Dr. Mamudu Publishes on Diabetes in Appalachia

Dr. Hadii Mamudu, Professor for the Department of Health Services Management and Policy in the East Tennessee State University College of Public Health, is lead author of an article in the Journal of Diabetes and its Complications.  The article, The co-existence of diabetes and subclinical atherosclerosis in rural central Appalachia: Do residential characteristics matter?,  discusses Central Appalachia’s disproportionate burden of cardiovascular diseases and diabetes.

Dr. Timir Paul of the James H. Quillen College of Medicine, Dr. David Stewart of the Bill Gatton College of Pharmacy, Dr. Gerald Blackwell of Ballad Health, along with Dr. Sylvester Orimaye and Amy Poole of the College of Public Health, are co-authors.  Additional co-authors include faculty of Baylor University, the University of Miami, The George Washington University and the University of California in Los Angeles.

The 1st and 7th leading causes of deaths in the United States are cardiovascular diseases and diabetes respectively, with cardiovascular disease accounting for 614,348 deaths in 2014 and diabetes for 252,806 deaths in 2015.  Approximately 9.4% of the U.S. population or 30.3 million people had diabetes in 2015, with an additional 86 million people having prediabetes including 7.2 million who have not yet been diagnosed.  These chronic diseases, however, are not distributed evenly across the U.S.

Although the Central Appalachian region is disproportionately burdened by these diseases and their risk factors, there is a paucity of research examining residential characteristics and Central Appalachian residents' predisposition for co-existing chronic diseases. This study examines patients with diabetes and the most common marker of CVD: subclinical atherosclerosis.

Between 2012 and 2016, 3000 patients from Central Appalachia were screened for subclinical atherosclerosis, using coronary artery calcium score.  Of these, 419 participants had diabetes. Patients were categorized into four groups, with emphasis on those having subclinical atherosclerosis.  Among participants, prevalence of cardiovascular disease risk-factors ranged from 11.7% for current smokers to 69.2% for those with family history of cardiovascular disease. Average Body Mass Index was 29.8. Compared to patients with diabetes only, age, being male, having hypertension, and being a former smoker were associated with increased likelihood of having diabetes/subclinical atherosclerosis. At the zip-code level, unemployment rate was significantly associated with having diabetes/subclinical atherosclerosis.

Consistent with clinical guidelines, the study results reinforce the need to integrate coronary artery calcium screening into primary care diabetes programs while addressing spatial issues that predispose patients to have diabetes/subclinical atherosclerosis.