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Inconsistent use of medications by elderly Mexican Americans with diabetes may explain their greater risk of some complications

Several studies have documented higher rates of diabetic complications of the kidney, eye, and circulation (including nontraumatic limb amputations) among Mexican American diabetes patients compared with white patients. The inconsistent use of diabetic medications by elderly Mexican Americans may underlie their increased risk for some diabetes complications, suggests a study supported by the Agency for Healthcare Research and Quality (HS11618). The researchers found that over one-third (36 percent) of elderly Mexican Americans with diabetes inconsistently used their prescribed diabetic medications, and those who were inconsistent in their medication use were more likely to develop kidney problems or die over a 7-year period.

Researchers from the Medical Branch and the Health Science Center of the University of Texas analyzed data from the four waves of the Hispanic Established Population for the Epidemiology Study of the Elderly. In-home interviewers assessed consistency in use of diabetes medications among 908 elderly Mexican Americans who had diabetes. Over a period of 7 years, 148 of these individuals discontinued their diabetes medications, 16 had not used their diabetes medications in the 2 weeks prior to the interview, and 160 had no diabetic medications at home, despite their self-report of taking medicine for diabetes. The rates of inconsistent drug use for those on oral hypoglycemic drugs and those on insulin (with or without oral hypoglycemic drugs) were similar (34 and 38 percent, respectively).

Patients who did not have Medicaid or private/HMO health insurance and those who were age 75 or older were much more likely to be inconsistent with treatment. Patients with inconsistent use of medication were more likely than consistent users to report kidney problems at followup, after controlling for years of diabetes, insurance status, and other factors. Inconsistent use of medication also increased the risk of death from any cause by 43 percent and diabetes-related deaths by 66 percent over a period of 7 years.

See "Inconsistent use of diabetes medications, diabetes complications, and mortality in older Mexican Americans over a 7-year period," by Yong-Fang Kuo, Ph.D., Mukaila A. Raji, M.D., Kyriakos S. Markides, Ph.D., and others, in the November 2003 Diabetes Care 26(11), pp. 3054-3060.

Editor's Note: Another AHRQ-supported study on diabetes shows that type 2 diabetes is associated with a reduction in work productivity. For details see Lavigne, J.E., Phelps, C.E., Mushlin, A, and Lednary, W.M. (2003). "Reductions in individual work productivity associated with type 2 diabetes mellitus." (AHRQ grant HS09891). Pharmacoeconomics 21(15), pp. 1123-1134.

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