and Medicare (vs health maintenance organization) enrollees and patients with high morbidity were less likely to have sustained poor glycemic control. Wide glycemic variability was significantly related to being younger than age 50, longer duration of diabetes, having coronary artery disease, and taking 5 to 9 medications per year.
Conclusion
Results indicate that duration of diabetes, age, number of medications, morbidity, and type of insurance coverage are risk factors for sustained poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Patients younger than age 50 and those with a history of coronary heart disease should be warned of the health risks of wide glycemic variability.