New Study Reveals Large Gaps in Diabetes Care in New York City
More than 90% of New Yorkers already diagnosed with diabetes are in danger of heart attack or stroke; One in four New York City adults is at high risk of developing diabetes
December 30, 2008 – A new study from the Health Department reveals huge gaps in the care that New Yorkers with diabetes receive. High blood pressure and high cholesterol pose extreme hazards to people with diabetes, increasing the risk of heart attack and stroke. Treating these conditions can spare persons with diabetes from complications and early death. But according to the new study – published online this week in the journal Diabetes Care – fewer than 10% of New Yorkers with diabetes are fully controlling their conditions. More than 90% of them have elevated blood pressure, cholesterol or blood sugar – placing them at increased risk of heart attacks, strokes and other complications.
The new study includes other concerning findings as well. Some 500,000 New York City adults have been diagnosed with diabetes; 200,000 more have the condition but don’t know it. In addition, the new study suggests that 1.4 million non-diabetic New Yorkers have high enough blood sugar levels to place them at high risk of developing diabetes. This high rate of “pre-diabetes” is a forecast for a huge wave of future illness.
“Diabetes continues to plague our city,” said Dr. Thomas R. Frieden, New York City Health Commissioner. “The hundreds of thousands of New Yorkers with diabetes whose blood pressure, cholesterol or blood sugar are not under control are at risk of devastating consequences – heart attacks, stroke, blindness, kidney failure and amputations.”
New York City, like many urban communities, has a higher concentration of poverty than the rest of the nation. The city also has greater racial/ethnic diversity, resulting in a larger proportion of people at a high risk of developing diabetes. The Health Department’s study found that adults making less than $20,000 a year were almost twice as likely as higher-income adults to have diabetes (15.7% versus 8.9%). Black New Yorkers were at higher rates than whites (14.5% versus 10.7%). And Asian New Yorkers had the highest rates of both diabetes (16.1%) and pre-diabetes (32.4%), despite having lower rates of overweight (according to the body mass index).
Diabetes has become epidemic during the past two decades, fueled by rising rates of obesity and physical inactivity. In New York City, more than 80% of people with diabetes are overweight or obese. Reversing the obesity epidemic requires action on many fronts, including reducing consumption of soda and other sweetened beverages – a major contributor to weight gain and the growing diabetes problem. In a study published last spring in the Journal of Urban Health, Health Department researchers reported that 27% of New York City adults consume one or more sugar-sweetened sodas each day. The frequent soda drinkers consumed an average of nearly two cans – or 300 extra calories – every day. The biggest soda consumers were Black and Latino New Yorkers, people with less than a college education, and those from low-income households – the same people at highest risk of diabetes.
Knowing the ABCs
For people who have diabetes, controlling the ABCS – A1C (blood sugar), blood pressure, cholesterol and smoking – is critical to staying healthy. Yet the new study, based on data from the 2004 NYC Health and Nutrition Survey, found that half of people with diagnosed diabetes had elevated blood pressure and nearly two thirds had high cholesterol. Many had not been prescribed medications for either condition, and only 12% were on insulin – compared with 23% nationally. This lack of treatment suggests that many of New York City’s medical institutions are failing to meet nationally recognized standards for managing diabetes.
“In the fight against diabetes, the good news is that we can prevent it and manage it,” said Lorna Thorpe, deputy commissioner for the Health Department’s epidemiology division. “By making lifestyle changes – like eating well, getting more physical activity and cutting out sugary drinks – people at risk for developing diabetes can prevent it. People who have diabetes can lead longer, healthier lives by knowing and controlling their ABCS through these same lifestyle changes and appropriate medical treatment.”
The new study stresses the need to create environments that foster healthy eating and encourage physical activity. Chronic disease is common in settings where junk food abounds, fresh produce is scarce, and opportunities for physical activity are lacking. Conversely, environments that encourage exercise, discourage smoking and provide better food choices can improve people’s health. Physical activity and nutrition programs have been shown to reduce the progression to diabetes in those at highest risk by 60%. New York City has launched numerous efforts – from increased tobacco taxes to the prominent posting of calorie information – to make healthy choices easier.
About the Survey
In 2004, New York City implemented its first community-level Health and Nutrition Examination Survey (NYC HANES). From June through December 2004, a population-based, cross-sectional examination survey was conducted with non-institutionalized New York City adult residents, age 20 or older. A sample of adult residents underwent a detailed health interview and brief physical exam. During interviews, the department determined previously diagnosed diabetes. Researchers then measured fasting plasma glucose in a probability sample of New York City adults to gauge the prevalence of undiagnosed diabetes, and of pre-diabetes. The complete diabetes study is available at: http://care.diabetesjournals.org/.
The survey has enabled the Health Department to learn how many New Yorkers suffer from basic conditions such as diabetes, high blood pressure, high cholesterol and depression, and better target the City’s health resources.