Public health and clinical implications of high hemoglobin A(1c) levels and weight in younger adult native American people with diabetes

Background: Type 2 diabetes mellitus is a major public health issue for Nat ive American people. Because glycemic levels are predictive of diabetes out come, understanding determinants of high hemoglobin A(1c) (HbA(1c)) levels may provide targets for prevention efforts. Objectives: To investigate determinants of high HbA(1c) levels in Native Am erican people. Methods: We conducted a population-based, cross-sectional-study of 206 part icipants-with diabetes from 8 Native American communities in New Mexico. We used linear regression to assess the relationship of HbA(1c) level with ag e, body mass index (BMI), treatment type, duration of diabetes, physical ac tivity, and diet. Results: Age, dietary pattern, and treatment type were determinants of HbA( 1c) levels. Participants younger than 55 years had the highest adjusted HbA (1c) levels at 9.5% and those 65 rears and older had the lowest levels at 7 .8%. According to a participant's dietary intake, HbA(1c) levels were highe st for those who consumed the most fat and sugar, and high consumption of f at and sugar affected HbA(1c) levels most among those younger than 55 years . Participants treated with insulin had the highest hemoglobin A(1c) levels . Physical activity was not associated with HbA(1c) level. Conlusions: We found an increasing severity of diabetes among younger peopl e. To avoid increased morbidity and mortality in the future, young Native A merican adults with diabetes need vigorous therapy to maintain tight glucos e control.